The tonsils and adenoids are part of the body’s immune system, a system whose primary responsibility is to fight infection. The tonsils are located in the back of the throat, and the adenoids are located higher up behind the nose and soft palate and are not visible without special instruments.
The problems that most frequently affect the tonsils and adenoids are recurrent infections and significant enlargements or obstructions that cause breathing, sleep, and swallowing problems. The tonsils and adenoids can become infected and swell and cause a sore throat. This is called tonsillitis or adenotonsillitis when the adenoids are involved. Enlarged adenoids can make it hard to breathe and cause middle ear problems as well.
Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can occur. Tumors of the tonsils are not uncommon.
Tonsillitis is an infection in one or both tonsils. One sign is swelling of the tonsils. Other symptoms can include:
- Redness in the tonsils
- A white or yellow coating on the tonsils
- A slight voice change due to swelling
- Sore throat
- Discomfort or pain when swallowing
- Swollen lymph nodes in the neck
- Bad breath
Signs of adenoid problems include:
- Mouth breathing
- Talking as if the nostrils are pinched
- Breathing noisily
- Recurrent ear infections
- Sleep apnea
Tonsil and adenoid infections are often viral. Symptomatic therapy following a negative strep screen is usually advised. Antibiotic therapy can be helpful if persistent symptoms remain, or if there is evidence of a peritonsillar abscess. A peritonsillar abscess develops when the infection spreads to the space between the tonsil and the surrounding muscles of the throat. Patients are usually quite ill, and the pain is typically on one side and is associated with difficulty opening the mouth, swollen nodes, and a “hot potato” voice. Drainage of the abscess is usually necessary.
Additionally, an otolaryngologist at York ENT may conduct the following to gather more information about the tonsils and adenoids:
- Complete throat cultures help assess which specific bacteria are causing the infection
- X-rays assist in determining the size and shape of the adenoids
- Blood tests help in determining infections such as mononucleosis
Depending on each specific case, the otolaryngologist may recommend surgery if there is a history of frequent infections or trouble breathing. A tonsillectomy is surgery to remove the tonsils. An adenoidectomy is surgery to remove the adenoids.
The incidence of tonsil removal is lower today than in the past because of success with antibiotics. If left alone, some tonsils may shrink on their own. When necessary, the otolaryngologist will recommend a tonsillectomy for patients who suffer a chronic recurrence of tonsillitis, swollen tonsils that make breathing or swallowing difficult or for obstructive sleep apnea (a condition in which the patient stops breathing during sleep). Tonsillectomies are more common among children, but many adults who have the surgery find they suffer fewer infections and need less medication.
The otolaryngologist may recommend surgical removal of infected or enlarged adenoids. This surgery, called an adenoidectomy, is often recommended for patients who have difficulty breathing, suffer from sleep apnea or have recurrent middle ear infections.
Having adenoids removed is especially important when repeated infections lead to sinus and ear infections. Enlarged adenoids can interfere with Eustachian tube function, which can sometimes lead to hearing loss. Therefore, children whose infected adenoids cause frequent earaches and fluid buildup may require an adenoidectomy as well as ear tube surgery.
Although adenoids can be taken out without the tonsils, the tonsils may need to be removed at the same time. Sometimes this is necessary to expose the adenoids during surgery. The otolaryngologist will make this decision on an individual basis for each patient. In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For those patients, treatment with steroids such as prednisone is sometimes helpful and surgical therapy is reserved for those who do not respond to medical therapy.