Tonsils and adenoids are two different tissues but are both part of the body’s defense/immune system that help fight germs and prevent against infection. Tonsils are located at the back of the throat on either side of the tongue. Adenoids are located behind the nose on the back wall of the nasal cavity. They are not visible when your regular doctor examines the nose and mouth. Their purpose is to grow during the first years of life to filter and fight germs that commonly enter through the mouth and nose (especially in infants and toddlers). They decrease in size around age seven years. In their efforts to block infection to vital organs (heart and lungs), tonsils and adenoids unfortunately can get infected.
When Infection Hits
Sore throats get infected by viruses or bacteria. It is important to note that throats can be sore from other causes including post-nasal drip, throat clearing or dryness (often caused by sleeping with the mouth open). Your doctor will examine the throat, and best practice is to do a throat swab (rapid tests can be done with results in 10 minutes) to determine whether it is a bacterial infection (usually strep throat) or viral. In both cases, anti-pyretics, fluids and soft foods, pasteurized honey for children older than one year, salt water gargles and room humidifiers can be used for supportive care. However, if it is a bacterial tonsillitis, antibiotics will also be given. Untreated bacterial infections can lead to complications that can affect the heart (rheumatic fever), kidneys (glomerulonephritis) or nervous system (PANDAS)
Enlarged adenoids due to infections can disturb a child’s quality of life by interfering with breathing while awake and asleep, and by blocking a small tube between the ears and throat that can subsequently cause frequent ear infections to develop. Mouth breathing can lead to dental and gum problems. Severe snoring and poor sleep can lead to behaviour problems and school difficulties.
Currently, tonsils and adenoids are not removed simply for recurrent infections. Trials of saline sprays, nasal steroid sprays and anti-inflammatory drugs are often tried first, well before surgery is considered.
What If Surgery Is Needed?
If complications arise with tonsils and adenoids, the next step is a referral to an ENT for surgical consideration. Children are usually between the ages of two to six years.
Surgery for tonsils (called a tonsillectomy) is performed when the tonsils interfere with breathing or because of complications like abscesses, heart, kidney or neuropsychiatric problems. Surgery for adenoids (called an adenoidectomy) is considered if obstruction causes ear infections and hearing loss, or when obstructive sleep apnea (OSA) is suspected.
OSA means your child goes through long pauses between breaths followed by a gasp of air. The pauses are caused by the adenoids obstructing the air passage. Untreated OSA can lead to increases in blood pressure affecting heart function and decreases in growth hormone levels affecting growth and development. We are seeing more OSA due to rises in childhood obesity.
Potential complications from surgery, which need to be weighed against the potential benefits, include bleeding, infection, dental injury or taste disturbance. Talk to your doctor if you have any concerns or questions.
Over time large tonsils can lead to difficulty swallowing and breathing difficulties. Symptoms of enlarged tonsils include:
- acute sore throat (dry, scratchy, itchy, painful)
- fever, nausea
- tummy pain
- sore neck
- pain when swallowing
- refusing to eat or drink
Signs of infected adenoids include:
- restless sleeping
- sleep apnea (when a child stops breathing for a few seconds)
- mouth breathing
- nasal voice
- speech problems
- recurrent ear infections
Originally published in ParentsCanada magazine, Spring 2017.