Tonsils: You can live with them, and you can live without them.
Tonsils and adenoids are part of the body’s immune system, which is responsible for protecting the body against viruses, bacteria and foreign substances by producing an immune response. Other parts of the immune system include the thymus, spleen, lymph nodes, lymphocytes, white blood cells, and antibodies. As you can see, the human body has this down to a science.
Tonsils, the two round “bumps” visible in the back of the throat, and adenoids, high in the throat behind the nose and the roof of the mouth, are present at birth. They normally increase in size, peaking around age 12. In most people, the tonsils and adenoids then shrink by age 20 or so.
Tonsils and adenoids don’t always “play by the rules.” They are the immune system’s first line of defense against bacteria and viruses that enter the mouth and the nose, but sometimes they can become more of a nuisance. The two most common problems are recurrent infections and significant swelling, resulting in nasal obstruction, breathing difficulty, swallowing issues, and sleep problems. Infection that spreads deep into surrounding tissue is tonsillar cellulitis, which results in a collection of pus behind a tonsil.
When tonsils are infected, a patient feels it. Common symptoms are fever, sore throat, ear pain, tender lymph nodes in the neck, difficulty breathing through the nose, and daytime sleepiness. Other symptoms may include abdominal pain, stiff neck, and headache.
And a parent can see, hear and even smell infected tonsils. Signs include redder-than-normal tonsils, white or yellow coating on the tonsils, muffled voice or voice change, noisy breathing, and bad breath. Obstruction to breathing causes snoring and disturbed sleep, which may lead to behavioral problems or decline in school performance. Sleep apnea, pauses in breathing for a few seconds during sleep, is another sign.
What to do when you think there’s a problem. If there is difficulty breathing, extreme difficulty swallowing, or drooling, immediately go to the ER or call 911. If not, it’s best to see your teen’s primary-care provider to note any change in tonsil and adenoid size, and record any history of problems. A sore throat lasting more than 48 hours should be checked.
Strep tests and throat cultures — the first step in an evaluation — can help in determining the cause of the throat infection. Strep throat is caused by group A beta hemolytic streptococcus, the most common bacterium infecting the tonsils. If untreated, strep throat can cause complications, such as kidney inflammation or rheumatic fever.
However, most cases of tonsillitis are caused by a common virus and not bacteria. In viral infections, the strep test and throat cultures will be negative. Blood tests may be helpful in diagnosing viral infections such as mononucleosis. A sleep study may be helpful in determining whether there is a sleep disturbance or apnea. X-rays may be required to see the degree of adenoidal swelling. Further testing may need to be done by an otolaryngologist — an ear, nose and throat doctor.
Treatment options. Tonsillitis caused by bacteria is treated with antibiotics. In some patients, severe enlargement may obstruct the airway, and treatment with steroids is necessary. Removal of the tonsils (tonsillectomy) and/or adenoids (adenoidectomy) may be recommended. The decision to remove the tonsils and adenoids must be weighed against the history of their natural shrinkage and against the risks of anesthesia and bleeding, as well as the missed school days (and ice cream bills) to recover from the procedure.
Surgery was once a common occurrence. Now it is usually performed only when bacterial tonsillitis occurs frequently, doesn’t respond to other treatments, or causes serious complications. Tonsillectomy usually reduces the frequency and severity of strep throat infections, although it is still possible to get strep throat.
My advice is focus on prevention. The germs that cause viral and bacterial tonsillitis are contagious. To prevent their spread, wash hands thoroughly and frequently, avoid sharing food, utensils, glasses, water bottles, and toothpaste — and replace a toothbrush after being diagnosed with an infection or your child may get it yet again.