Tonsillectomy and Adenoidectomy

What are the tonsils (tonsillitis)?

The Tonsils are an accumulation of lymphoid tissue (tissue that produces antibodies) of ovoid shape, located on the wall of the oropharynx. They have on their surface structures called crypts, which are tubular and extend into the depth of the tonsils.

The abnormal growth (hyperplasia) of the tonsils may cause mouth breathing, abnormal position of the tongue, impaired speech and orofacial growth disturbances.

What are adenoids?

They are a triangular mass of lymphoid tissue (like the tonsils), located in the nasopharynx. This anatomical relationship between the adenoids and nasopharynx, affects the Eustachian tube (the connection between the nose and middle ear) and to the sinuses. So it is very common in children that present adenoiditis, to have otitis media and / or sinusitis infections.

What is the difference between acute tonsillitis and chronic tonsillitis?

In general, the difference lies in the time of evolution of the disease. Arbitrarily determined that if the process is acute, the infection has more than 3 weeks and less than 3 months and chronic, if the infection lasts for more than 3 months.

Acute tonsillitis, is perhaps the most common disease of tonsils and occurs as a sore throat, dysphagia (painful swallowing), fever (not in all cases) and cervical lymphadenopathy (swollen glands in the neck).

Some symptoms of chronic tonsillitis are peritonsillar erythema, tonsillar growth and a decreased number of crypts in the tonsils as a result of chronic inflammation, which is evident with a shiny and smooth surface of the tonsils

What is the difference between acute adenoidits and chronic adenoidits?

Acute Adenoiditis is clinically difficult to distinguish from any other infectious disease of the upper airway. You can usually differentiate it if snoring occurs during the infectious episode and disappears once it is cured.

In chronic adenoiditis, nasal discharge is present and presents with a persistent cough, halitosis (bad breath), postnasal discharge, nasal voice and chronic nasal congestion. It may occasionally be associated with otitis media and it is important to differentiate this from a sinus infection.

There is an entity known as recurrent acute adenoiditis, which is defined as the presence of 4 or more episodes of acute adenoiditis in a period of 6 months. If the child with adenoiditis remains asymptomatic between infections, a prophylactic treatment can be considered, especially when these episodes are associated with recurrent otitis media with effusion or no effusion or tracheobronchial hyperreactivity.

When a child presents adenoiditis or recurrent sinus infections, the possibility should be considered that the child is having gastroesophageal reflux disease (GERD).

What are the indications for adenoidectomy?

Adenoid growth that obstructs the nose and forces the patient to breathe steadily through their mouth, sleep disturbances such as sleep apnea, failure to thrive, abnormalities in the way of speaking, or present any severe orofacial/dental abnormalities, that the patient presents with adenoiditis, recurrent otitis media with or without effusion, chronic otitis media or if suspected benign or malignant neoplasm.

What are the indications for tonsillectomy?

Excessive growth of the tonsils to generate airway obstruction, sleep disorders like sleep apnea, impaired speech, orofacial abnormalities, recurrent or chronic tonsillitis, peritonsillar abscess tonsillitis, acute obstruction of the airway, halitosis and suspected benign or malignant neoplasm.

Most frequent causes of acute tonsillitis and adenoiditis?

Infection may be caused by both bacterial and viral agents. Most common Bacteria are group A Streptococcus, Staphylococcus aureus, Haemophilus influenza, Klebsiella pneumonia, and the most frequent viruses are Epstein Barr, herpes simplex, adenovirus and influenza virus.

What is the treatment for chronic tonsillitis and adenoiditis?

Typically, initial treatment for these diseases is antibiotics. Failing this, the next course of action must be an adenoidectomy, tonsillectomy or both at one time depending on the case.

Adenoidectomy is justified in cases where there is persistent nasal obstruction and repeated infections. Benefits include the improvement of nasal ventilation and lower incidences of recurrent infections such as otitis media, sinusitis, and improvement and or even disappearance of snoring and sleep apnea.

Tonsillectomy is performed in the following cases; in cases where there is unilateral tonsillar growth, when there has been a peritonsillar abscess, when there is severe obstruction of the airway in the oropharynx and when there are 7 infectious episodes per year or 3 episodes per year over the course of 3 years or 5 episodes per year in the course of 2 years, accompanied in most cases by a fever equal to or greater than 38 C and purulent exudate on the tonsils.

Adenoidectomy and tonsillectomy (adenotonsillectomy) are carried out together in the majority of patients, since the tissue is very similar in both structures, and when adenoids gets affected the tonsils get affected too and vice versa. The decision for removing one or both is up to the ENT doctor.