Tonsils and Adenoids

Professor Henry Pau, ENT Surgeon explains these common problems that could affect your child’s health

What are tonsils and what symptoms should I look out for in my child?

Tonsils are normal lymphoid tissues in the throat (see picture 1). Sore throat is a common paediatric health problem and can be caused by tonsillitis. Symptoms of tonsillitis include lethargy, fever, sore throat and inability to eat or drink due to the pain. Occasionally, patients with tonsillitis may find it difficult to breathe due to their enlarged tonsils and they must seek medical advice immediately. Tonsillitis can be caused by bacterial infection and oral antibiotics would be the first line treatment.

Tonsillitis can also be caused by viral infection including glandular fever but oral antibiotics should be given to prevent secondary bacterial infection. One should remember that Amoxil should not be given if glandular fever is suspected as this could cause a rash on the patient’s body. It is essential that patients with tonsillitis are kept well-hydrated especially very young children. In very severe cases, the patients may require intravenous fluid and antibiotics. Severe tonsillitis can cause collection of pus around the tonsils, namely quinsy which requires incision and drainage.

What are adenoids and what symptoms should I look out for in my child?

Adenoid is the lymphoid tissue located at the back of the nose (see picture 2). Inflammation or enlargement of the adenoid can cause constant nasal discharge and blockage. Patients with enlarged adenoid and tonsils can present with snoring, and in severe cases, they develop obstructive sleep apnoea (OSA). OSA is a breathing disorder characterised by brief interruptions of breathing during sleep and can be caused by enlarged adenoid and tonsils. Young patients with OSA present with snoring, daytime sleepiness and sometimes hyperactivity towards the evening. OSA can cause heart and blood pressure problems if left untreated.

Do we need our tonsils and adenoids?

Although tonsils and adenoids are part of our immune system, our body can fight germs without them. It is necessary to remove tonsils (tonsillectomy) and adenoid (adenoidectomy) if they are doing more harm than good.

When do children need to have tonsillectomy and adenoidectomy?

Tonsillectomy should be considered when the patient is suffering from recurrent tonsillitis and/ or quinsy. It should also be considered in conjunction with adenoidectomy when the patient suffers from OSA.

How are the operations done?

Both tonsillectomy and adenoidectomy are performed under general anaesthetic (the patient is asleep). The tonsils and/or the adenoid are removed through the mouth and there will not be any cuts on the outside of the face or the throat at all.

How long will the child be in the hospital?

The child will come into hospital in the morning of the operation and can normally go home later on the same day.

Can there be problems?

Tonsil and adenoid surgeries are very safe but every operation has a small risk. The most serious problem is bleeding, which may need a second operation to stop it. However, bleeding does not happen very often. During the operation, there is a very small chance that the lips, teeth and tongue may be injured.

It is normal to have sore throat and ears following tonsillectomy and adenoidectomy. It is paramount that the child is given regular painkillers for at least the first week following the operation and that the child eats normal food. Eating will help the child’s throat to heal.

Where can I go locally for more advice?

You should always take your child to see your GP in the first instance. If the GP feels a referral is needed, you can choose the NHS or private route. My private practice is at Nuffield Health Leicester Hospital as they have an established children’s service covering several specialities including ENT seeing over 1000 children on average every year.