Tonsils are two tissues located on both sides of the uvula that is visible through the mouth with a direct look. The adenoids, on the other hand, are a tissue in the rearmost part of the nasal cavity, in the upper part of the back of the uvula (the area called the nasopharynx) and are invisible with direct look. Both adenoid and tonsil structures are lymphoid tissues and contribute to the body’s immune system. However, these tasks are usually exist in the first years of life, and when children reach the age of 3-4, they may start to grow and cause problems, especially secondary to frequent upper respiratory tract infections. Apart from infection, allergic rhinitis is also a common cause of growth. Adenoid tissue usually starts to shrink with age (especially after 9-10 years old) and disappears during adulthood.
What complaints do the patient have in adenoid enlargement and infection?
The most common complaints are nasal congestion, mouth breathing, sleeping with mouth open and snoring at night, apnea during sleep (breathing stop seems more when it become along with the enlarged tonsils), nocturnal coughs, impaired speech tone and hearing loss (It is due to fluid accumulation in the middle ear). In addition to these, facial development, jaw and palate structure may be impaired due to continuous sleep with mouth open. This appearance, which is formed by narrow and long face appearance and tapering in the lower jaw, is called adenoid face view in these children. Besides, problems such as high arched palate and crooked teeth can also be seen in the mouth due to upper jaw development problems.
What complaints are there in tonsillitis and tonsil growths?
Although different in each child, complaints such as sore throat, difficulty swallowing, pain in the ear, fever, weakness, nausea and vomiting, sometimes abdominal pain, snoring and sleep apnea are observed. Especially when the tonsils and adenoids grow together, problems such as sleep apnea and heart failure (cor pulmonale) by narrowing the upper respiratory tract may occur, if these problems last long.
Group A Beta Hemolytic Streptococci are the most common microorganisms that cause tonsillitis and sometimes antibodies formed after these microbial inflammations can cause serious problems in the body called Acute Rheumatic Fever (inflammation in joints and heart valves) and Glomerulonephritis (kidney inflammation).
What are the reasons for removing the adenoids (adenoidectomy surgery)?
Adenoids should be removed when the children have nasal congestion, snoring, sleep apnea, jaw and tooth structure disorders, frequent upper respiratory tract infections (frequent nasal discharge and sinusitis, frequent middle ear inflammation) and fluid accumulation in the middle ear (otitis media with effusion).
In what cases should tonsils be removed (tonsilectomy surgery)?
Exact criteria for the removal of tonsils:
Tonsil enlargements that block the respiratory tract or cause difficulty swallowing, tumors located in the tonsil (especially if a malignant tumor is suspected) and recurrent bleeding from the tonsil area.
Non-absolute criteria for tonsil removal:
Frequent recurrent tonsil infection attacks (seven or more in the last year, five or more for each year in the last two years, three or more for each year in the last three years, which these are called recurrent tonsillitis or chronic tonsillitis), abscess formed around tonsils (peritonsiller abscess), halitosis (due to the accumulation of secretions and food residues in the recesses on the tonsil surface) and those with heart valve problem.
Is there an age limit for tonsil and adenoid surgeries?
Although these surgeries are usually performed after the age of 3-4, they can also be applied at an earlier age in case of mandatory situations.
How to perform surgeries and what are the risks that may occur afterwards?
Tonsil and adenoid surgeries are performed under general anesthesia, and the duration of the operation is 15-45 minutes depending on the condition of the adenoid alone, tonsil alone or tonsil removing with the adenoid together. Cold knife technique (classical tonsilectomy) can be used as a surgical technique, as well as different methods such as “thermal welding”, “electrocoter”, “harmonic scalpel” or “radiofrequency”. The aim of the development of different methods is mainly to reduce postoperative pain and bleeding complaints.
Pain is the most common complaint after surgery and occurs due to tonsil removal rather than adenoid. Sometimes it is in the form of pain in the ear and patients complain of an earache that they suspect is an inflammation of the ear.
Another postoperative complication is bleeding and usually more frequent in the first 24 hours and requires up to two weeks of caution. It is usually overcome without creating any problem with strict follow-up.
The belief that the body’s defense system decreases after tonsil surgery is not scientifically proven and is not clinically thought to be a problem. Again, the incidence of pharyngitis after tonsil surgery does not differ compared to those who do not have tonsil surgery.
How should nutrition be after surgery?
In the first 10 days, hot, solid-hard, acidic and spicy foods should be avoided, plenty of liquids should be taken and starting with softer foods and gradually transitioning to solid foods (after 4-5 days). In these patients, difficulty in swallowing and loss of appetite due to pain, nutritional deficiency, dehydration and fever due to dehydration can be seen. Therefore, proper nutrition and fluid intake are very important in the postoperative period. While problems related to swallowing difficulties are not observed in patients with adenoids removed alone, they are more common in those with tonsil removal.