When should I remove my adenoids and tonsils?
The adenoids are two small lumpy balloon like tissues behind the back of the nose and throat. They are part of the lymphatic system which is lots of piping and tubing around the body with little storage tanks and pumps to move it around.
The lymphatic system produces white blood cells and proteins and fats in a liquid form. The lymph system is a major part of the body’s immune system that fights infections, cleans up dead cells and even destroys cancer cells naturally.
The adenoid, also known as a pharyngeal tonsil or nasopharyngeal tonsil, is a bunch of grapelike tissue situated behind the nose, where the nose joins the throat. They usually disappear around four to five years of age.
After birth, enlargement begins and continues until aged 5 to 7 years. Symptomatic enlargement between 18 to 24 months of age is not uncommon, meaning that snoring, nasal airway obstruction and obstructed breathing may occur during sleep. However, this may be reasonably expected to decline when children reach school age, and progressive shrinkage may be expected thereafter.
What do they do?
Tonsils are the immune system’s first line of defence against ingested or inhaled foreign bacteria, viruses. Tonsils have on their surface specialised antigen capture cells called M (like the police crime detection cell) cells that allow them to recognise bacteria and viruses.
Recent studies have provided evidence that the tonsils produce T lymphocytes, (Traffic controllers which control the body’s immune fighting response) also known as T-cells. Thus they are part of the police force of the human body.
The effects of large adenoids
An enlarged adenoid can become nearly the size of a ping pong ball and completely block airflow through the nasal passages.
Even if the enlarged adenoid is not substantial enough to physically block the back of the nose, it can obstruct airflow enough so that breathing through the nose requires an uncomfortable amount of work, and inhalation occurs instead through an open mouth.
The enlarged adenoid can also obstruct the nasal airway enough to affect the voice without actually stopping nasal airflow altogether.
Enlargement of the adenoid, especially in children, causes an atypical appearance of the face, often referred to as adenoid faces.
Features of adenoid faces include
- Mouth breathing
- An elongated (long) face
- Prominent incisors (front teeth poking out)
- Hypoplastic maxilla (flat face)
- Short upper lip
- Raised nostrils
- A high arched palate (top of the mouth becomes high like a dome).
Can they be treated?
Yes when problem causing adenoids are first detected and the amount of block confirmed by X-rays or CT scans, antibiotics, anti-inflammatories and medicines to stop allergies are used to treat them. Most of the cases respond well to medication.
How are they removed?
Surgical removal of the adenoid is a procedure called adenoidectomy. Adenoid infection may cause symptoms such as excessive mucus production, which can be treated by its removal.
Studies have shown that adenoid regrowth occurs in as many as 20% of the cases after removal. Carried out through the mouth under a general anaesthetic (or less commonly a topical), adenoidectomy involves the adenoid being scooped out like scooping ice-cream, or cauterised (burnt by electric current), or vaporised by lasers or melted by a machine called a coblator.
Is there any risk involved in the procedure?
Apart from the usual risks associated with anaesthesia and any surgery, there are no additional risks associated with adenoidectomy done properly.
The author is a Consultant ENT and Head and Neck surgeon, attached to Jaslok Hospital , Breach Candy Hospital and Desa’s Hospital