What are the tonsils?

Tonsils are areas of soft tissue on both sides of the throat. They help the body fight infection by filtering out germs that enter the body through the mouth and nose. There are other tissues like the tonsils that help filter out germs too. They are called the adenoids.

What are the adenoids?

The adenoids also help the body fight off infection. The adenoids are the areas of soft tissue in the upper throat right behind the nose.
What types of problems can someone have with their tonsils and adenoids?

Sometimes the tonsils and/or the adenoids are so enlarged that they block the throat and breathing airway. This can cause difficulty breathing and other serious health problems. A child's doctor may call this condition tonsillar hypertrophy or obstruction.

While helping the body fight off germs, the tonsils and adenoids may also get infected. If the infection is great enough to cause inflammation, this condition is called tonsillitis.

What is tonsillectomy?

Tonsillectomy is a surgery in which the tonsils are removed from the throat. An "adenoidectomy" is a similar surgery that removes the adenoids. In children, it is common to remove the tonsils and the adenoids at the same time. This procedure is called an "adenotonsillectomy."

What are the most common reasons for tonsillectomy?

The tonsils may be removed for two main reasons:

• Obstruction: The most common reason tonsils are removed is because they are so large that they block or obstruct the throat. This may cause difficulty in breathing or even more serious health problems.
• Chronic infection: Chronic or recurring infections in the tonsils can lead to chronic tonsillitis. Removing the tonsils can help reduce the number of throat infections.

What is obstruction?

If a child has enlarged or swollen tonsils, a physician may call this obstruction. Obstruction means the tonsils are so large that they are blocking part of the breathing airway and/or the throat. Today, 75 percent of all tonsillectomies are performed for this reason.

Symptoms of obstruction may include:

• Snoring
• Loud and/or labored breathing
• Severe difficulty swallowing
• Mouth breathing
• Frequent and disruptive gasping or snorting noises

The problems caused by obstruction vary from child to child. Some children may have difficulty breathing, such as sleep-disordered breathing or obstructive sleep apnea.

What is sleep-disordered breathing?

Sleep-disordered breathing is a condition in which people do not breathe properly while sleeping. Obstructive sleep apnea (OSA) is severe form of SDB characterized by breathing that stops several times during the night.

Symptoms of sleep-disordered breathing may include:

In children younger than five,

• Gasping for air while sleeping
• Breathing stops while sleeping
• Breathing through the mouth while sleeping
• Regularly waking up in the middle of the night
• Daily irritability
• Restlessness
• Snoring every night

In addition to these, in children older than five,

• Bed wetting at night
• Behavior problems
• Shortened attention span
• Abnormally low weight, weight gain and appetite for their age

What problems can sleep-disordered breathing lead to?

If left untreated, sleep-disordered breathing problems, such as pediatric OSA, could lead to much more serious health issues such as:

• Poor growth: During sleep, the body usually releases a hormone that helps it grow. If a child is constantly waking up during the night, his or her body may not be releasing a regular amount of this growth hormone resulting in slowed growth.
• Bedwetting at night: Sleep disturbances during the night could increase the amount of urine that the body makes, leading to bedwetting.
• Sleep deprivation: If a child wakes up constantly at night, he or she may not be getting enough sleep. This could lead to mood swings, a decrease in their energy and happiness and even obesity.
• Psychological, behavioral, or emotional problems: Interrupted sleep caused by sleep-disordered breathing can lead to problems such as depression and attention deficit hyperactivity disorder (ADHD).

There is good news though. Studies have shown that after undergoing tonsillectomy and/or adenoidectomy for obstructive symptoms, many of these problems are resolved. One study found that children who had an adenotonsillectomy, showed reduced symptoms of ADHD and daytime sleepiness and higher cognitive functioning one year following the procedure.

What is tonsillitis?

Tonsillitis refers to the inflammation of the tonsils caused by an infection. Recurring infections in the tonsils could lead to chronic tonsillitis and other chronic infections.

What causes tonsillitis?

Tonsillitis is usually contagious and is spread just like a cold; that is, through coughing, sneezing, etc. Viruses and bacteria can cause tonsillitis. Almost all children get at least one tonsil infection in their lifetime.

What are the symptoms of tonsillitis?

The symptoms of tonsillitis include:

• Fever
• Persistent sore throat
• Redness of the tonsil area
• Yellow discharge on the tonsils
• Tender lymph nodes on both sides of the neck

What are chronic infections and why are they treated with tonsillectomy?

Infections in the tonsils and adenoids that keep coming back are called chronic infections. If these infections are not stopped, they could cause more serious health problems.

A child's doctor may first prescribe antibiotics to fight infections. If antibiotics do not work, the doctor may recommend tonsillectomy and/or adenoidectomy. Removing the tonsils and/or adenoids helps to prevent infections from coming back.

Doctors typically recommend removing the tonsils for chronic tonsillitis based on the following guidelines:

• Three to four episodes of infectious tonsillitis per year for three years in a row
• Five episodes of infectious tonsillitis in one year
• Seven episodes of infectious tonsillitis in two years