What are the tonsils and adenoid anyway?

One of the most common conversations I have with parents every day concerns the tonsils. As we head into the fall and school gets underway I thought I would share a little information about these 2 pesky structures in the back of the throat which can be the source for a number of problems for children.

What are the tonsils and adenoid anyway?
First, to understand how diseases of the tonsils occur and the consequences of different treatment options, basic knowledge about the structure and function of the tonsils and adenoid is needed. The tonsils and adenoid are part of a collection of lymphoid tissue called Waldeyer’s ring. Lymphoid tissue is involved in the production of infection fighting cells within the body, so Waldeyer’s ring is involved in the initiation of an immune response in children who sample their world by placing things in their mouth. The tonsils, or palatine tonsils, sit at the entrance to the throat next to the tongue whereas the adenoid, or pharyngeal tonsil, sits in the back of the nose. Interestingly, you also have tonsil tissue in the back of your tongue as well!

What are reasons for removing the tonsils and adenoid?
In general there are 2 main reasons that we consider surgery for diseases of the tonsils and adenoid: recurrent throat infections and upper airway obstruction during sleep. Our criteria for removing tonsils for recurrent infections has changed over the decades as we attempt to identify children “severely” affected by this disease process who can not wait until they eventually outgrow the problem, which most do. In general we follow these guidelines, called the Paradise Criteria, to determine how many infections to allow:

• ≥7 infections in 1 year
• ≥5 infections in 2 consecutive years
• ≥3 infections in 3 consecutive years

What constitutes an infection? A child must have at least a sore throat. Additionally, we see swollen lymph nodes in the neck, fever ≥ 101 ° F, infection covering the tonsil surface and positive tests for the presence of the most common bacterial cause, Streptococcus pyogenes.

The most common reason I recommend tonsil and adenoid removal is upper airway obstruction. This often occurs during the night’s deepest sleep when the body relaxes. In a lot of cases it can cause obstructive sleep apnea which can be very problematic for a child’s growth and development. Signs and symptoms to look out for include:

• Snoring with pauses in breathing
• Gasping for air
• Frequent arousals from sleep

Additionally, untreated sleep apnea can cause poor growth, poor school performance, bed wetting and behavioral problems such as hyperactivity, especially at night.

What to do next?

The first step is always going to be to discuss issues related to recurrent sore throats and sleep problems with the person who knows your child’s health the best, your primary care physician. If they think the problem warrants consideration of further treatment our team at Eastern Shore ENT is here to help! With all aspects of your care being handled here on the Eastern Shore, from consultation to surgery, we can take the best care of your child possible with the convenience and comfort of remaining close to home.

Brian Hixon, MD