Structure of the tonsils
The tonsils are clusters of tissue, lymphatic otherwise lymphatic, located in the throat. They are part of the immune barrier, making them an important part of the body’s immune system.
We distinguish:
- The palatine tonsils, also called lateral tonsils – the largest, are located on the lateral walls of the throat, behind the tongue. They have a characteristic undulating surface, somewhat resembling a walnut. The depressions in the tonsils are called crypts.
- The pharyngeal tonsil-also known as the third tonsil-is located at the top of the throat just behind the nasal cavity. It is not visible when looking into the mouth, as it is located behind/above the palate. The easiest way to assess the size of the third tonsil is to examine it with an endoscope through the mouth.
- Trumpet tonsils – are the lateral parts of the third tonsil located around the orifices of the Eustachian tubes, that is, at the junction of the throat and ear. The back of the tongue and the entire pharyngeal mucosa are also dotted with numerous lymphoid papules, which also serve the body’s defense functions.
Function of the tonsils
The tonsils play the most significant role in childhood, when the number of new immune stimuli for the body is greatest – the greatest stimulation of the immune system occurs. As the general immunity matures and strengthens, the size of the tonsils decreases. Still, their defensive role for the body is important. In adulthood, the pharyngeal tonsil usually disappears, and the lateral tonsils shrink considerably and can be completely invisible when located deep in their niches. Tissue of the tonsils is specialized to recognize and fight microbes entering through the mouth and nose. It fights the microorganisms it encounters and informs the body of their appearance. The immune memory thus generated allows the body to fight off further infections more easily and quickly. Naturally, microorganisms entering the body settle on the tonsils, which inform the immune system of the presence of an “intruder”. The body sends leukocytes there, which effectively fight the microorganisms. This is how the tonsils function properly. If the tonsil tissue is diseased, the immune barrier does not work properly and does not manage to get rid of potogens. As more and more leukocytes appear trying to fight the pathogen, the lymphoid tissue of the tonsils overgrows and instead of protecting the body, it becomes a source of chronic infections.
Looking at a cross-section of the tonsil, pathogenic processes begin in the outer part, while the inner, more circulated part generally remains healthy. Therefore, the goal of our surgeries performed at Krajmed is to shrink the tonsils, i.e. to remove only the diseased, outer part of the tonsil and leave the deeper, healthy tissue to continue performing its defensive functions.
Evaluation of the tonsils
The third tonsil is difficult to evaluate because it is hidden behind the palate. A nasopharyngeal X-ray or cephalometry shows the size of the third tonsil well, but does not inform about its structure. The modern and best method for evaluating the third tonsil is endoscopic examination. An endoscope is an optical device that brings in light and makes the examined area visible. An endoscope with so-called side optics inserted through the mouth into the throat, makes the entire nasopharynx visible and allows to evaluate not only the size of the tonsil, but also the presence of an inflammatory process or excessive secretion, and allows to evaluate the orifices of the Eustachian tubes and the posterior part of the nasal cavity. This method is quick, convenient, painless and provides a lot of relevant information. The palatine tonsils should not occupy more than 1/3 of the distance between the lateral pharyngeal wall and the midline. Their structure is important – they can be smooth or irregular, with lingering secretions (so-called stagnant suppositories) or with deposits (stones). The pivots are a characteristic symptom of the inflammatory process taking place in the tonsils, while unpleasant mouth odor is the result of epithelial cells and bacteria lodging inside the tonsil tissue. Under normal conditions, the crypts are wide open to the lumen of the throat and spontaneously clear themselves.
Symptoms of hypertrophy of the third tonsil
- Nasal blockage – the only proper breathing is through the nose, which is a natural filter and air conditioner – it cleans, warms and humidifies the inhaled air. Inhalation made through the nose increases the tension in the lung tissue and the right amount of air reaches the alveoli.
- Snoring and apnea during sleep– snoring is usually accompanied by restless, shallow sleep and frequent waking during the night. In addition, there is excessive sweating and lack of rest despite long sleep. The consequence is chronic fatigue, and in the case of long-lasting symptoms there are general disorders, for example: delayed physical or intellectual development. Of great concern are apneas during sleep (a pause in breathing usually accompanied by snoring), which cause significant hypoxia in the developing body.
- Recurrent otitis media, fluid in the ears – these problems are caused by blockage of the outlets of the ear trumpets through hypertrophied lateral parts of the third tonsil (trumpet tonsils). The primary symptom that draws attention is hearing loss. The child does not respond to the words of caregivers, sets the TV louder or approaches the TV while watching cartoons, and begins to learn poorly. Repeated otitis media causes severe earaches. During an ear examination, the presence of fluid in the eardrum cavities or retraction of the eardrums is observed. The proper procedure is to unblock the ear trumpets and insert ventilation drains into the eardrum cavities.
- Speech disorders – some sounds, for example: m, n, ą, ę are pronounced when air flows through the nose. Nasal blockage does not allow proper pronunciation and causes what is known as closed nasalization.
- Bite disorders – breathing through the mouth leads to jaw drooping and receding. When the third tonsil is hypertrophied, attempts to wear braces fail, precisely because of obstructed breathing through the nose. When this goes on for a long time, facial development can be disrupted with unfavorable changes in facial features.
- Other symptoms of tonsil disease include watery eyes, pallor, restless sleep, sweating during sleep, bedwetting.
Pharmacological treatment
Drug treatment and hypertrophied tonsils in children
Pharmacological treatment is the treatment of choice for acute conditions that cause hypertrophied tonsils in children. In particular, streptococcal infections should be treated with an antibiotic. Recurrent and persistent tonsil infections require surgical treatment.
Operative treatment
The palatine tonsils can be removed partially or completely. In children, we almost always use the method of partial removal, commonly called tosilotomy (t-to), or tonsil reduction. The inflammatory processes of the tonsils are more severe on their surface, while their deeper part is generally healthy. Thus, the healthy, inner, functioning part of the tonsil is left and the diseased, outer part, which harbors bacteria and is a source of infection, is removed. This preserves the defense barrier necessary for health. The surgical technique using a special probe that, while cutting out the diseased tissue, inhibits bleeding in the healthy part of the tonsil at the same time, keeps the patient safe during the operation and facilitates healing in the postoperative period. The only correct method when performing tonsil surgery is to use general anesthesia (anesthesia). This ensures patient comfort and proper performance of the operation. Parents accompany the child before and after the surgery, as this increases the child’s sense of security. A mother or father goes to the operating room with the child and accompanies him until he falls asleep. The operation takes 30-60 minutes. In children, tonsil surgery is often combined with the insertion of ear drains. The combination of precise surgical techniques and the use of new generation anesthetic drugs minimizes the risk of complications. In the first hours after surgery, children’s reactions can vary. Most sleep for 30 minutes to 2 hours, but some wake up earlier and may be crying and restless. Thanks to our techniques, vomiting in the postoperative period is rare. The child is discharged home 3 to 4 hours after leaving the operating theater.
Management after tonsil surgery
The recovery period lasts 7-14 days.
Physical activity
- 4-6 hours after surgery you can go home
- on the day of surgery, avoid increased physical exertion and activities that require balancing type: bicycle, rollerblades
- Going outdoors from the day after the operation
- we recommend not sending the child to kindergarten / nursery for a period of 2 weeks, school for a period of 7 days
- cease participation in physical education classes for 2 weeks and pool for 4 weeks.
Diet after tonsillectomy/reduction surgery
Excision of tonsils in children is a specific procedure, and here the diet after the procedure should be according to the preferences of the patient. Drink plenty of fluids (at least 30 ml/kg/day). Drinks can be cool, warm but not hot. On the day of surgery, it is recommended to take semi-liquid / soft foods, e.g.: yogurts, jellies, ice cream, soups, cheese, cold cuts, bread without crusts. By lowering the temperature of the throat, ice cream significantly reduces swelling and reduces pain. Consuming them is therefore advisable and recommended.
To reduce the pain of swallowing, painkillers can be used – 30 minutes before eating.
After surgery on the third tonsil, there are no restrictions on the type of food consumed, as it does not reach the nasopharynx. Foods only must not be hot.
Drugs
Painkillers are usually recommended, e.g.: paracetamol, lozenges, sometimes an antibiotic. Do not use drugs containing acetylsalicylic acid for 14 days, e.g.:Acard, Acesan, Alka-prim, Alka-Seltzer, Ascalcin, Askodan, Aspirin, Asprocol, Calcipirin, Coffepiryne, Etopyrin, Excedrin, Copyrin, Plocard, Polopyrin, Pyramidon, Scorbolamid, Upsarin, etc. These drugs reduce clotting and can cause dangerous bleeding.
Possible symptoms after surgery
- Subfebrile condition – up to 38’C for several days
- Sore throat that persists for 7 – 10 days. It is especially aggravated in the morning and while eating
- Yellow plaques on the tonsils – are the equivalent of a scab on the skin after a cut. They cause an unpleasant odor from the mouth, but they are not a symptom of the purulent process / decay / necrosis, but the natural healing process of mucous membranes and disappear after 7 – 14 days
- Ear pain – this is known as granted pain and if the ear is not blocked (normal hearing), the only treatment is the use of painkillers. This pain subsides after the throat heals
- altered speech – is caused by increased tension in the throat muscles and can last up to several months
- Rhinitis – especially severe in children, is due to the fact that proper breathing through the nose was impaired before the operation. After removal of the tonsils, the nose becomes unobstructed, the child begins to breathe properly, but the nasal mucosa is not adequately resistant and prepared for the inhaled air, so it reacts with excessive mucus secretion (runny nose, nasal blockage). This symptom usually does not require treatment and resolves spontaneously. You can use cleansing measures – saline preparations. Prolonged rhinitis for more than 6 months may suggest concurrent sinus disease
- pain / tension in the neck and occipital area, pain when moving the head – are the consequence of the wound in the throat
If you suspect your child has a problem with diseased tonsils come to our Center. We invite you for consultation, diagnosis and treatment. You can make an appointment by phone at 22 458 69 69 or online through the Patient Portal on our website.
