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Ear, Nose and Throat

Enlargement of the Tonsils and Adenoids

The tonsils are two masses of tissue found on either side of the back of the throat. The adenoids are located high in the throat behind the nose and roof of the mouth. Together, they act as the body’s first line of defense against infection by “sampling” viruses and bacteria that enter the body through the nose and mouth. They then signal the rest of the immune system to form antibodies to resist and fight future infections.

Sometimes, however, the tonsils and adenoids become infected and act as more of a liability than an asset. These tissues often become susceptible to recurrent bacterial infections and inflammation that may lead to breathing, swallowing and sleeping problems. These conditions are most common in children, but can be seen in adults as well.

Tonsillitis

Tonsillitis refers to an infection of the tonsils caused by a virus or bacteria. This condition is common in children and spreads through contact with throat or nasal fluids. When infected, the tonsils become red, swollen and painful. They may be coated with a white or yellow substance.

Most cases of tonsillitis are caused by a virus, although it can sometimes be caused by the same bacteria that causes strep throat. Tonsillitis symptoms are similar to those of strep throat or a common cold and may include:

A sore throat, sometimes accompanied by ear pain
Red, swollen tonsils
Slight vocal changes due to swelling
Difficulty or discomfort when swallowing
Swollen lymph nodes in the neck
A fever
Bad breath
A headache

Enlargement of Tonsils and Adenoids

The tonsils and adenoids may become enlarged as a result of a viral or bacterial infection. This enlargement can partially obstruct the airway, making it hard to breathe through the nose. Breathing during sleep may be disturbed as a result of this nasal obstruction.

Some signs of tonsil and adenoid enlargement are:

Breathing through the mouth instead of the nose most of the time
A nasally sound to the voice
Chronic runny nose
Loud breathing during the day
Snoring at night
Restlessness during sleep and pauses in breathing for a few seconds a time while sleeping (sleep apnea)
Daytime sleepiness, especially in children

Bacterial infections of the tonsils and adenoids can be treated with various antibiotics. While most cases of enlarged tonsils or adenoids return to their normal size once the infection has been treated, they may remain enlarged in patients with frequent or chronic infections. Surgical removal is considered when conditions are resistant to medical therapy or frequently recur and when enlarged tonsils or adenoids cause continued difficulty breathing, even in the absence of an obvious infection.

Chronic infections of the adenoids can affect other areas such as the Eustachian tube – the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and a buildup of fluid in the middle ear space that may cause temporary hearing loss.

Surgical Removal of the Tonsils and Adenoids

Surgical removal of the tonsils and adenoids is performed on an outpatient basis under general anesthesia. Though often removed at the same time in an adenotonsillectomy, not all patients require the removal of both sets of tissues. In these cases, Dr. Menachof performs either a tonsillectomy or an adenoidectomy.

In addition to reducing the frequency of recurring infections, removing the tonsils and adenoids can make speaking and eating less difficult, eliminate mouth-breathing, reduce snoring and help treat obstructive sleep apnea in some patients.