Thirty years ago removal of the tonsils was recommended for a large proportion of children between the ages of 3 and 5. Whenever the tonsils were removed, the adenoids (tonsil-like tissue behind the nose) were also taken out. But now attitudes have changed.
Tonsils & Adenoids
A tonsillectomy - or operation for removal of the tonsils - is likely to be performed nowadays only when the tonsils have become chronically infected or enlarged sufficiently to obstruct breathing. Removal of adenoids is performed only when diseased adenoids cause nose or ear complications and other methods of treatment fail to produce the desired results. In spite of this trend in thinking, tonsillectomy and adenoidectomy, often referred to as "T and A," are still estimated to be the most common operations in surgery today.
What purpose do tonsils and adenoids serve?
Tonsils and adenoids act as a defense against infections that invade the body through the nose and mouth. They are part of the lymphatic system of the body, a protective system who's cells attach and literally devour bacteria. They are very active during the early year of life.
Since small children put dirty fingers, toys, and a variety of strange objects into their mouths and are exposed to germs from many sources, these built-in germ traps are very useful. Of course, they can't possibly destroy every germ that enters the nose and throat, but they do serve as barriers against many bacteria. For this reason they frequently get involved in infections such as colds and sore throats and may become overwhelmed by infection.
Once they have become chronically infected, they may become themselves a source of continuing or recurring infection instead of a protective device. Also, their usefulness decreases as a child grows older and develops immunity to many infections.
What do tonsils and adenoids look like?
Tonsil tissue consists of several sets of spongy, glandular masses arranged in a ring in the throat and behind the nose. The tissue commonly referred to as "the tonsils" is a pair of almond shaped structures that can be seen on each side of the throat just behind and above the level of the tongue. When inflamed these throat tonsils are small and barely visible, but when they are acutely infected, they become greatly enlarged and may almost meet in the middle of the throat.
Another pair of tonsils, the lingual, is positioned on both sides of the tongue at its base. When infected, they too become enlarged and may suffer the same kinds of infections as the throat tonsils.
The third mass of tonsil tissue, the adenoids, is located above and behind the soft palate, where the nose and mouth come together. They are on the back wall of the space behind the nose and in the line of air passing from the nose to the throat and wind pipe. They are usually smaller than the other sets of tonsils. When they are infected they may grow large enough to block the free flow of air into the throat from the nostrils and thus force one to breathe through the mouth, or they may prevent air from entering the middle ears.
When and why are the tonsils and adenoids removed?
Doctors may advise removal of the tonsils for a variety of reasons. The patient may be suffering from repeated acute tonsillar infection (tonsillitis) accompanied by sore throat and swelling and inflammation of the adenoids. In a severe case of tonsillitis, the continued enlargement of the tonsils could interfere with normal breathing, swallowing, or speech. Infection from the tonsils can spread to other areas, resulting in infections of the ears or nose.
Tonsillectomies are rarely rushed into nowadays. The disease-fighting cells of the tonsils, helped by modern antibiotic drugs, may overcome the bacteria so that the swelling and soreness associated with tonsillitis disappear. The physician may wish to observe the tonsils periodically for as long as a year before deciding whether to remove them.
Enlarged and infected adenoids may cause recurrent ear infections or accumulation of fluid in the middle ear. Both of these conditions interfere with hearing. Hearing is often restored by removal of the adenoids.
After making the decision to operate, the doctor takes several precautions. He makes sure that enough time has elapsed since the patient has had a cold or an acute inflammation of the tonsils. Also, if the patient has been exposed to an infectious communicable disease, the doctor postpones the operation until all chance of developing the disease has passed.
How could a child be prepared for the operation?
When a child finds out he has to go to the hospital for an operation, he may be quite frightened. Parents should not try to dispel his fears by telling him he is merely going on a pleasant little trip that will be all fun and no pain.
On the other hand, too much vivid detail should also be avoided - such as telling the child that a man is going to cut something out of his throat with a knife.
A better approach is to acquaint the child with that "strange" and somewhat overwhelming building, the hospital, and with some of the people who will take care of him there. Explain that the doctors and nurses are his friends. They will help him and see that these tonsils wont bother him any more.
He does not have to worry about being away from family and school for a long time. The young child's hospital stay will usually be only a day or two. Furthermore, within a week after his operation, he can look forward to playing as usual and going back to school. The older child takes longer, because his operation covers a larger healing area.
After the operation, the patient may have difficulty eating and talking, but with soft foods and rest he soon recovers. he should avoid active games until completely healed, and should report any appearance of blood in his mouth after the first day or two.
A final word to parents:
Deciding whether a tonsillectomy or adenoidectomy is necessary for your child should be left to the physician. Parents should not try to talk the doctor into performing an operation against his better judgment. Nor should they try to persuade him to use antibiotics if he feels such drugs may involve a needless risk that an operation would be preferable.
In younger children tonsils and adenoids are useful, even though occasionally infected. Removal of tonsils and adenoids does not guarantee freedom from colds and sore throats. These tissues should be removed only when permanent change makes them a source of trouble rather than a protection against it. Let the doctor decide.