Similar to lymph nodes, tonsils and adenoids are an important part of the immune system. While the tonsils are located in the throat at the back of the mouth, the adenoids rest higher up in the throat, at the back of the nose. When viruses and bacteria enter the body through the nose and mouth, the tonsils and adenoids are the firstline of defense. If they become enlarged or chronically infected, they can cause significant problems. In this situation, the swollen tonsils or adenoids can take up a large amount of the airway, causing difficulty with breathing, particularly during sleep. It can also result in swallowing difficulties for a small number of children. In the case of recurring infections where a child has been treated with multiple courses of antibiotics, removal is sometimes the best alternative.
Tonsils and adenoids are commonly removed if they cause sleep-related breathing difficulties or if they become recurrently infected. Not everyone will need to have to have them removed. Some people can go all of their lives without having any trouble with their tonsils and adenoids. Children who show signs of sleep disordered breathing such as snoring, restless sleep, choking/gasping or pauses in breathing during sleep, arching of the neck during sleep and fatigue and/or exhaustion during the day are often recommended for removal of the tonsils and adenoids to prevent long-term damage to the heart and improved cognitive function during the day. Difficulty with breathing during sleep can prevent a child from resting comfortably during the deeper stages of sleep, resulting in daytime behavioral problems, difficulty concentrating and exhaustion. If it is unclear as to whether or not a child has sleep apnea a sleep study, a special test designed to evaluate breathing during sleep, may be recommended. Tonsil removal is also commonly recommended in children with recurring strep throat and tonsillitis. Adenoid removal is often recommended for recurring sinus infections in younger children and those with chronic ear infections or fluid in the ears. In some children with poorly controlled asthma, removal of chronically inflamed or infected tonsils and adenoids can improve their airway symptoms and asthma control. Finally, those children with a condition known as PFAPA, which includes periodic fevers, cold sores, enlarged neck lymph nodes, and sore throat may also be recommended for tonsillectomy.
Surgery is not the only option when it comes to any of the conditions described above, including sleep apnea and chronic tonsillitis, but it may be the best option in some cases. For sleep apnea, a common alternative therapy is continuous positive airway pressure (CPAP). This involves having a child wear a breathing mask at night to prevent the tonsils and adenoids from obstructing the airway. This therapy, while highly effective, is difficult to tolerate for many adults, let alone children. For recurrent tonsillitis, antibiotics and supportive therapy including fluids can be effective. Over time, recurrent strep throat infections can decrease in frequency and tonsillectomy may not be required.
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