Tonsils and Adenoids

The tonsils and adenoids are basically lymph nodes that are located in the back of the throat (tonsils) and in the back of the nose (adenoids). They are not different from any of the hundreds of lymph nodes that are located in the neck, chest, abdomen, and groin. As such, they are part of the immune system of the body and they do not possess any special features related to their position, specially, there is no evidence to suggest that they pick up the bacteria as it enters the mouth. The size of the tonsils and adenoids fluctuates dramatically depending on the age of the patient and in the presence of an infection.

What could go wrong with the tonsils and adenoids?

There are two problems that could be associated with the tonsils and adenoids:

  1. Large tonsils and adenoids could block off the air and food passage behind the nose and throat. This usually exhibits itself in children and could cause persistent obstruction of the nose and persistent breathing though the mouth. The most important problem with the blockage occurs at the night time when the patient wind passage could block off completely for few seconds. This is never serious at the time it occurs but could cause significant problems if persistent for few months or years without treatment, mainly by affecting the heart and the lungs.
  2. Recurrent infections of the tonsils: the surface of the tonsils contains many small pockets that tend to accumulate dead skin and food debris. These pockets are very good areas for the bacterial growth. Bacteria will then gain access to the tonsils themselves and cause an infection.

When the patient takes antibiotic, it goes through the blood to the tonsils and clears the infection. However, the pockets on the surface of the tonsils will continue to have bacteria since the blood and antibiotics do not have access to these areas that do not have any blood vessels. This in turn causes recurrent infections from these pockets.

The only implication of recurrent infections of the tonsils in the pain and discomfort associated with these recurrent infections. Heart disease secondary to rheumatic fever does not occur except in cases where these infections have been ignored for a long time, usually in areas where medical care is inadequate.

What are the reasons for removing Tonsils or Adenoids?

There are two indications for removal of Tonsils and adenoids:

  1. Definitive indications or reasons: Sleep Apnea, or the patient ceasing to breath at night time for few seconds secondary to the enlarged tonsils and adenoids.
  2. Relative indications: such as recurrent infections or nasal obstruction that is not causing sleep apnea. The decision to proceed with tonsillectomy is tied up to the frequency of these infections and how much of a problem it for the patient.

Would I miss my tonsils?

When lymph nodes are removed, the body will usually compensate and regenerate to cope with the loss. Although some people have raised theoretical concerns about the removal of tonsils, there have been many studies to look at any ill effects of removal of the tonsils and there is no reason to believe that the surgery that has performed routinely for the last few hundred years is harmful for the human body.

What should I except from surgery?

The surgical procedure will usually take 30 minutes. It is usually done under general anaesthesia. After surgery the patient will experience pain and discomfort which is usually relieved with pain medication.

Patients will also have some temperature for about a week after surgery. The main issue in the care of the tonsillectomy patient is maintenance of adequate fluid intake especially in children. As long as hydration is maintained there are no other significant issues to be concerned about. Infection after surgery does not occur. Bleeding occurs very infrequently after surgery, usually after one week of the procedure when the temporary scab that had formed is replaced with a permanent one. Therefore, it is important not to eat any hard foods especially between the seventh and the tenth day after surgery. If the bleeding occurs after surgery, it is easily taken care of by the doctor who should be contacted.

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