Tonsils and adenoids form part of a ring of lymphoid tissue encircling the back of the throat and nose . The tonsils and adenoids are part of the lymphatic system and help to protect one from infection by trapping germs that come in through one ’ s mouth and nose . They can only be examined by special instruments or an X-ray .

Tonsils and adenoids fight infection and can become enlarged when they get infected ( Fig 1 ). They help the body fight infection by forming antibodies to germs that enter the nose and mouth . Sometimes , tonsils and adenoids cause problems by being too large . Studies so far show that a child ’ s immunity is not affected after the tonsils and adenoids are removed when indicated .

Fig 1

The tonsils and adenoids occasionally become infected ( called tonsillitis ), causing swollen and sore adenoids . Adenitis and recurrent tonsillitis ( Adenotonsillitis ) are caused by chronic inflammation triggered by a persistent bacterial infection of the adenoids or tonsils .

Tonsillitis occurs when the tonsils become inflamed from infection . The symptoms of tonsillitis vary greatly depending on the cause of the infection and can occur either suddenly or gradually .

SYMPTOMS OF TONSILLITIS

• Sore throat

• Fever ( low or high grade )

• Headache

• Decreased appetite

• Feeling unwell

• Nausea and vomiting

• Stomach aches

• Painful swallowing

• Visual redness or drainage in throat

Adenoids hypertrophy ( enlarged adenoids ) Adenoiditis is when adenoids become inflamed , often triggered by a persistent bacterial infection of the adenoids or tonsils . Recurrent or chronic inflammation of the adenoids can result in enlarged adenoids ( hypertrophy ), making it hard to breathe and causing a sore throat or ear problems . Enlarged adenoids and their effect on hearing Frequently infected adenoids can lead to fluid collection in the middle ear , causing temporary hearing loss . It can also lead to frequent ear infections . Removing the adenoids ( adenoidectomy ) is used to help children with chronic earaches accompanied by fluid in the middle ear , referred to as otitis media with effusion .

SYMPTOMS OF ADENOIDITIS OR ENLARGED ADENOIDS

The symptoms of adenoiditis vary greatly depending on the cause of the infection and can occur either suddenly or gradually . The following are the most common symptoms of adenoiditis .

• Breathing through the mouth

• Noisy breathing

• Snoring

• Nasal speech

• Periods at night when breathing stops for a few seconds Nasal obstruction Nasal obstruction is anything that impedes the flow of air into and out of the nose . The obstruction may block one or both nasal passageways . If the nasal obstruction appears to coincide with a certain time of the year , it may be caused by an allergy , such as pollen . If the blockage appears to be only one side of the nose , then the anatomical cause is most likely . Snoring is often a symptom of an anatomical cause for a nasal obstruction .

Although most cases of nasal obstruction are temporary ( caused by sinusitis , allergies or overuse of nasal sprays ), the blockage may be caused by an anatomical factor such as a deviated septum , nasal polyps or foreign objects . Avoidance of an allergen , if the cause is allergic , can help alleviate symptoms . If the cause of the obstruction is anatomical , surgery is usually required . Treatment for tonsillitis and adenoiditis Antibiotics are commonly used when you have a bacterial infection of the tonsils and adenoids . Antibiotics are the first line of defence , especially with Streptococcus . Steroids can be useful for patients with infectious mononucleosis , where severe enlargement may obstruct the airways . In such cases , treatment with steroids ( e . g ., prednisone ) can be helpful .

INDICATIONS FOR REMOVAL OF T�� T��SI�S A�D��R AD���IDS �T��SI����T��Y A�D��R AD���ID��T��Y�

• Recurrent Tonsillitis Tonsillitis is an infection of the tonsils . Symptoms include high fever and severe sore throat .

• Snoring / Obstructive Sleep Apnoea ( OSA ) Enlarged tonsils and adenoids are the most common cause of snoring and obstructive sleep apnoea in children . If untreated , this may cause behavioural and learning issues .

Over time , untreated OSA may also have ( negative ) effects on blood pressure and the heart .

• Chronic Otitis Media with Effusion Persistent fluid in the middle ear may be linked to enlarged or infected adenoids .

• Chronic Sinusitis Sinusitis is an inflammation of the sinuses . Removing the adenoids may benefit children with recurrent or persistent sinus infections that do not respond to antibiotic treatment .

• Peritonsillar Abscess ( Quincy ) ( Fig 2 )

Fig 2 : A peritonsillar abscess occurs when pus forms around the tonsil .

• Tumours Asymmetry of the tonsils may be a sign of a tumour ( eg lymphoma ) of the larger side .

DIAGNOSING TONSIL AND ADENOID PROBLEMS

To diagnose problems of the ear , nose , and throat , the ENT surgeon will start by examining your head and neck . In addition to looking at and touching your nose , ear , and throat , the surgeon will use an endoscope to examine your ear , nose , and throat .

In addition to a physical examination with basic instruments , there are other tests and techniques your ENT surgeon may use to check your tonsils and adenoids , including :

• Throat culture - to identify what type of infection the patient has in the throat

• Strep test - if the surgeon suspects a strep throat

• Blood test - to diagnose infections such as mononucleosis

• Sleep study or polysomnogram - to diagnose sleep apnea caused by enlarged tonsils and adenoids

SURGICAL TREATMENT

Tonsillectomy or adenoidectomy is when your tonsils or adenoids are removed . This procedure is performed when infections keep returning even after using antibiotics . It is also an option if enlarged tonsils or adenoids are causing difficulty breathing . Occasionally , the adenoids are removed at the same time as the tonsils , when indicated . Another reason to remove the tonsils and adenoids is a tumour or cancer in adults .

The complications can be primary or secondary bleeding . Primary bleed usually occurs immediately after surgery , and secondary bleed anywhere between five to 10 days post-surgery .

The patient should not have any sore throat with a fever about a week before surgery to reduce the incidence of bleeding from the operation site . – The HEALTH

Datuk Dr Balwant Singh Gendeh is a Senior Consultant ENT ( Otorhinolaryngology ) surgeon at Pantai Hospital Kuala Lumpur

BY DATUK DR BALWANT SINGH GENDEH