Adenoids and Tonsils

Adenoids and tonsils are fleshy tissue that sit at the back of the nose (adenoids) and throat (tonsils). They are a type of lymph tissue which trap and fight infections within the body. There are lots of this type of tissue within the body, including lymph nodes and lymph tissue which sits at the back of the tongue.

Enlarged adenoids

Adenoids typically start to enlarge in early childhood. If they enlarge to block the back of the nose, symptoms such as snoring, mouth breathing, excess nasal discharge and hyponasal speech (speaking like you have a constant cold). Often children grow out of these issues as they get older. Occasionally enlarged adenoids cause ongoing symptoms which require treatment. Enlarged adenoids may also cause sleep apnoea.

Treatment options include conservative management as often these symptoms will resolve with time. A trial of intranasal steroid may be appropriate after consultation and examination. Surgery to remove the adenoids is reserved for severe cases of obstruction or sleep apnoea. For details and complications of surgery see below.

Tonsils

Tonsils typically start to enlarge in early childhood, as the immune system becomes mature. Sometimes they enlarge to the point that they can cause symptoms such as snoring, choking and sleep apnoea. Tonsils can also become infected , causing tonsillitis, and occasional more serious infections in the throat.

Examination

Examination of the nose includes looking at the entrance to the nostrils with a small speculum and a light source. Getting the child to breathe through the nose onto a mirror is also helpful in identifying reduced airflow through the nasal cavities. Examining the adenoids can be a challenge, especially in younger children, as the adenoids sit right at the back of the nose, and thus a flexible telescope inserted through the nostril is the only way to get a good view of the adenoid tissue. Often this examination is not required as a good history will be enough .

Examination of the tonsils is through the oral cavity, often using a tongue depressor to aid the view.

Surgery

Depending on the reason for surgery, different methods of removing the tonsils and adenoids may be discussed. All surgeries are performed under general anaesthetic.

Most of these procedures are performed as day case surgeries, although this can depend on the severity of symptoms and the age of the child.

Adenoidectomy

Removal of the adenoids is generally performed via the mouth, using a gag to keep the mouth open and a small mirror to view the back of the nose. The adenoids are removed with a ‘heat wand’ which removes the adenoids down to the level of the underlying muscle. Given the nature of adenoid tissue, it is impossible to remove them entirely, however as this technique is performed under direct vision, the vast majority can be seen and removed.

Tonsillectomy and tonsillotomy

The indications for tonsillectomy in children include recurrent tonsillitis and OSA. In the case of OSA, an adenoidectomy may also be performed if the adenoids are enlarged. There are a number of different techniques that may be used to perform a tonsillectomy, including cold steel dissection, bipolar diathermy or coblation tonsillectomy.

Tonsillotomy (also known as subtotal or partial tonsillectomy) is a popular surgical alternative in children, particularly for treatment of obstructive sleep apnoea. This technique is performed with a coblator, which is a radiofrequency ablation device, which safely removes tonsil tissue, down to the tonsil capsule. There is a small risk of re-growth of the tonsil tissue, however this does not often cause a problem. This technique is preferred, particularly in younger children.

Common postoperative complications associated with tonsillectomy include pain and postoperative bleeding. With coblation tonsillotomy theses risks are significantly reduced. Children also bounce back to normal diet and activities quicker with coblation tonsillotomy.