Troublesome tonsils

klopotliwe-migdalkiDoes your child catch infections frequently, snore, or hear badly? This may be caused by the tonsils. Do you need to remove them? Many parents are afraid of this procedure because of a number of myths that have grown around it. This’s why we check if there’s cause for concern.

There are two tonsils in the pharynx and there is the so-called third tonsil in the rhinopharynx. ‘These are clusters of lymphatic tissue composed of cells engaged in the destruction of microorganisms that cause infections. Due to their location, they constitute a barrier that protects the body from pathogenic factors entering the organism together with inhaled air or through the digestive system,’ explains Agnieszka Strzembosz, MD, PhD, a laryngologist from the Medicover Hospital. The pharyngeal tonsil (called the third tonsil) is located on the posterior wall of the rhinopharynx, behind the soft palate and the uvula – it cannot be seen without specialist medical equipment. However, we can see the palatine tonsils with the naked eye, located symmetrically on both sides of the passage from the oral cavity to the throat.

When the tonsils enlarge

During an infection the tonsils enlarge because they produce more antibodies in order to fight microorganisms attacking the organism. After recovery, they should return to their normal size; however, this does not always happen. Frequently recurring upper respiratory tract infections, allergies, asthma, or so-called oesophagopharyngeal reflux may lead to tonsil hypertrophy. If this happens, instead of serving as sentinels, they become hotbeds for bacteria. As a result, your child can become sick more often. Hypertrophied tonsils also disturb the patency of the nasal cavity, which means that the child may have a runny nose, breathe through their mouth, and talk ‘through the nose’ for many weeks or even months. This ailment also causes the child to sleep restlessly, snore, wake up coughing, or cough while sleeping and in the morning complain of headaches and tiredness. It can also hinder swallowing food, and result in speech disturbances and trouble hearing. ‘Hypertrophied tonsils can block a part of the auditory tube and the lack of ventilation can result in fluid concentration in the ear, which favours the development of otitis media. Therefore, if a child cannot catch what people are saying or they are constantly increasing the volume of the stories or cartoons they listen to, they should visit a doctor, as it may indicate hearing problems,’ adds Agnieszka Strzembosz, MD, PhD.

Should we remove them or not?

If we suspect that our child’s tonsils are enlarged, we should visit an otolaryngologist so the doctor can look at them. A fiberscope is currently used to do this. It’s a soft, thin cable with a small camera on the end that is several millimetres across that can be inserted into the nose. If the little patient cooperates with the doctor, this examination can be performed in a laryngological surgery even on a three-year-old. Otherwise, a fiberscope assessment can be done in an operating room under short general anaesthesia.

Based on the results of the examination and the analysis of the course of the disease, a specialist makes a decision concerning treatment. If the child’s condition hasn’t improved after preservative treatment and if the enlarged tonsils are hindering the child’s normal functions, an operation is necessary: either adenoidectomy (adenoid removal) or tonsillectomy (reduction of the size of the tonsils). The procedure lasts for approximately 30 minutes and the patient can often be discharged on the same day. ‘Usually on the first day it is recommended that the child be given painkillers and in specified cases antibiotic therapy is proscribed,’ says Agnieszka Strzembosz, MD, PhD. ‘Parents should also see to it that for several subsequent days the child stays at home, avoids physical exercise and hot and spicy food, and drinks a lot,’ she adds.

Tonsil myths

There are numerous myths concerning tonsil procedures, so it’s no wonder a large number of parents are afraid of surgical intervention. One such myth is that tonsils regrow and that removing them compromises your immunity. However, most of the time there is nothing to be afraid of and these statements are groundless if the procedure is preceded by a thorough analysis and assessment of the child’s health condition, as well as examinations. The risk of adenoid tissue regrowth or of the occurrence of temporary immunodeficiency after the operation can be determined on the basis of this assessment. ‘Adenoidectomy does not lead to immunodeficiency; however, in the case of tonsillectomy, susceptibility to infection can last for up to six months in some children. Therefore, after it is performed, parents should make sure that the child’s diet is appropriate and avoid large communities of children when there are upper respiratory tract infections going around, in particular in early spring or late autumn. It is also advisable to plan so-called climatic therapy, which means summer holidays at the seaside or winter holidays in the mountains,’ sums up Agnieszka Strzembosz, MD, PhD.


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