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FAQ Throat

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  • What are Tonsils and Adenoids?

    Tonsil and adenoids are part of the lymphoid tissue system. The lymphoid system, as a whole, works to help the body’s immune system. Tonsils and adenoids, however, have not been found to contribute much to the body’s immune system. Tonsils are located in the back of the throat and adenoid tissue is located in the roof of the throat. Tonsils can become a source of recurrent infection or airway obstruction. Adenoids usually disappear by adulthood, but can be a source of nasal obstruction and a reservoir for chronic ear infections in children.
  • My doctor wants to remove my tonsils and adenoids. Do I need these for my immune system to work properly?

    Tonsillectomy and Adenoidectomy have been performed for centuries. No studies have ever shown that removing tonsil or adenoid tissue has a negative effect on the immune system.
  • What is tonsil and adenoid surgery?

    Surgical removal of the tonsils and adenoids (known as a T&A) is one of the most common operations performed on children in the U.S.
  • What are the risks of surgery?

    T&A procedures are not without risk. Under ideal conditions, the death rate is 1 child per 250,000 operations. Approximately 4% of children bleed on the fifth to eighth day after surgery. A few of these children may need a blood transfusion or additional surgery. All children experience throat discomfort for several days. Some children whose speech was previously normal develop hypernasal speech because the soft palate no longer closes completely.
  • When is surgery not necessary?

    Some T&As are performed for unwarranted reasons. You can always find someone to perform surgery on your child; in fact, this is the main risk of “doctor shopping.”

    1. Large tonsils
      Large tonsils do not mean “bad” tonsils or infected tonsils. The tonsils are normally large during childhood (called “physiological hypertrophy”). They can’t be “too large” unless they touch each other. The peak size is reached between 8 and 12 years of age. Thereafter, they spontaneously shrink in size each year, as do all of the body’s lymph tissues.
    2. Recurrent colds and viral sore throats
      Several studies have shown that T&As do not decrease the frequency of viral upper respiratory infections (URIs). These URIs are unavoidable. Eventually your child develops immunity to these viruses and experiences fewer colds per year.
  • When is surgery necessary?

    Sometimes the tonsils should come out. But the benefits must outweigh the risks. All but the first three of the following valid reasons are rare. Once you decide a T&A is needed, the ear, nose, and throat surgeon will decide if the tonsils, adenoids, or both need removal.

    1. Persistent mouth-breathing
      Mouth-breathing during colds or hay fever is common. Continued mouth-breathing is less common and deserves an evaluation to see if it is due to large adenoids. The open-mouth appearance results in teasing, and the mouth-breathing itself leads to changes in the facial bone structure (including an overbite that could require orthodontia).
    2. Abnormal speech
      The speech can be muffled by large tonsils or made hyponasal (no nasal resonance) by large adenoids. Although other causes are possible, an evaluation is in order.
    3. Severe snoring
      Snoring can have many causes. If the adenoids are the cause, they should be removed. In severe cases, the loud snoring is associated with retractions (pulling in of the spaces between the ribs) and is interrupted by 30- to 60-second bouts of stopped breathing (sleep appnea).
    4. Heart failure
      Rarely, large tonsils and adenoids interfere so much with breathing that blood oxygen is reduced and the right side of the heart goes into failure. Children with this condition are short of breath, have limited exercise tolerance, and have a rapid pulse.
    5. Persistent swallowing difficulties
      During a throat infection, the tonsils may temporarily swell enough to cause swallowing problems. Some children refuse solid foods. If the problem is persistent and the tonsils are seen to be touching, an evaluation is in order. This problem more often occurs in children with a small mouth.
    6. Recurrent abscess (deep infection) of the tonsil
      Your child’s physician will make this decision.
    7. Recurrent abscess of a lymph node draining the tonsil
      Your child’s physician will make this decision.
    8. Suspected tumor of the tonsil
      These rare tumors cause one tonsil to be much larger than the other. The tonsil is also quite firm to the touch, and usually enlarged lymph nodes are found on the same side of the neck.