HEALTHWATCH
Look into your throat
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When should one opt for surgery to remove tonsils and adenoids? Dr. RAVI RAMALINGAM and Dr. K. K. RAMALINGAM clarify.
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ALMOST 1200,000 tonsillectomies and/or adenoidectomies are performed each year in India. "T&A" (short for tonsillectomy and adenoidectomy) is the second most common operation performed for children, though it is not unusual for an adult to require a tonsillectomy. Although T&A is not recommended as often as before, it still improves the health of many children and adults.
Recent studies indicate that adenoidectomy may be beneficial treatment for some young children affected by chronic otitis media with effusion (fluid in the ears).
Tonsils and adenoids are composed of tissue similar to the lymph nodes or "glands" found in the neck, groin and other places in the body. They are part of a "ring" of glandular tissue encircling the back of the throat. The adenoids are located high in the throat behind the nose and soft palate (roof of the mouth) and are not visible through the mouth without special instruments. The tonsils are the two masses of tissue on either side of the back of the throat.
Tonsils and adenoids are located strategically near the entrance to the breathing passages where they can catch incoming infections. They "sample" bacteria and viruses and can become infected themselves. It is thought that they help form antibodies to those "germs" as part of the body's immune system to resist and fight future infections.
This is performed in the first few years of life, but it is less important as the child gets older. In fact, there is no evidence that tonsils or adenoids are important after the age of three. One recent study, showed that children, who have their tonsils and adenoids removed, suffer no loss in their future immunity to disease.
A popular myth is that tonsils and adenoids filter bacteria out of what we swallow and breathe like a kitchen strainer. This is untrue. Such a filter would not allow the passage of food particles and would make eating impossible.
How does the ENT surgeon check tonsils and adenoids?
The primary methods that are used to evaluate tonsils and adenoids include:
Medical history; physical examination; bacteriological cultures; X-rays; blood tests; possible additional studies.
The most common problems affecting the tonsils and adenoids in children are recurrent infections (causing sore throats) and significant enlargement (causing trouble with breathing and swallowing). Recurrent acute infections of the tonsils also occur in adults. So do abscesses around the tonsils, chronic tonsillitis, and infections of small pockets (crypts) within the tonsils that produce bad smelling, cheesy-like formations. Tumours can also grow in the tonsils, but are rare.
The common symptoms are recurrent sore throats, fever, chills, bad breath, nasal congestion or post-nasal drainage or obstruction, recurrent ear infections, mouth breathing, snoring, and sleep disturbances. See an ENT surgeon when you notice these problems.
Bacterial infections of the tonsils are initially treated with antibiotics. Surgery may be recommended for some. The two primary reasons are recurrent infection despite antibiotic therapy and difficulty breathing due to enlarged tonsils and/or adenoids. Obstruction to breathing causes snoring and disturbed sleep patterns. Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes malformations of the face and improper alignment of the teeth.
Chronic infection in the tonsils and adenoids can also affect nearby structures such as the Eustachian tube (the passage between the back of the nose and the inside of the ear). This can lead to frequent or chronic ear infections with earaches and hearing loss.
In adults, the possibility of cancer or a tumour may be another reason for removing the tonsils and adenoids.
If your surgeon has determined that a tonsillectomy and/or adenoidectomy are needed, prepare for the operation. Encourage the child to think of it as something to make him healthier. Children should be aware they will have a sore throat after surgery, but it will only last a few days. They should also be reassured that they will not look differently afterward.
For at least two weeks before surgery, avoid taking aspirin or other medications that contain aspirin. Advise the doctor of any other medications the patient is taking. Inform the surgeon of any problems the patient or his family may have had with anaesthesia; if the patient has sickle cell disease, bleeding disorders, is pregnant, has specific views on blood transfusion, or has been taking steroids in the past year, the surgeon.
The patient should not eat anything the day before surgery. This restriction also applies to chewing gum, mouthwashes, throat lozenges, toothpaste and water. Anything in the stomach may be vomited during anaesthesia, and this is dangerous.
A blood test and possibly a urine test are usually done before surgery. When the patient arrives, he/she will go either to the room or to a holding area while preparations are made for surgery. The anaesthesiologist or nursing staff may meet the patient and family to review the history. The patient will then be taken to the operating room and given an anaesthetic. Intravenous fluids are usually given during and after surgery. After the operation, the patient will enter the recovery unit. Observation should be continued until the patient is adequately recovered from surgery and safe to be discharged. Many patients are released after eight to 10 hours. Others are kept overnight. Intensive care may be needed for selected cases. No standard fixed period of observation is safe for all patients.
There are several post-operative symptoms that may arise. These include, but are not limited to, swallowing problems, vomiting, fever, throat pain, and ear pain. These are not uncommon, and they may all occur. Occasionally, bleeding may occur post-operatively. In this case, your surgeon should be notified immediately.
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