Tonsils and Adenoids

What are tonsils and adenoids?

The tonsils sit on either side of the throat, and the adenoids sit at the back of the nose, in the nasopharynx. Both are lymphoid tissues and part of the immune system; they play a role in the body’s first encounters with germs, especially in early childhood. In most children the adenoids begin to shrink after school age and largely regress by adolescence.

Sometimes these tissues become infected frequently, and sometimes they grow large enough to block the airway, the nose or the Eustachian tube that ventilates the ear. That is when symptoms start and treatment is considered. Because they have an immune role, not every enlargement or every sore throat calls for surgery; the decision is made carefully.

Who do they cause problems for?

Enlarged adenoids are mainly a childhood problem. Tonsil problems occur in both children and adults: in adults the main reasons for a visit are recurrent tonsillitis, an abscess around the tonsil, tonsil stones (tonsilloliths) that cause bad breath, and snoring. Different findings, such as a tonsil that is enlarged on one side only or growing quickly, are always assessed separately.

Symptoms

Symptoms depend on whether the tissue is repeatedly infected or enlarged enough to cause obstruction:

• Frequent sore throats and tonsillitis with fever
• Mouth breathing, sleeping with the mouth open and constant nasal blockage
• Snoring, pauses in breathing and restless sleep
• Nasal-sounding speech and a constantly runny nose
• Recurrent middle ear infections or reduced hearing due to fluid in the ear
• Difficulty swallowing, bad breath, white stones on the tonsils
• In children: attention problems during the day, poor appetite and slow growth

Examination and diagnosis

The examination looks at the size and surface of the tonsils and the surrounding tissue, and checks the lymph nodes in the neck. Because the adenoids cannot be seen through the mouth, a thin endoscope is passed through the nose to assess their size and how much they block the back of the nose. In some children a side X-ray of the neck may be used instead.

In children with ear complaints, the eardrum is examined and, if needed, tympanometry (which shows fluid in the middle ear) and a hearing test are performed. If breathing pauses during sleep are suspected, a detailed history is taken and a sleep study may be requested when appropriate. The number of infections, whether they came with fever and which antibiotics were used are important for the decision, so patients or parents may be asked to keep a record.

Treatment options

Not every enlargement or sore throat needs surgery. Viral throat infections settle on their own, while bacterial tonsillitis is treated with appropriate antibiotics. For nasal blockage due to enlarged adenoids, especially when there are signs of allergy, nasal sprays and saline rinses may be tried for a period. In children with mild symptoms, watchful waiting is often enough, as these tissues tend to shrink with age.

Surgery is considered when symptoms are frequent and affect quality of life, when there is a breathing problem during sleep, or when the ears or the development of the teeth and jaw are affected. The main reasons are:

• Frequent tonsillitis: commonly used guideline criteria are 7 or more documented episodes in one year, 5 or more per year for two years, or 3 or more per year for three years
• Snoring and sleep apnea due to large tonsils and/or adenoids
• Recurrent middle ear infections or persistent ear fluid together with enlarged adenoids
• An abscess around the tonsil (especially if it recurs)
• Problems related to constant mouth breathing
• Situations where another condition is suspected, such as one-sided enlargement

How is the operation done?

Tonsillectomy and adenoidectomy are performed under general anesthesia through the mouth; there is no external incision on the face or neck. When needed, both procedures are done in the same session, and in children with persistent ear fluid, ventilation tubes may be placed in the eardrums under the same anesthesia.

Adenoid surgery is usually short, and tonsillectomy is completed in under an hour in most patients. Many patients go home the same day or after one night of observation. For young children, patients with sleep apnea and those with other health conditions, an overnight stay may be preferred. The exact duration is determined at the examination.

Operations are performed at Medical Park Antalya Hospital. Blood tests and an anesthesia assessment are done beforehand; any family history of bleeding problems or use of blood thinners must be reported.

Recovery timeline

In children who have only their adenoids removed, recovery is usually complete within a few days. After tonsillectomy the process takes longer:

1. Day 1A sore throat and discomfort on swallowing are expected. Painkillers are taken regularly as advised by the doctor. Drinking plenty of fluids and starting with cool, soft foods are recommended.
2. First weekPain often increases between days 3 and 7 and may be felt in the ears; this is usually normal. A white-yellow coating forms where the tonsils were, which is part of healing. Lukewarm or cool soft foods (yogurt, puddings, purées) are preferred; hot, spicy, acidic and hard foods are avoided. Fluid intake must be kept up.
3. Week 2The risk of bleeding continues, especially between days 5 and 10. If blood comes from the mouth or nose, or there is spitting or vomiting of blood, contact the doctor or the nearest emergency department without delay. Children usually return to school and adults to work towards the end of this period.
4. 1 monthHealing in the throat is largely complete and a normal diet resumes. A follow-up visit checks healing; for those operated on because of ear fluid or sleep problems, the course of these symptoms is followed.

Risks and how they are reduced

The most important risk of tonsillectomy is bleeding after surgery; it mostly occurs in the first hours or between days 5 and 10, and may sometimes require another procedure. Other risks include pain, weakness from not drinking enough, temporary changes in taste, voice changes and anesthesia-related risks. After adenoidectomy, the tissue may regrow to some extent over time.

To reduce these risks, any history of bleeding is asked about and tests are done before surgery, and blood thinners and certain painkillers are adjusted according to medical advice. Eating, drinking and pain control after surgery are explained in detail, and families are told verbally and in writing when to seek emergency care.