What are 'Tonsils' ? The tonsils are oval collections of lymphatic tissue located in the back of the throat on the right and left sides. The uvula hangs down from the middle of the soft palate, between the tonsils.The primary purpose of the tonsils is to trap and destroy viruses and bacteria. Usually, tonsils do their job well. But sometimes bacteria or viruses get into the tonsils and infect them. When this happens, you have tonsillitis. Some children and adults are prone to develop infections of the tonsilsWhat is an acute tonsilitis ?Tonsillitis is an inflammation of the glands of the throat, which results in a sore throat. Acute tonsillitis may present with redder-than-normal tonsils, a yellow or white coating on the tonsils, a funny-sounding voice, swollen lymph nodes/glands in the neck, fever and bad breath. Most forms of tonsillitis are contagious and are spread by droplet transmission. Treatment consists of antibiotics, painkiller, fever medication, gargle and taking lots of fluids. It will usually resolve after treatment.What problems can tonsil cause ?a. Recurrent sore throats, throat infection.If these acute infections are especially severe and become more frequent, the tonsils themselves can become the source of throat infection. Abscess (quinsy) can also arise around the tonsillar space. In such a case, it may be best to remove the tonsils later after the acute episode of infection, particularly if they interfere with everyday activities (i.e work, schooling).b. Snoring and mouth breathing.Frequent infection makes the tonsils grow in size (hypertrophy) over time. Some people have large tonsils despite infrequent infection of the throat or tonsils. Large tonsils blocking and narrowing the airway can reult in constant mouth breathing, heavy snoring or obstructive sleep apnea OSA (apnea = cessation of breathing), during which the patient stops breathing and experiences a drop in the oxygen content in the bloodstream. As a consequence, they may feel tired and sleepy the next day due to the poor quality of sleep, hence affecting their concentration. OSA in the adults can predispose to hight blood pressure (hypertension), and cardiovascular/heart problems.c. Recurrent ear infections. Frequent infection of the tonsils can also lead to secondary infection of the middle ear, leading to severe pain in the ear, fever and hearing loss.d. Bad/foul-smelling breath (halitosis). This is due to bacteria in the oral cavity acting on the infected material in the tonsils and tiny stones containing high sulphur content, producing a foul smell.d. Altered voice quality. If the tonsils are extremely large they may cause a stuffy sounding, or muffled voice as narrowing of the throat interferes with voice production.What is 'Tonsillectomy'?A tonsillectomy is an operation/surgery which removes the tonsils. It is done under general anaesthesia after taking into consideration patient's symptoms and complications from enlarged or chronically infected tonsils.What are the benefits of surgery ?a. Fewer sore throats:Once the tonsils are removed, patients are much less likely to have bacterial infections in the back of the throat. However, viral infections in this area is still possible. Frequency and severity of infective sore throat generally reduces. Removal of the tonsils will prevent tonsillitis and abscess collection around this area; however it cannot stop other illnesses with sore throats. b. Decreased snoring and mouth breathing: Patients who snore, or mouth breathe because of enlarged tonsils, often have a decrease in these symptoms after surgery. However, if other problems exist, such as a crooked nasal passage, a long soft palate or a thick tongue, these symptoms may continue after the procedure.c. Fewer ear infections: More significant improvement if any enlarged obstructive adenoid is removed during the surgery as well (see ‘Adenoids’ section below)d. Fresher breath:If halitosis is present because of chronically infected tonsils, this may improve after surgery. However, bad breath may persist if it is caused by bacteria in other areas of the mouth. Gum disease, failure to floss, or other medical or dental problems can also contribute to bad breath. e. Improved voice quality: If the tonsils and adenoids are extremely large they may cause a stuffy sounding, or muffled voice. Removal of these tissues can help improve air flow and voice quality.
What are 'Adenoids' ? The adenoids are lymphatic tissue located above the soft palate on the back wall of the throat near the eustachian tubes (ET). The ET tubes are small air passages that connect the space under the eardrum (middle ear) with the back of the nose (also called nasopharynx). When you clear your ears on an airplane, you are equalizing air pressure through the ET.The primary purpose of the adenoids is to trap and destroy viruses and bacteria, just like your tonsils.Similarly, the adenoids can increase in size due to frequent infection and/or inflammation. Enlarged adenoids can cause nasal blockage, rhinosinusitis, snoring, frequent ear infection (acute otitis media, middle ear effusion) and foul breath. If problematic, it can be removed surgically.
Sometimes, adenoids can mimick cancerous lesions in the nasopharynx (eg. nasopharyngeal carcinomaor commonly called NPC) or vice versa, making biopsy necessary to exclude the more sinister counterpart.
This patient education is provided in good faith to help patients and their families learn more about their medical conditions, the options available to them and the possible consequences of their decisions. This information is not intended to be used for diagnosis, or treatment of any specific individual. Please consult with your ENT doctor regarding your particular circumstances.
TONSILLECTOMY refers to removal of the tonsils.ADENOIDECTOMY refers to the removal of the adenoids. Both the surgeries can be done concurrently (called ADENOTONSILLECTOMY) or independently.For more details on surgical care after the operation, please kindly click this link.
Right picture : Acute tonsillitis with exudates on both tonsils. Left picture : Stones (red arrow) in the right tonsils
Notice the tonsil crypts in the resected tonsil on the left. On cross section (right picture), these crypts (white arrows) from small ‘tunnels’ into the core of the tonsil. Food debris can get stuck here, causing bacterial infection or foul smell in the mouth or forming ‘stones’ (tonsillolith). Picture on the right -source: Dhingra Diseases of ENT 3rd edition textbook
What are the complications of tonsils removal surgery ?Most are in the immediate or early postoperative period. They include bleeding from the operative site, infection, local trauma to the oral cavity region.But these are rare incidences (less than 3%) and generally, tonsil surgery is very safe.Scientific researches over the years had also shown that removing the tonsils does not cause any significant problems with the immune system in long term.It should be emphasized that all decisions for or against surgery are dependent upon the individual patient's particular situation. Patients will be thoroughly counselled before any decision for surgery made.
For more details on surgical care after the operation, please kindly click this link.
There are many ways to remove the adenoids and tonsils depending on the surgeon and instruments available.Here, the tonsils are removed under direct vision using different instruments and different techniques ( e v e n using the same instrument), including:•Cold steel instruments•Monopolar and bipolar Diathermy•Radiofrequency ablation•Harmonic scalpel•Carbon dioxide (CO2) laserAdenoidal removal performed with microdebrider (a special rotating blade) under endoscopic guidance also has t h e following advantages:•faster, more accurate, and complete removal of adenoidal tissue•less risk of injury to important structure eg the Eustachian Tube opening, therefore reducing risk of scarring, pharyngeal stenosis•less postoperative pain
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Talks about TONSILS on 14/2/14((for educational purposes)
DR. VINCENT TANConsultant Ear, Nose and Throat, Head and Neck Surgeon,MD (UKM), MS ORL-HNS (UKM), DOHNS RCS Edinburgh (UK), MRCS Edinburgh (UK), Postgrad. Cert.in Allergy (UK), A.M. (Mal), Fellowship in Rhinology (Singapore)Fellowship in Head and Neck Oncology & Surgery (Amsterdam)