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3201 South 16th Street
Milwaukee, WI 53215-4537
414-383-7528
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Tonsils and Adenoids
Insight into Tonsillectomy and Adenoidectomy
Tonsils and adenoids are masses of tissue that are similar to
the lymph nodes 
or
"glands" found in the neck, groin, and armpits.
Tonsils are the two masses on the back of the throat. Adenoids
are high in the throat behind the nose and the roof of the
mouth (soft palate) and are not visible through the mouth
without special instruments.
Tonsils and adenoids are near the entrance to the breathing passages where they can catch incoming germs, which cause infections. They "sample" bacteria and viruses and can become infected themselves. Scientists believe they work as part of the body's immune system by filtering germs that attempt to invade the body, and that they help to develop antibodies to germs.
This happens primarily during the first few years of life, becoming less important as we get older. Children who must have their tonsils and adenoids removed suffer no loss in their resistance.
What Affects Tonsils and Adenoids?
The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and significant enlargement or obstruction that causes breathing and swallowing problems.
Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen. Tumors are rare, but can grow on the tonsils.
When Should I See My Doctor?
You should see your doctor when you or your child suffer the common symptoms of infected or enlarged tonsils or adenoids.
The Exam
The primary methods used to check tonsils and adenoids are:
- Medical history
- Physical examination
- Throat cultures/Strep tests
- X-rays
- Blood tests
What Should I Expect At the Exam?
Your physician will ask about problems of the ear, nose, and throat and examine the head and neck. He or she will use a small mirror or a flexible lighted instrument to see these areas.
Cultures/strep tests are important in diagnosing certain infections in the throat, especially "strep" throat.
X-rays are sometimes helpful in determining the size and shape of the adenoids. Blood tests can determine problems such as mononucleosis.
How Are Tonsil and Adenoid Diseases Treated?
Bacterial infections of the tonsils, especially those caused
by streptococcus,
are first treated with antibiotics. Sometimes, removal of
the tonsils and/or adenoids may be recommended. The two primary
reasons for tonsil and/or adenoid removal are (1) recurrent
infection despite antibiotic therapy and (2) difficulty breathing
due to enlarged tonsils and/or adenoids.
Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness in adults and behavioral problems in children. Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes malformations of the face and improper alignment of the teeth.
Chronic infection 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 potential hearing loss.
Recent studies indicate adenoidectomy may be a beneficial treatment for some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).
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 (e.g., cortisone) is sometimes helpful.
Tonsillitis and Its Symptoms
- Tonsillitis is an infection in one or both tonsils. One sign is swelling of the tonsils. Other signs or symptoms are:
- Redder than normal tonsils
- A white or yellow coating on the tonsils
- A slight voice change due to swelling
- Sore throat
- Uncomfortable or painful swallowing
- Swollen lymph nodes (glands) in the neck
- Fever
- Bad breath
Enlarged Adenoids and Their Symptoms
If you or your child's adenoids are enlarged, it may be hard to breathe through the nose.
Other signs of constant enlargement are:
- Breathing through the mouth instead of the nose most of the time
- Nose sounds "blocked" when the person speaks
- Noisy breathing during the day
- Recurrent ear infections
- Snoring at night
- Breathing stops for a few seconds at night during snoring or loud breathing (sleep apnea)
Surgery
Your child: Talk to your child about his/her feelings and provide strong reassurance and support throughout the process. Encourage the idea that the procedure will make him/her healthier. Be with your child as much as possible before and after the surgery. Tell him/her to expect a sore throat after surgery. Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward. If your child has a friend who has had this surgery, it may be helpful to talk about it with that friend.
Adults and children: For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye's syndrome).
- If the patient or patient's family has had any problems with anesthesia, the surgeon should be informed. If the patient is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the surgeon should be informed.
- A blood test and possibly a urine test may be required
prior to surgery.
Generally, after midnight prior to the operation, nothing (chewing gum, mouthwashes, throat lozenges, toothpaste, water) may be taken by mouth. - Anything in the stomach may be vomited when anesthesia is induced, and this is dangerous.
When the patient arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet with the patient and family to review the patient's history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.
After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient until discharged. Every patient is special, and recovery times vary for each individual. Many patients are released after 2–10 hours. Others are kept overnight. Intensive care may be needed for select cases.
Your ENT specialist will provide you with the details of pre-operative and postoperative care and answer any questions you may have.
After Surgery
There are several postoperative symptoms that may arise. These include (but are not limited to) swallowing problems, vomiting, fever, throat pain, and ear pain. Occasionally, bleeding may occur after surgery. If the patient has any bleeding, your surgeon should be notified immediately.
Any questions or concerns you have should be discussed openly with your surgeon, who is there to assist you.
Sore Throats
What Causes a Sore Throat?
Sore throat is a symptom of many medical disorders. Infections cause the majority of sore throats and are contagious. Infections are caused either by viruses such as the flu, the common cold, mononucleosis, or by bacteria such as strep, mycoplasma, or hemophilus.
While bacteria respond to antibiotic treatment, viruses do not.
Viruses: Most viral sore throats accompany flu or colds along with a stuffy, runny nose, sneezing, and generalized aches and pains. These viruses are highly contagious and spread quickly, especially in winter. The body builds antibodies that destroy the virus, a process that takes about a week.
Sore throats accompany other viral infections such as measles, chicken pox, whooping cough, and croup. Canker sores and fever blisters in the throat also can be very painful.
One viral infection takes much longer than a week to be cured:
infectious mononucleosis,
or "mono." This virus lodges in the lymph system,
causing massive enlargement of the tonsils, with white patches
on their surface and swollen glands in the neck, armpits,
and groin. It creates a severely sore throat and, sometimes,
serious breathing difficulties. It can affect the liver, leading
to jaundice— yellow skin and eyes. It also causes extreme
fatigue that can last six weeks or more.
"Mono," a severe illness in teenagers but less severe in children, can he transmitted by saliva. So it has been nicknamed the "kissing disease," but it can also be transmitted from mouth-to-hand to hand-to-mouth or by sharing of towels and eating utensils.
Bacteria: Strep throat is an infection caused by a particular strain of streptococcus bacteria. This infection can also damage the heart valves (rheumatic fever) and kidneys (nephritis), cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections.
Because of these possible complications, a strep throat should be treated with an antibiotic. Strep is not always easy to detect by examination, and a throat culture may be needed. These tests, when positive, persuade the physician to prescribe antibiotics. However, strep tests might not detect other bacteria that also can cause severe sore throats that deserve antibiotic treatment. For example, severe and chronic cases of tonsillitis or tonsillar abscess may be culture negative. Similarly, negative cultures are seen with diphtheria, and infections from oral sexual contacts will escape detection by strep culture tests.
Tonsillitis is an infection of the lumpy tissues on each side of the back of the throat. In the first two to three years of childhood, these tissues "catch" infections, sampling the child's environment to help develop his immunities (antibodies). Healthy tonsils do not remain infected. Frequent sore throats from tonsillitis suggest the infection is not fully eliminated between episodes. A medical study has shown that children who suffer from frequent episodes of tonsillitis (such as three- to four- times each year for several years) were healthier after their tonsils were surgically removed.
Infections in the nose and sinuses also can cause sore throats, because mucus from the nose drains down into the throat and carries the infection with it.
The most dangerous throat infection is epiglottitis, caused by bacteria that infect a portion of the larynx (voice box) and cause swelling that closes the airway. This infection is an emergency condition that requires prompt medical attention. Suspect it when swallowing is extremely painful (causing drooling), when speech is muffled, and when breathing becomes difficult. A strep test may miss this infection.
Allergy: The same pollens and molds that irritate the nose when they are inhaled also may irritate the throat. Cat and dog danders and house dust are common causes of sore throats for people with allergies to them.
Irritation: During the cold winter months, dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings. This often responds to humidification of bedroom air and increased liquid intake. Patients with a chronic stuffy nose, causing mouth breathing, also suffer with a dry throat. They need examination and treatment of the nose.
Pollutants and chemicals in the air can irritate the nose and throat, but the most common air pollutant is tobacco smoke. Other irritants include smokeless tobacco, alcoholic beverages, and spicy foods.
A person who strains his or her voice (yelling at a sports event, for example) gets a sore throat not only from muscle strain but also from the rough treatment of his or her throat membranes.
Reflux: An occasional cause of morning sore throat is regurgitation of stomach acids up into the back of the throat. To avoid reflux, tilt your bedframe so that the head is elevated four- to six-inches higher than the foot of the bed. You might find antacids helpful. You should also avoid eating within three hours of bedtime, and eliminate caffeine and alcohol. If these tips fail, see your doctor.
Tumors: Tumors of the throat, tongue, and larynx (voice box) are usually (but not always) associated with long-time use of tobacco and alcohol. Sore throat and difficulty swallowing, sometimes with pain radiating to the ear, may be symptoms of such a tumor. More often the sore throat is so mild or so chronic that it is hardly noticed. Other important symptoms include hoarseness, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.
When Should I See a Doctor?
Whenever a sore throat is severe, persists longer than the usual five- to seven- day duration of a cold or flu, and is not associated with an avoidable allergy or irritation, you should seek medical attention. The following signs and symptoms should alert you to see your physician:
- Severe and prolonged sore throat
- Difficulty breathing
- Difficulty swallowing
- Difficulty opening the mouth
- Joint pain
- Earache
- Rash
- Fever (over 101°)
- Blood in saliva or phlegm
- Frequently recurring sore throat
- Lump in neck
- Hoarseness lasting over two weeks
When Should I Take Antibiotics?
Antibiotics are drugs that kill or impair bacteria. Penicillin or erythromycin (well-known antibiotics) are prescribed when the physician suspects streptococcal or another bacterial infection that responds to them. However, a number of bacterial throat infections require other antibiotics instead. Antibiotics do not cure viral infections, but viruses do lower the patient's resistance to bacterial infections. When such a combined infection occurs, antibiotics may be recommended. When an antibiotic is prescribed, it should be taken as the physician directs for the full course (usually 10 days). Otherwise the infection will probably be suppressed rather than eliminated, and it can return. Some children will experience recurrent infection despite antibiotic treatment. When some of these are strep infections or are severe, your child may require a tonsillectomy.
Should Other Family Members be Treated or Cultured?
When a strep test is positive, many experts recommend treatment or culturing of other family members. Practice good sanitary habits; avoid close physical contact; and sharing of napkins, towels, and utensils with the infected person. Handwashing makes good sense.
What If My Throat Culture Is Negative?
A strep culture tests only for the presence of streptococcal infections. Many other infections, both bacterial and viral, will yield negative cultures and sometimes so does a streptococcal infection. Therefore, when your culture is negative, your physician will base his/her decision for treatment on the severity of your symptoms and the appearance of your throat on examination.
How Can I Treat My Sore Throat?
A mild sore throat associated with cold or flu symptoms can be made more comfortable with the following remedies:
- Increase your liquid intake.
- Warm tea with honey is a favorite home remedy.
- Use a steamer or humidifier in your bedroom.
- Gargle with warm salt water several times daily: ¼ tsp. salt to ½ cup water.
- Take over-the-counter pain relievers such as acetaminophen
(Tylenol Sore Throat®, Tempra®) or ibuprofen
(Motrin IB®, Advil®).
I Have Trouble Swallowing
Swallowing Disorders
Difficulty in swallowing (dysphagia) is common among all age groups, especially the elderly. The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. This may be caused by many factors, most of which are temporary and not threatening. Difficulties in swallowing rarely represent a more serious disease, such as a tumor or a progressive neurological disorder. When the difficulty does not clear up by itself in a short period of time, you should see an otolaryngologist–head and neck surgeon.
How You Swallow
People normally swallow hundreds of times a day to eat solids,
drink liquids, and swallow the normal saliva and mucus that
the body produces. The process of swallowing has four stages:
- The first is oral preparation, where food or liquid ismanipulated and chewed in preparation for swallowing.
- During the oral stage, the tongue propels the food or liquid to the back of the mouth, starting the swallowing response.
- The pharyngeal stage begins as food or liquid is quickly passed through the pharynx, the canal that connects the mouth with the esophagus, into the esophagus or swallowing tube.
- In the final, esophageal stage, the food or liquid passes through the esophagus into the stomach.
- Although the first and second stages have some voluntary control, stages three and four occur by themselves, without conscious input.
What Causes Swallowing Disorders?
Any interruption in the swallowing process can cause difficulties. It may be due to simple causes such as poor teeth, ill fitting dentures, or a common cold. One of the most common causes of dysphagia is gastroesophageal reflux. This occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort. Other causes may include: stroke; progressive neurologic disorder; the presence of a tracheostomy tube; a paralyzed or unmoving vocal cord; a tumor in the mouth, throat, or esophagus; or surgery in the head, neck, or esophageal areas.
Symptoms
Symptoms of swallowing disorders may include:
- drooling;
- a feeling that food or liquid is sticking in the throat;
discomfort in the throat or chest (when gastroesophageal reflux is present);
a sensation of a foreign body or "lump" in the throat;- weight loss and inadequate nutrition due to prolonged or more significant problems with swallowing; and
- coughing or choking caused by bits of food, liquid, or saliva not passing easily during swallowing, and being sucked into the lungs.
Who Evaluates and Treats Swallowing Disorders?
When dysphagia is persistent and the cause is not apparent, the otolaryngologist–head and neck surgeon will discuss the history of your problem and examine your mouth and throat. This may be done with the aid of mirrors or a small tube (flexible laryngoscope), which provides vision of the back of the tongue, throat, and larynx (voice box). If necessary, an examination of the esophagus, stomach, and upper small intestine (duodenum) may be carried out by the otolaryngologist or a gastroenterologist. These specialists may recommend X-rays of the swallowing mechanism, called a barium swallow or upper G-I, which is done by a radiologist.
If special problems exist, a speech pathologist may consult with the radiologist regarding a modified barium swallow or videofluroscopy. These help to identify all four stages of the swallowing process. Using different consistencies of food and liquid, and having the patient swallow in various positions, a speech pathologist will test the ability to swallow. An exam by a neurologist may be necessary if the swallowing disorder stems from the nervous system, perhaps due to stroke or other neurologic disorders.
Possible Treatments
Many of these disorders can be treated with medication. Drugs that slow stomach acid production, muscle relaxants, and antacids are a few of the many medicines available. Treatment is tailored to the particular cause of the swallowing disorder.
Gastroesophageal reflux can often be treated by changing eating and living habits, for example:
- eat a bland diet with smaller, more frequent meals;
- eliminate alcohol and caffeine;
- reduce weight and stress;
- avoid food within three hours of bedtime; and
- elevate the head of the bed at night.
If these don't help, antacids between meals and at bedtime may provide relief.
Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or restimulating the nerves that trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully.
Some patients with swallowing disorders have difficulty feeding themselves. An occupational therapist can aid the patient and family in feeding techniques. These techniques make the patient as independent as possible. A dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary.
Once the cause is determined, swallowing disorders may be treated with:
- medication
- swallowing therapy
- surgery
Surgery is used to treat certain problems. If a narrowing or stricture exists, the area may need to be stretched or dilated. If a muscle is too tight, it may need to be dilated or released surgically. This procedure is called a myotomy and is performed by an otolaryngologist–head and neck surgeon.
Many causes contribute to swallowing disorders. If you have a persistent problem swallowing, see an otolaryngologist–head and neck surgeon.
(Source: American Academy of Otolaryngology - Head and Neck Surgery)