LINDA J. DINDZANS, MD Office: 414-536-7000
JODI M. KORNAK, MD, MS,
FACS
Fax: 414-536-7001
Doctor, Explain Tonsils and Adenoids
Insight
into Tonsillectomy and Adenoidectomy
Tonsils and adenoids
are masses of tissue that are similar to the lymph nodes or "glands" found
in the neck, groin, and armpits. Tonsils are the two masses on the back of the
throat. Adenoids are high in the throat behind the nose and the roof of the
mouth (soft palate) and are not visible through the mouth without special
instruments.
Tonsils and
adenoids are near the entrance to the breathing passages where they can catch
incoming germs, which cause infections. They "sample" bacteria and
viruses and can become infected themselves. Scientists believe they work as
part of the body's immune system by filtering germs that attempt to invade the
body, and that they help to develop antibodies to germs.
This happens
primarily during the first few years of life, becoming less important as we get
older. Children who must have their tonsils and adenoids removed suffer no loss
in their resistance.
What Affects
Tonsils and Adenoids?
The most
common problems affecting the tonsils and adenoids are recurrent infections
(throat or ear) and significant enlargement or obstruction that causes
breathing and swallowing problems.
Abscesses
around the tonsils, chronic tonsillitis, and infections of small pockets within
the tonsils that produce foul-smelling, cheese-like formations can also affect
the tonsils and adenoids, making them sore and swollen. Tumors are rare, but
can grow on the tonsils.
When Should
I See My Doctor?
You should
see your doctor when you or your child suffer the common symptoms of infected
or enlarged tonsils or adenoids.
The Exam
The primary
methods used to check tonsils and adenoids are:
- Medical history
- Physical examination
- Throat cultures/Strep tests
- X-rays
- Blood tests
What Should
I Expect At the Exam?
Your
physician will ask about problems of the ear, nose, and throat and examine the
head and neck. He or she will use a small mirror or a flexible lighted
instrument to see these areas.
Cultures/strep
tests are important in diagnosing certain infections in the throat, especially
"strep" throat.
X-rays are
sometimes helpful in determining the size and shape of the adenoids. Blood
tests can determine problems such as mononucleosis.
How Are
Tonsil and Adenoid Diseases Treated?
Bacterial
infections of the tonsils, especially those caused by streptococcus, are first
treated with antibiotics. Sometimes, removal of the tonsils and/or adenoids may
be recommended. The two primary reasons for tonsil and/or adenoid removal are
(1) recurrent infection despite antibiotic therapy and (2) difficulty breathing
due to enlarged tonsils and/or adenoids.
Such obstruction
to breathing causes snoring and disturbed sleep that leads to daytime
sleepiness in adults and behavioral problems in children. Some orthodontists
believe chronic mouth breathing from large tonsils and adenoids causes
malformations of the face and improper alignment of the teeth.
Chronic
infection can affect other areas such as the eustachian tube – the passage
between the back of the nose and the inside of the ear. This can lead to
frequent ear infections and potential hearing loss.
Recent studies
indicate adenoidectomy may be a beneficial treatment for some children with
chronic earaches accompanied by fluid in the middle ear (otitis media with
effusion).
In adults,
the possibility of cancer or a tumor may be another reason for removing the tonsils
and adenoids.
In some
patients, especially those with infectious mononucleosis, severe enlargement
may obstruct the airway. For those patients, treatment with steroids (e.g.,
cortisone) is sometimes helpful.
Tonsillitis
and Its Symptoms
Tonsillitis is
an infection in one or both tonsils. One sign is swelling of the tonsils. Other
signs or symptoms are:
- Redder than normal tonsils
- A white or yellow coating on the tonsils
- A slight voice change due to swelling
- Sore throat
- Uncomfortable or painful swallowing
- Swollen lymph nodes (glands) in the neck
- Fever
- Bad breath
Enlarged
Adenoids and Their Symptoms
If you or
your child's adenoids are enlarged, it may be hard to breathe through the nose.
Other signs
of constant enlargement are:
- Breathing through the mouth instead of the
nose most of the time
- Nose sounds "blocked" when the
person speaks
- Noisy breathing during the day
- Recurrent ear infections
- Snoring at night
- Breathing stops for a few seconds at night
during snoring or loud breathing (sleep apnea)
Surgery
Your
child: Talk to your child about his/her feelings and provide strong
reassurance and support throughout the process. Encourage the idea that the
procedure will make him/her healthier. Be with your child as much as possible before
and after the surgery. Tell him/her to expect a sore throat after surgery.
Reassure your child that the operation does not remove any important parts of
the body, and that he/she will not look any different afterward. If your child
has a friend who has had this surgery, it may be helpful to talk about it with
that friend.
Adults
and children: For at least two weeks before any surgery, the patient should
refrain from taking aspirin or other medications containing aspirin. (WARNING: Children
should never be given aspirin because of the risk of developing Reye's
syndrome).
- If the patient or patient's family has had any
problems with anesthesia, the surgeon should be informed. If the patient
is taking any other medications, has sickle cell anemia, has a bleeding
disorder, is pregnant, has concerns about the transfusion of blood, or has
used steroids in the past year, the surgeon should be informed.
- A blood test and possibly a urine test may be
required prior to surgery.
- Generally, after midnight prior to the
operation, nothing (chewing gum, mouthwashes, throat lozenges, toothpaste,
water) may be taken by mouth. Anything in the stomach may be vomited when
anesthesia is induced, and this is dangerous.
When the
patient arrives at the hospital or surgery center, the anesthesiologist or
nursing staff may meet with the patient and family to review the patient's
history. The patient will then be taken to the operating room and given an
anesthetic. Intravenous fluids are usually given during and after surgery.
After the
operation, the patient will be taken to the recovery area. Recovery room staff
will observe the patient until discharged. Every patient is special, and
recovery times vary for each individual. Many patients are released after 2–10
hours. Others are kept overnight. Intensive care may be needed for select
cases.
Your ENT
specialist will provide you with the details of pre-operative and postoperative
care and answer any questions you may have.
After
Surgery
There are
several postoperative symptoms that may arise. These include (but are not
limited to) swallowing problems, vomiting, fever, throat pain, and ear pain.
Occasionally, bleeding may occur after surgery. If the patient has any
bleeding, your surgeon should be notified immediately.
Any questions or concerns you have should be discussed openly with
your surgeon, who is there to assist you.
Reprinted from the