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Tonsils And Adenoids

Tonsils and adenoids were blamed for so many things in the twentieth century that many people still think of them as villains that have to be removed eventually, the sooner the better. This is the wrong way to look at them. They are there to help overcome infection and build the body's resistance to germs. The tonsils and adenoids are made of lymphoid tissue, like the glands (lymph nodes) that you can often feel along the sides of the neck or behind a child's ears. Lymphoid tissue swells up in the process of killing germs and builds immunity.

The tonsils

The tonsils normally grow until the age of eight. then shrink. Doctors used to think that all very enlarged tonsil. were diseased and should be removed, but that isn't true. There is no need to remove the tonsils, even when they are large, from a child who is otherwise healthy. Frequent colds, sore throats and ear infections are not good reasons for a tonsillectomy. If tonsils are so large that they obstruct the airway, they may need to be removed. Tonsils that are chronically infected or that have pockets of infection in them may also need to go.

The adenoids

The adenoids are clusters of lymphoid tissue up behind the soft palate, where the nose passages join the throat. When they become greatly enlarged, they may block this passageway and cause mouth-breathing and snoring. They may also prevent the free discharge of mucus and pus from the nose, thus prolonging colds and sinus infections. Or they may block the Eustachian tubes that drain the middle ear, resulting in chronic ear infections. Sometimes these conditions can be treated with antibiotics; sometimes surgical removal of the adenoids is necessary.

There is also a condition, called obstructive sleep apnea, in which the adenoids are so large that they obstruct the breathing passages when the child sleeps. Not only does he snore loudly, which is not dangerous, but there are periods when he cannot breathe through the passages at all. The parents may hear a long pause (more than five seconds) in the child's snoring, during which he cannot move air at all and may act as if he is trying to catch his breath. This condition often requires removal of the adenoids to ensure open breathing passages at night. Milder forms of sleep apnea also exist: the child keeps breathing but the Oxygen level in the blood drops low enough to interfere with sleep.

Occasionally an ear specialist will remove the adenoids in a child with chronic or recurrent ear infections as a way to drain e ear through the Eustachian tube. If the tonsils are removed, e adenoids are sometimes cut out, too, but there may be reason to take out the adenoids alone if they are a persistent obruction and leave the tonsils.

The adenoids always grow back to some extent and the body always tries to grow new lumps of lymphoid tissue where the tonsils used to be. This isn't a sign that the operation was incompletely done or has to be done again. It shows only that the body means to have lymphoid tissue in that region and tries hard to replace it.

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