Enlarged Tonsils and Sleep Apnea, Fatigue, Hearth Problems

Hypertrophic Tonsils and Health Problems

Hypertrophic Tonsils and Health Problems - Kissing Tonsils

Photo description: The photo shows tonsils that completely obstruct the airway in the mouth. it is seen that the tonsils are in contact with each other (kissing tonsils), tonsil operation is performed for treatment purposes. In this case, heart and vascular diseases may also occur due to respiratory crises, which may cause complaints such as snoring, breathing in sleep, tiredness in the morning, headaches in the morning and tired awakening.

Tonsils and adenoid

Although tonsils are present in the embryonic period, they have their typical structures in the postnatal period. These structures should not only be considered locally, but the effect on the upper respiratory tract; and the anatomical importance of the face during complex development should be considered. Tonsil diseases and tonsils are a significant part of the diseases of the ear, especially in the ear, nose and throat.

Tonsils are oval shaped tissues located on both sides of the soft palate at the back of the throat and easily observable when the mouth is open. Tonsils and adenoid are important structures of our immune system. They are the first barriers that meet the germs received by breathing and initiate the struggle against them. They are more active in the first 10 years of life. In the following period, their functions and importance are relatively reduced. While the tonsils continue their existence, the adenoid usually turns into a small lymphoid tissue after 10 years of age and by the onset of puberty.

About tonsil diseases

In spite of their valuable function in our immune system, tonsils can sometimes be the source of important infections and health problems. In such cases, they may require surgery. Tonsillectomy surgery is one of the most frequently performed operations in childhood.

Prevention of complications such as glomerulonephritis, rheumatic fever and heart valve diseases, which may be caused by infections of the tonsils of streptococci in the past, was the primary criterion for the decision of surgery. During the last 10-15 years, both the physician and the drug treatments were more easily accessible, and the improvement and improvement in the conditions of care and protection resulted in a relative reduction in these types of complications. This has led to a relative decrease in the frequency of infections due to infection.

Causes of tonsil growth (hypertrophy)

Enlarged Tonsils and Sleep Apnea, Fatigue, Hearth Problems

Hypertrophy is the enlargement of B cells in enlarged tonsils. The causes are:

1. Diet,

2. Genetic factors,

3. Personal changes,

4. Local and systemic infection episodes, especially bacterial and viral infections,

5. Exposure to cigarette smoke,

6. Tangier disease.

7. Asymmetric tonsil growths: Tumors, atypical infections (atypical mycobacteria and fungal infections), granulomatous diseases, throat and pharynx region is caused by tumors may cause the asymetric tonsil growth. Tumor events are more common in adults.

Tangier's disease is a yellow-orange hypertrophy of the tonsils and occurs after cholesterol deposition in the tonsils after alpha lipoprotein deficiency.

Tonsil size, mechanical obstruction to do; and it is important if the size of the person affects eating and respiratory functions. It does not necessarily depend on inflammation. However, tonsils of acute airway obstruction are usually associated with acute infection.

Definition of kissing tonsils

In addition, the respiratory problems caused by the tonsils and adenoid are too large, sleep disorders that can cause continuous snoring and respiratory arrest may also cause surgical decision. Especially the case of tonsils which are too big to come in contact with one another is called kissing tonsils. Many studies have shown that development and behavioral disorders can develop in this type of children and that learning-school performance is adversely affected.

How to understand enlarged tonsil in children?

In children, tonsils are larger than normal and may cause many serious problems, from sleep problems, temporary breathing to development and behavioral disorders. Especially in children with enlarged tonsil, symptoms such as breathing in sleep, snoring lying on the back, loud noise during breathing, bad breath, sweating may occur. A simple mouth open throat examination is sufficient for the diagnosis of hypertrophic tonsils.

Tonsil growth, obstruction in the childhood is one of the most common causes of surgery. Chronic tonsil growth may cause no symptoms and may not cause any problems. However, pathological conditions leading to significant growth in tonsil size account for 80% of obstructive sleep apnea in children.

Tonsil growth begins in early childhood and continues until atrophic changes (contraction) occur in adolescence. The cause of this incident is not fully known.

Symptoms and risks of enlarged tonsils in children

In children, morning headache, secondary enuresis (bed bed at night), daytime sleepy state, nervous and angry attitude, behavior changes, changes in school performance, swallowing problems can be seen together. A growth disorder may appear in the child's growth curve. Caloric intake may be inadequate due to respiratory problems of the child. Severe cases may develop congestive heart failure. In some children, obstructive apnea occurs.

Symptoms and risks of enlarged tonsils in adults

It is not uncommon for obstructive sleep apnea due to enlarged tonsils in adults. These patients are usually obese, overly sleepy and snoring. In sleep, apnea attacks occur following snoring, and sleep is either superficial or the person wakes up following apnea. Night sleep as a result of recurrent apneas normal sleep structure deteriorates, the person wakes up in the morning with a headache can not be heard. Heart rhythm disturbances in these patients include unexplained night deaths; pulmonary (lung) hypertension and right heart failure, systemic hypertension can be seen. With the removal of a portion of the soft palate in adult patients, a significant improvement in the symptoms can be achieved. Heat-controlled radiofrequency application is one of the safe and effective treatment methods for obstructive tonsil growth. It is a method that tolerates the patient comfortably. Although minimal pain and difficulty in swallowing may occur, patients may rapidly return to normal activities. In this way, by decreasing the tonsil size, the airway is expanding and the symptoms are significantly reduced. Enlarged tonsils may also occur due to a malignant tumor, and if such doubt exists, tonsils should be taken for histopathological diagnosis.

Obstructive sleep apnea can be seen in the adult age group as mentioned above. The main complaints of patients snoring; sleep apnea and breathing difficulties and sleepiness all day long. Minor complaints, difficulty in making and maintaining activities that require attention; sleep without physical rest, tired from sleep, feeling drowsiness; personality changes; comprehension difficulties; headaches in the morning; night urination and impotence. These issues should be specifically asked when taking a story from patients.

As the size of the tonsils increases, obstructive sleep apnea may occur and the associated disease risks may increase!

Sleep apnea may occur, or exacerbation of existing sleep apnea symptoms may occur, especially in patients with enlarged tonsils that narrowing the airway in the throat. In patietns with hypertrophic tonsils, day time sleepeness, fatigue, hypertansion (at the long time), sleep apnea can be seen.

Chronic occlusive tonsil enlargement

This is a pathological condition which is mostly seen in children. It is one of the most common causes of upper airway obstruction. It may result in congestive heart failure. In these children, obstructive sleep apnea is also common. Frequent loud snoring, mouth open sleep, nighttime awakening, daytime sleepiness, sleep voiding, excessive sweating, continuous movement during sleep, low school performance, nasal speech are seen. In addition, daytime swallowing difficulty and loss of appetite are common complaints. They are smaller in size and weight than their peers. If the obstruction is advanced, in the morning, headaches, learning disabilities, aggressive personality traits, extreme shyness. In children with chronic nasal fever and tonsil growth, face and head growth pattern is affected due to continuous mouth open breathing. In such children, a long face, the mouth is constantly open, upper lip to pull up and the upper incisors are exposed to the child such as the mentally disabled pathological conditions are seen.

Enlarged tonsils may cause the "positional sleep apnea"

In patients with enlarged tonsils, "positional sleep apnea" is more common. In other words, sleep apnea attack is seen more frequently on the back. Generally, when patients are lying on their side, the airways are relieved (the tonsils move forward and sideways, the obstructive effects in the airways are eliminated!).

Proper proportion of sleep apnea and hypertension

There is a bidirectional relationship between hypertension and sleep apnea. Sleep apnea syndrome is detected in 30% of patients with hypertension. Hypertension disease is present in approximately half of patients with sleep apnea syndrome. In normal subjects, systemic blood pressure decreases by 20 to 23 percent during sleep and returns to normal daily level with wake-up. In patients with sleep apnea, there is no expected drop in blood pressure during sleep at night. At first, at night, high blood pressure during sleep is seen over time and hypertension occurs. With the increase in the severity of sleep apnea, there is an increase in the risk of developing hypertension.

Difficulty in treating hypertension in patients with sleep apnea

In studies, it is emphasized that the risk of developing hypertension increases 2 times in people with a high rate of sleep apnea, and the more severe sleep apnea in people with hypertension, the higher the rate of blood pressure medication or the addition of new drugs, the more difficult it is to control blood pressure.

Over time, treatment-resistant hypertension may develop in patients with sleep apnea

In the absence of treatment of sleep apnea, high blood pressure may not be effectively controlled and hypertension may develop in time. Although at least 3 blood pressure medications with different mechanisms of action are used at an effective dose, resistant hypertension is present when blood pressure values ​​cannot be controlled at the desired level. In a recent study, sleep apnea syndrome was found to be as high as 83 percent in patients with hypertension resistant to drug therapy. Controlling the blood pressure by determining the treatable causes of resistant hypertension reduces the risk of hypertension and the risk of heart disease and stroke by reducing the effect on hypertension. In spite of drug therapy, patients with unstable blood pressure should be evaluated for sleep apnea syndrome.

It is recommended that patients with resistant hypertension who are loudly snoring, awakening in the night breathing with a feeling of blockage, who are accompanied by night sweats, morning awakening or daytime sleepiness, should apply to sleep centers and sleep tests are recommended. In patients with sleep apnea, positive airway pressure and apnea treatment have an effect on control of blood pressure values.

Similar links >> How is Sleep Apnea Revealed When Lying On The Back in Deep Sleep? / Tonsils and Adenoids / Tonsillectomy Operation in Istanbul

Source links >> The effects of obstructive sleep apnea syndrome due to adenotonsillar hypertrophy on the cardiovascular system in children / Clinical predictors of sleep disordered breathing in children at moderate altitude / [Cor pulmonale caused by hypertrophic adenoid glands and tonsils: indications for tonsillectomy and adenoidectomy in a 2-year-old child].

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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