Tonsils and adenoids

[DrAnil]

What are tonsils?

The tonsils are two fleshy lumps at the back of the throat. If you look in the mirror, with your mouth wide open, you can see them. The thing that dangles down in the middle is the uvula (you-view-la). The tonsils are either side of it. Healthy tonsils are pale pink in colour, sometimes with white spots. Infected tonsils are more red in colour. They may have yellow or green spots of pus, or grey ulcers, or a thick cheesy off-white coating.

What are adenoids?

Adenoids are cauliflower-like swellings at the back of the nose. You can’t normally see them because they are above and behind the uvula. If the adenoids are too big, they may block the nose and cause glue ear.

Why do we have tonsils and adenoids?

Normal tonsils and adenoids act as a barrier to help fight infections. They are made of lymphoid tissue, part of the body’s immune system. Bacteria, virus and other particles in air and food get trapped in their folds. Immune cells sample everything. If they detect a potentially dangerous invader, they attack and destroy it with their natural chemical weapons. Some immune cells leave the battlefield and travel to the lymph glands in the neck with a message for reinforcements. The lymph glands are like factories for immune cells and antibodies. Antibodies are chemical weapons tailored specifically to one type of virus or bacterium. If the virus is new to the body, the lymph glands may be slow to react, and the invader can gain considerable ground and cause illness. But if the virus has been encountered before, the immune cells remember its structure. They rapidly switch on production of neutralising antibodies, which prevent infection from progressing. The person is immune to that virus. Unfortunately, there are hundreds of different viruses and bacteria which can cause illness. Throughout childhood, we are constantly exposed to different viruses. This probably explains why the tonsils and adenoids grow in size until around the age of 8, then, in most cases, begin to shrink. By adult life, the adenoids should have virtually disappeared, and the tonsils should be small.

        

[DrAnil]

 

Acute tonsillitis – red and swollen tonsils.
Key:
t = tonsil
u = uvula

Adenoids seen through a nasal endoscope

 

Adenoidal child. Typical facial appearance, mouth breathing. The back of the nose is blocked by large adenoids.

 

        

[Anonymous]

Why remove the tonsils and adenoids?

Although the tonsils and adenoids, when healthy, do help fight infections, sometimes they cause much more trouble than they are worth.

• Infected tonsils can be very painful, especially on swallowing.
• Sufferers go off their food, some children fail to grow.
• Time is lost from school or work.
• Very high temperatures cause fits in some children.
• An abscess (quinsy) can form which needs emergency hospital admission.
• Very large tonsils can obstruct breathing at night.
• Bad breath can be caused by decomposing food and bacteria trapped in the deep folds of the tonsils.
• If the adenoids get too big, they cause blockage of the nose and Eustachian tube, resulting in glue ear.
• Some tonsils are chronically infected, causing constant sore throat.

If the tonsils are frequently or chronically infected, they are no longer working properly. In fact, they have been "subverted" by the enemy bacteria, acting as reservoirs for infection.

• There is plenty of other lymphoid tissue in the throat which takes over the work of the tonsils and adenoids if they are removed.
• It is not true that removing the tonsils and adenoids makes you more likely to get chest or stomach infections.

What can be done apart from surgery?

Tonsillitis can get better on its own. Simple treatment with

• rest
• plenty of fluids
• painkillers
• such as paracetamol or aspirin (not aspirin for children under 12 years) may be sufficient.

More severe infections can be treated with antibiotics. To prevent attacks, ensure

• a healthy balanced diet
• regular exercise
• plenty of fresh air
• Do not smoke
• do not expose children to passive smoking.
• If your child is a fussy eater, give multivitamin supplements.
• Encourage oral hygiene restrict sweets, and brush teeth at least twice daily.
• Insist on sensible bed times – lack of sleep can depress the immune system.

Many children go through a phase of repeated attacks of tonsillitis, especially when they start school and become exposed to a greater variety of viruses and bacteria. I usually recommend waiting at least a year or two, to see if the attacks will stop. A further bout of repeated attacks of tonsillitis is common in the teenage years, often following glandular fever. Again, it is sensible to wait and see for at least a year, to see if they will settle down. On the other hand, this is an important time at school for study and examinations. If it seems likely that the attacks will continue and disrupt education, operation may be the best solution.

        

[Anonymous]

 

 

Tonsils removed – yellow spots are crypt debris

 

Crypt debris from the tonsils comprising dead layers of shed skin, trapped decomposing food, bacteria and other micro-organisms. This debris provides a sheltered home for germs, forming biofilms.Antibiotics don’t penetrate into the crypt debris. Germs living in a biofilm state are resistant to antibiotics.

 

Biofilm in a tonsil crypt as seen under the microscope.

        

[drsushant]

 

What is the success rate of surgery?

 

• Removing the tonsils is completely effective in stopping tonsillitis.
• But you can still get ordinary sore throats. They will not be as bad as tonsillitis.
• Removing the adenoids is very effective at restoring the ability to breathe through the nose, unless it is blocked for some other reason e.g. allergy or sinusitis.
• Adenoidectomy is about 70% effective in treating glue ear, but the beneficial effect takes several months to develop.

What are the risks of surgery?

Tonsillectomy and adenoidectomy are very safe procedures in modern medical practice. But no operation is totally risk free.

• At worst, you could die or suffer brain damage – but you are more likely to be injured in a road accident. A general anaesthetic carries a minimal risk, with consultant anaesthetists using modern drugs and monitoring equipment.
• There is a risk of excessive bleeding, either during or up to two weeks after the operation.
• About 2% of patients may need a second operation to control bleeding, readmission to hospital, or a blood transfusion.
• Most serious bleeds happen in the first few hours after operation.
• During this recovery period, trained nurses will monitor your condition carefully.
• There is a risk of picking up an infection in the recovery period. Infection is more likely if you don’t eat and drink properly. That is why you should make sure you take painkillers half an hour before meals, so that it won’t be too sore to swallow.
• If you do get an infection, you may get some further bleeding and might need antibiotics, or you might need to be re-admitted to hospital for treatment.
• Your voice will change character after removing the tonsils or adenoids, ususally for the better, but some might not like it.
• There may be some numbness of the tongue or side of the mouth. This will normally be temporary, occasionally it is permanent.
• There may be some change in the sense of taste. This will normally be temporary, occasionally it is permanent.

Is the operation more dangerous in adults?

No. Tonsillectomy is relatively safe at any age, but it is more painful in adults and teenagers than in young children. There are no absolute age limits. The youngest patient I have operated on was six months, for breathing obstruction. The oldest was 93, for cancer of the tonsils.

Position for removal of tonsils and adenoids under general anaesthetic

How is the operation done?

Tonsils and adenoids are removed under general anaesthetic (fully asleep) in the operating theatre. The anaesthetist usually sends you to sleep by giving an injection. The drug injected acts very rapidly, within a few seconds. To stop the needle from hurting children, the ward nurse puts special cream on the back of the hand. It numbs the skin, so the needle doesn’t hurt. Sometimes, if a vein can’t be found or the child is too frightened, we send you to sleep with gas. This may take several minutes to work. Once you are asleep, the anaesthetist puts a plastic tube in your mouth. It goes to the trachea (windpipe) so that you can breathe during the operation. A special gag holds the mouth wide open. Both tonsils and adenoids are removed through the mouth. There is no external cut. Any excessive bleeding is controlled by a combination of pressure swabs, diathermy (electric cautery) and stitches. If you do need stitches, they will be self-dissolving. They will not need to be removed.

        

[drmithila]

 A sore throat is pain, scratchiness or irritation of the throat that often worsens when you swallow.

A sore throat is the primary symptom of pharyngitis — inflammation of the pharynx, or throat. But the terms "sore throat" and "pharyngitis" are often used interchangeably.

The most common cause of a sore throat is a viral infection, such as a cold or the flu. A sore throat caused by a virus usually resolves on its own with at-home care. A bacterial infection, a less common cause of sore throat, requires additional treatment with antibiotic drugs.

Other less common causes of sore throat may require more complex treatment.

        

[drmithila]

 

• Red, swollen tonsils
• White or yellow coating or patches on the tonsils
• Sore throat
• Difficult or painful swallowing
• Fever
• Enlarged, tender glands (lymph nodes) in the neck
• A scratchy, muffled or throaty voice
• Bad breath
• Stomachache, particularly in younger children
• Stiff neck
• Headache

In young children who are unable to describe how they feel, signs of tonsillitis may include:

• Drooling due to difficult or painful swallowing
• Refusal to eat
• Unusual fussiness

When to see a doctor 
It’s important to get an accurate diagnosis if your child has symptoms that may indicate tonsillitis.

Call your doctor if your child is experiencing:

• A sore throat that doesn’t go away with the first drink or two in the morning
• Painful or difficult swallowing
• Extreme weakness, fatigue or fussiness

Get immediate care if your child:

• Has difficulty breathing
• Has extreme difficulty swallowing
• Is drooling

        

[drmithila]

 At-home care

Whether tonsillitis is caused by a viral or bacterial infection, at-home care strategies can make your child more comfortable and promote better recovery.

If a virus is the expected cause of tonsillitis, these strategies are the only treatment. Your doctor won’t prescribe antibiotics. Your child will likely be better within seven to 10 days.

At-home care strategies to use during the recovery time include the following:

• Encourage rest. Encourage your child to get plenty of sleep and to rest his or her voice.
• Provide adequate fluids. Give your child plenty of water to keep the throat moist and prevent dehydration.
• Provide comforting foods and beverage. Warm liquids — broth, caffeine-free tea or warm water with honey — and cold treats like ice pops can soothe a sore throat.
• Prepare a saltwater gargle. If your child can gargle, a saltwater gargle of 1 teaspoon (5 milliliters) of table salt to 8 ounces (237 milliliters) of warm water can help soothe a sore throat. Have your child gargle the solution and then spit it out.
• Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat, or sit with your child for several minutes in a steamy bathroom.
• Offer lozenges. Children older than age 4 can suck on lozenges to relieve a sore throat.
• Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.
• Treat pain and fever. Talk to your doctor about using ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) to minimize throat pain and control a fever. Aspirin has been linked with Reye’s syndrome, so use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

Antibiotics
If tonsillitis is caused by a bacterial infection, your doctor will prescribe a course of antibiotics. Penicillin taken by mouth for 10 days is the most common antibiotic treatment prescribed for tonsillitis caused by group A streptococcus. If your child is allergic to penicillin, your doctor will prescribe an alternative antibiotic.

Your child must take the full course of antibiotics as prescribed even if the symptoms go away completely. Failure to take all of the medication as directed may result in the infection worsening or spreading to other parts of the body. Not completing the full course of antibiotics can, in particular, increase your child’s risk of rheumatic fever and serious kidney inflammation.

Talk to your doctor or pharmacist about what to do if you forget to give your child a dose.

Surgery
Surgery to remove tonsils (tonsillectomy) may be used to treat frequently recurring tonsillitis, chronic tonsillitis, or bacterial tonsillitis that doesn’t respond to antibiotic treatment. Frequent tonsillitis is generally defined as:

• More than six episodes in one year
• More than four episodes a year over two years
• More than three episodes a year over three years

A tonsillectomy may also be performed if tonsillitis results in difficult to manage complications, such as:

• Obstructed sleep apnea
• Breathing difficulty
• A peritonsillar abscess that doesn’t improve with antibiotic treatment

Tonsillectomy is usually done as a one-day surgery. That means your child should be able to go home the day of the surgery. A complete recovery usually takes seven to 10 days.

        

[drsushant]

Millions of Americans reach for their cough drops or syrup at the first sign of a cough. However, scientists are unsure if and how these popular remedies work. Now, new findings from the Monell Center suggest that sucrose and menthol, ingredients commonly regarded as flavorings in these preparations, each act independently to reduce coughing.
Cough is a vital protective reflex that clears the respiratory tract of threats from mechanical stimuli like food and chemical stimuli such as airborne toxins and pollutants. As such, cough is necessary to protect the lungs, keep airways clear, and preserve life.
"Individuals with a weak cough reflex are at increased risk of pneumonia and of choking. Conversely, many acute and chronic conditions involve frequent coughing, leading to 30 million health care visits annually, with billions spent on over-the-counter medications and billions more lost due to reduced productivity," said lead author, Paul M. Wise, Ph.D., a sensory psychologist at Monell.
However, many aspects of coughing remain poorly understood, including how chemicals act to trigger and modulate cough.
In the current study, which appears in the June 2012 issue of Pulmonary Pharmacology and Therapeutics, 12 healthy young adults inhaled from a nebulizer containing capsaicin, the burning ingredient in chili peppers and a potent chemical stimulus for cough. After each inhalation, the amount of capsaicin was doubled. This procedure continued until the subject coughed three times within 10 seconds. The capsaicin concentration that induced the three coughs was labeled as the individual’s cough threshold.
In some sessions, the subjects held either a very sweet sucrose or plain water in their mouths for three seconds, spat the liquid into a sink, and then inhaled from the nebulizer.
In other sessions, subjects inhaled three breaths of either menthol-saturated air or clean air before each capsaicin inhalation. The menthol concentration was selected to approximate the cooling intensity of a menthol cigarette.
Both sucrose and menthol increased the amount of capsaicin needed to elicit a cough relative to plain water or clean air, respectively. Sucrose increased cough threshold by about 45 percent, while menthol increased it by approximately 25 percent.
"This is the first study to empirically show that sweet taste reduces cough. This also is the first study to show that menthol alone can reduce coughing in response to a cough-eliciting agent," said Monell sensory scientist Paul Breslin, Ph.D., an author on the study.
The findings support the hypothesis that adding menthol to cigarettes, popularly known as "menthols," may make it easier to begin smoking by suppressing the cough reflex, thus making the first cigarettes less distressing.
"Menthol may dull the sensitivity of sensory nerves in the airways and thereby actually disable an important reflex mechanism that would otherwise protect smokers from the chemical and particulate irritants present in cigarette smoke," said Wise.
Studies at Monell will continue to explore the chemical elicitation of cough, along with the receptors and genes involved in this system.
Also contributing to the research was Pamela Dalton, Ph.D., of Monell. Breslin also holds a position as professor in the Department of Nutritional Sciences at Rutgers University. Funding was provided by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health.

 

        

[Author]

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