What Are Tonsils & Adenoids
The tonsils are masses of tissue on both sides of the throat and the adenoids are similar tissue behind the palate. Tonsils and adenoids serve to develop immunity until the age of 2 – 3. Tonsils and adenoids also trap microorganisms entering through the throat and nose, producing antibodies to help fight infections.
What Is Tonsillitis?
Tonsillitis refers to inflammation of the pharyngeal tonsils. The inflammation may involve other areas of the back of the throat including the adenoids and the lingual tonsils (areas of tonsil tissue at the back of the tongue). There are several variations of tonsillitis: acute, recurrent, and chronic tonsillitis and peritonsillar abscess.
What Are The Symptoms of Tonsillitis?
The type of tonsillitis often determines what symptoms will occur:
- Acute tonsillitis: Patients have a fever, sore throat, foul breath, difficulty swallowing, painful swallowing and tender neck glands (lymph nodes).
- Recurrent tonsillitis: This diagnosis is made when an individual has multiple episodes of acute tonsillitis in a year.
- Chronic (long term) tonsillitis: Individuals often have a persistent sore throat, bad breath, tonsillitis, and persistently tender cervical nodes.
- Peritonsillar abscess: Individuals often have severe throat pain, high fever, drooling, foul breath, difficulty opening the mouth and muted voice quality.
Treatment For Tonsillitis
Tonsillitis is usually treated with a regimen of antibiotics. Fluid replacement and pain control are important. Hospitalisation may be required in severe cases, particularly when there is a problem with breathing. When tonsillitis is chronic or recurrent, a surgical procedure to remove the tonsils, tonsillectomy, is often recommended.
What is Sleep Disordered Breathing?
Large tonsils and/or adenoids may cause poor sleep quality (see picture below). The commonest symptom of sleep disordered breathing is snoring. Approximately 10 percent of children are reported to snore. Ten percent of these children (one percent of the total pediatric population) have obstructive sleep apnea. Currently only 10 to 15% of children with this problem are being treated. The Australian College of Pediatrics and Ear, Nose and Throat Surgeons have published a position paper suggesting an urgent need to address this significant problem of childhood development. To read the paper visit http://www.asohns.org.au/news/position-paper-on-tonsillectomy-and
When an individual, young or old, obstructs breathing during sleep, the body perceives this as a choking phenomenon. The heart rate slows, the sympathetic nervous system is stimulated, blood pressure rises, the brain is aroused, and sleep is disrupted. In most cases, a child’s vascular system can tolerate the changes in blood pressure and heart rate. However, a child’s brain does not tolerate the repeated interruptions to sleep, leading to a child that is sleep deprived, cranky, and ill-behaved.
Potential consequences of untreated pediatric sleep disordered breathing include:
- Snoring: A problem if a child shares a room with a sibling and during sleepovers.
- Sleep deprivation: The child may become moody, inattentive, and disruptive both at home and at school. The child will lack energy.
- Neurocognitive development – children with sleep disordered breathing are at risk of poor verbal and non-verbal intelligence, memory, psychomotor efficiency, concentration, executive and psychosocial functioning.
- Abnormal urine production: SDB also causes increased nighttime urine production, and in children, this may lead to bedwetting.
- Growth: Growth hormone is secreted at night. Low GH secretion may lead to slow growth or development.
- Attention decit disorder (ADD)Research suggests SBD can be associated with ADD.
A child with suspected SDB should be evaluated by an Ear, Nose & Throat surgeon. If the symptoms are significant and the tonsils and/ or adenoids are enlarged, the child is strongly recommended for adenotonsillectomy (removal of the tonsils and adenoids or T & A). Conversely, if the symptoms are mild, academic performance remains excellent, the tonsils are small, and puberty is eminent (tonsils and adenoids shrink at puberty), it may be recommended that SDB be treated only if matters worsen.
Treatment For Sleep Disordered Breathing
Adenotonsillecomy achieves a 80 – 95% percent success rate for childhood SDB. A failure rate is due to either adenoid re-growth or immature brain triggering mechanisms for breathing.
Tonsillectomy (Adenotonsillectomy)
The surgical procedure to remove the tonsils (and adenoids – if they are problematic) is called tonsillectomy (or adenotonsillectom) and requires hospitalization. The surgery is performed under general anesthetic with no external cuts. Tonsils and adenoids may be removed by electrocautery, cold dissection or harmonic scalpel, depending upon your particular case. In children (or adults) with sleep disordered breathing, an overnight stay in hospital to monitor oxygen levels in the post operative recovery period is required.
At the Norwest ENT Group, our surgeons all perform the latest Plasma Coblation Tonsillectomy technique, which has less pain, shorter times to eating and a quicker recovery.
Post operative pain is usually the most concerning symptom after the surgery. The patient usually requires 2 weeks of either school or work to re-cover.
Who Requires A Tonsillectomy (Adenotonsillectomy)
The Australiasian society of Ear, Nose and Throat Surgeons (otolaryngologists) and the Paediatric & Child Division of the Australasian College of Physicians has just published a position paper on the indications for tonsillectomy and adenotonsillectomy. The following indications are included as strong indications for surgery:
- Significant sleep disordered breathing with adenotonsillar obstruction
- Recurrent tonsillitis 7 episodes per year, 5 episodes in 2 years or 3 episodes in 3 years warrants consideration of surgical removal.
- Recurrent peritonsillar abscess
- Suspicion of cancer (see picture below)