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Runny nose

Dr Kevin Soh discusses how adenoid hypertrophy and adenoiditis can cause block nose, hearing loss, snoring, sleep apnea, academic underperformance, and growth retardation in children

FAQ on Tonsils/ Adenoids

What are Tonsils?

Tonsils and adenoidS are part of a “ring “of the glandular/lymphoid tissue encircling the back of the
throat. Tonsils are visible at the back of the mouth, on each side.

What are Adenoids?

The adenoid is found high in the throat, right behind the nose and needs special instruments in order to see it.

What role do they play in our body system?

They act as “policeman” and help to form antibodies to “germs” that invade the nose, mouth and
throat. This function maybe important in young children up to 3 years of age but there is no evidence
that it will be important thereafter.

Will my child suffer a loss of immunity after the removal of my tonsils/ adenoids?

The tonsils are only a very small part of our immune system. There are other lymph nodes in the body
that would act as defense mechanism. Many studies have shown that children that have their
tonsils/adenoids removed suffer no loss in their immunity to diseases.

Children who have their tonsils removed do not, on average, have any more illnesses than children who “keep” their tonsils. In fact, some children will get fewer illness like strep throat, after their tonsils are taken out.

The Examination

The primary methods used to examine tonsils and adenoids are:

• Medical history
• Physical examination
• X-rays/Endoscopy

What should I expect at the Examination?

The doctor will ask about your problems of the ear, nose, and throat and examine the head and neck. He will use a small lighted instrument to look into these areas.

Adenoids are checked via nasal optic examination using a flexible endoscope to evaluate the upper airway condition of children who are cooperative. A topical anesthetic is applied to the nasal cavity. This procedure is done in the clinic. The examination begins with an assessment of the nasal cavity and its structures up to the nasopharynx with a good view of the auditory tube. Generally the nasal optic examination is painless and well tolerated by children. Recording is usually done so that it is possible to review the images.

X-ray would be used if the child is uncooperative with the nasal optic examination. This is helpful in determining the size and shape of the adenoids.

3 Common Causes of Tonsillitis:

Group A streptococcus – common bacteria that cause throat infections in 1 in 5 patients including adults. Some patients may not have any symptoms but they are still capable of transmitting the bacteria. Group A streptoccus may also cause strep throat.

Infectious mononucleosis – caused by the Epstein Barr virus, can also produce symptoms of tonsillitis, especially in young children

Respiratory viruses – especially cold and flu viruses, could results in tonsillitis. These are not as severe as bacterial infections but sometimes may be difficult to differentiate between a viral and a bacterial infection.
A possible complication from bacterial tonsillitis is peritonsillar abscesses (quinsy). These occur when a clump of bacteria are “walled off” by new tissue growth. The abscess is not in the tonsil itself but on one side of it. Unlike simple tonsillitis, quinsy tends to be felt on only one side of the throat, and people with this condition can often be seen tilting their head to one side to reduce pain. Quinsy occurs in about 1 in 3,000 people per year and is more common in young adults with tonsillitis.
Symptoms and Complications of Tonsillitis
Usually pain/sore in the throat, but since the throat and ears share the same nerves, the pain may sometimes be felt in the ears. The pain is usually worse when swallowing. Very young children may not complain of a sore throat but may simply refuse to eat.
Other symptoms can include:
• Fever
• Bad Breath
• General feeling of unwell
• Headaches

What complications/risks will I have if my child doesn’t go for the surgery?

Enlarged adenoids can cause snoring, obstructive sleep apnea, running nose and in some instances
hearing problem thus causing nose and throat obstruction to breathing while you are sleeping. For a
better understanding on the implications of enlarged adenoids, please watch my video featured here.
I have explained in detail the problem enlarged adenoids could have on the child and the risks of not
treating this problem.

Outgrowing Your Tonsils

Some of you may be asking, if the tonsils are an important part of the immune system, why take them out? Most of the early education of your immune system occurs before age 6. Either during this time, or even long afterwards, if your tonsils are so large that they literally obstruct your breathing at night, then wouldn’t you think that this is a more important issue that needs to be dealt with? Doctors will also say that children will “grow out of it.” Yes, in most cases, they will, but based on all the recent studies, there’s plenty of evidence that before they “grow out of it,” there can be potential long-term consequences, including your risk for developing obstructive sleep apnea, heart disease, heart attack and stroke later in life.
In What Cases are Tonsils Surgery (Tonsillectomy) Needed?
For anyone who get tonsillitis often (more than 5 to 7 times during a 12-month period) or 3 episodes per year for 2 years in a row or tonsillitis does not respond to antibiotic therapy, your doctor might recommend a tonsillectomy to remove the tonsils. This is one of the common childhood surgery.
Although this surgery is common in childhood, it is not exclusively a childhood operation; adults can also have their tonsils or adenoids removed if neckessary. The tonsils can be removed without the adenoids and vice versa.

How is the surgery done?

The surgery is done under general anesthesia and this procedure is usually done as a day procedure.
This surgery usually takes between 45 minutes. The child needs to fast 4 hours prior to the surgery.
No food/drinks/water is allowed. For a younger child, there will be a shorter fasting period. The
operation is done via the oral cavity therefore no incision will be made on the nose or face.

What are the latest techniques for removing the tonsils or adenoids?
Specialised instruments such as coblation, radiofrequency and microdebrider are used to improve healing and reduce the side effect of pain after surgery.

What should my child take note prior to my surgery?

If the child has fever on the day prior to the surgery date, the doctor should be informed as the
surgery might be postponed if the child is found unfit for surgery. It should also be brought to the
doctor’s attention if the child has any history or family history of bleeding disorder or has any problem
with previous anesthetic event.

What to expect right after the surgery?

After the surgery, the child might be still sleepy as he/she is still recovering from the general
anesthesia but this effect will wear off after sometime. After which, he will be allowed to drink and eat.
Should there might a slight presence of blood in the child’s sputum but this is normal.

What are the things to take note after the surgery?

Few days after the surgery, the child may experience sore throat and dryness of the mouth but it will
slowly improve after sometime when the throat muscles are back to normal. Normal eating habits
should be resumed and this is greatly encouraged to prevent debris from accumulating and will also
aids in the recovery process. Pain killer that has been prescribed to the child must be taken to
minimize any throat discomfort and the entire course of antibiotics should be completed. There may
be a whitish coating at the back of the throat at the tonsillar beds during the first few days of recovery,
this is a normal phenomenon of a healing wound in throat.

Is there any diet restrictions post surgery?

No, there is no diet restriction post surgery and normal diet is greatly encouraged. After
tonsillectomy, the child is usually put on soft diet for a day or two.

Is there anything I should avoid post surgery?

During the first week post surgery, it is encouraged that the child should avoid contact with people
suffering from coughs, colds or other infections. Contact with smoking individuals and crowded places
should also not be encouraged.

Is there any follow up with the doctor post surgery?

Post surgery follow-up date will be given upon discharge from the hospital. Please do come for the appointment as the post surgery follow-up care is important in preventing possible complications.

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