Tonsils and Adenoids
Definition of Tonsils and Adenoids
Tonsils and adenoids are the elements of Waldeyer's lymphatic ring which settled in oral and nasopharyngeal region. Both are play role in immunity against airborne microorganisms which inhaled through the mouth and nose.
The tonsils are located on both sides of the back of the throat. The other names of adenoid are pharyngeal tonsil and nasopharyngeal tonsil. This lymphatic tissue is situated posterior of the nasal cavity, the roof of the nasopharyngeal area.
The eustachian tubes is opened to the nasal cavity in this region.
Why Tonsils and Adenoid Enlarged?
Tonsils and adenoid can grow depending on the recurrent infections and genetic causes. Living in crowded environments (such as kindergarten), exposure to cigarette smoke, atopy can be facilitated to lymphatic tissue growth. Although extremely rare, cancer sometimes causes enlarged tonsils or adenoids.
Tonsil and adenoid hypertrophy is a medical condition where the tonsils and adenoids become enlarged due to infection or depending on environmental-genetic reasons. The symptoms of this condition include sore throat, trouble swallowing, sleep apnea, or an middle ear infection.
The diagnosis of enlarged tonsils and adenoids is done by a clinician who will ask about the child’s symptoms and medical history and do a physical examination of the child’s ears, neck, mouth, and throat. A throat culture can help determine if the infection is bacterial or viral. A clinician can see if the tonsils are enlarged by looking inside a child’s mouth, however, adenoids are harder to see. The clinician may use an endoscope, a long, flexible tube with a light at the end to observe the adenoid. Other diagnostic tests could include an x-ray, blood test, or sleep study.
The treatment options for enlarged tonsils and adenoids depend on the cause of the infection. If diagnostic testing determines that the cause of the infection is bacterial, not viral, the clinician may prescribe antibiotics. Because antibiotics are only effective in treating bacterial infections, treatment will focus on the child’s comfort if a virus is causing the inflammation.
In the above photo, in a patient with enlarged tonsils, it is seen that the tonsils are in contact with each other (kissing tonsils) and there is little airway gap between the tonsils. The expression "kissing tonsils" is used, which means tonsils that touch each other, touch each other, hit each other in the midline. The statement here proves that there is tonsillar hypertrophy, which causes the air hole in the throat to become extremely narrow. If your child's tonsils come into contact with each other without any infection, you can keep in mind that your child has a higher risk of sleep apnea, breathing problems and snoring, and that surgical removal of the tonsils may be beneficial for heart health in the future. In children with kissing tonsil, difficulty sleeping in the supine position at night, the need to lie on their side or stomach, and breathing stops during deep sleep - sleep apnea may occur.
Symptoms of Enlarged Tonsils and Adenoid
The tonsils and adenoid are settled on the airways. Most enlarged tonsils and adenoids cause no symptoms. However, when they grow up in addition to breathing problems, ear and sinus related problems also can be seen.
Enlarged tonsils and adenoids may cause the following problems:
- Chronic ear infections and hearing loss: These problems result from blockage of the eustachian tube and fluid accumulation in the middle ear.
- Recurrent sinus infections
- Obstructive sleep apnea
- Discomfort when talking and breathing
- Difficulty swallowing
- Severe respiratory distress (in young infants)
- Bad breath
- Sleeping with your mouth open
- Sweating during sleep
- Daytime sleepiness / Decrease in sleep quality
- Decrease in school performance (for children)
- Increased risk of traffic accidents (for adults)
- Swollen lymph nodes (glands) in the neck
- Nose sounds "blocked" when the person speaks
- Noisy breathing during the day
- Decreased sense of smell or taste
In adults, enlargement of the tonsils and adenoid can cause to adverse effects on the cardiovascular system in long time (Source: Cor Pulmonale: A Disorder Stemming From Pulmonary Hypertension).
|In the photo above, a child with a newly recovered tonsillitis infection belongs to the patient. It is observed that the tonsils are hypertophic and there are still white areas on both tonsils.
Negative Effects of Adenotonsillar Hypertrophy on Child Personality and Behavior
Adenotonsillar hypertrophy have been thought to significantly relate with children's growth and learning capability.
This happens in children with tonsil and adenoid hypertrophy mainly in two ways:
First, adenotonsillar hypertrophy can lead to obstructive sleep apne syndrome (OSA) in children and OSA can lead to behavioral disturbances and learning deficits in children by different mechanisms.
Second, adenoid hypertrophy can cause to serous otitis media and hearing loss in children. Therefore, a decrease in school performance, perception difficulties and irritability can occur in these children.
Symptoms of tonsil cancer are very similar to symptoms of strep throat. indication for tonsillectomy will be emerged if the increase in the unilateral tonsillar size detected. In this case the patient should contact to an ear, nose and throat specialist. Parotid tumors rarely can also cause medial displacement of the tonsil thus tonsillar asymmetry.
Adenotonsillar Hypertrophy and Sleep Apnea Video
In the video above, a baby with adenotonsillar hypertrophy has difficulty in breathing, forced position change, snoring and fluttering movements while lying on his back. In this way, as a result of the narrowing of the airways during sleep, a decrease in the oxygen level, the secretion of stress hormone, an increase in blood pressure during sleep and an increase in the heart rate occur in the patients. If hypertrophy of adenoids and tonsils is not treated, an increased risk of cardiovascular disease may occur in the long term. The collapse of the respiratory tract here causes the onset of oxidative stress. Recurrent episodes of split or intermittent sleep and wakefulness occur, such as transitioning to deep sleep and transitioning from deep sleep to superficial sleep, or waking up, changing body position during sleep. Babies with narrow airways may also have symptoms such as sweating under the neck and chin, sweating from the mouth, salivation, and reflux-related odor in the mouth, which mothers notice. Unlike patients with adult sleep apnea syndrome, daytime sleepiness may not be very evident in infants with sleep apnea syndrome.
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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
Mobile phone: +90 533 6550199
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47