In this video, Dr Kevin Soh discusses how adenoid hypertrophy and adenoiditis can cause a blocked nose, hearing loss, snoring, sleep apnea, academic underperformance and growth retardation in children.

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 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 role do they play in our body system?

They act as “policemen” and help to form antibodies to “germs” that invade the nose, mouth and throat. This function may be 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 defence mechanisms. Many studies have shown that children who have their tonsils/adenoids removed suffer no loss in 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 less 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.

Diagram of an adenoids examination

Adenoids are checked via nasal optic examination using a flexible endoscope (no pain) to evaluate the upper airway condition of children who are cooperative. A topical anaesthetic 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. The recording is usually done so that it is possible to review the images.

An 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.

Common causes of tonsillitis

1. 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 streptococcus may also cause strep throat.

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

3. Respiratory viruses – especially cold and flu viruses, could result in tonsillitis. These are not as severe as bacterial infections but sometimes may be difficult to differentiate between a viral and bacterial infection.

Symptoms and complications of tonsillitis

Symptoms of tonsillitis usually include pain/soreness in the throat. 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 being unwell
• Headaches

Is the adenoids a liability?

They become a liability when they become infected (adenoiditis) or when they grow too large in size (adenoid hypertrophy).

What problem do enlarged adenoids cause?

Enlarged adenoids can cause snoring, obstructive sleep apnea, running nose and in some instances hearing problems thus causing nose and throat obstruction to breathing while they are sleeping. Obstructive sleep apnea is when a child briefly stops breathing while sleeping. It often occurs because of a blockage in the airway.

For a better understanding of the implications of enlarged adenoids, you may watch this video where Dr Kevin Soh explains in detail the implications enlarged adenoids (adenoid hypertrophy) could have on the child and the risks of not treating this problem.

At what age would your adenoids disappear?

Graph showing the size of adenoids relative to age

Adenoids begin to shrink around age 5 to 7 in children, and in most children, they would be almost completely gone by the teenage years.

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 their risk for developing obstructive sleep apnea, heart disease, heart attack and stroke later in life.

In what cases are tonsils surgery (tonsillectomy) needed?

Your doctor might recommend a tonsillectomy to remove the tonsils for those 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
  • Have tonsillitis that does not respond to antibiotic therapy

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 necessary. The tonsils can be removed without the adenoids and vice versa.

How is the surgery done?

The surgery is done under general anaesthesia 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 of prior to my surgery?

If the child has a 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 a bleeding disorder or has any problem with previous anaesthetic events.

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 anaesthesia but this effect will wear off after some time. After which, he will be allowed to drink and eat. 

Should there be a slight presence of blood in the child’s sputum, this is normal.

What are the things to take note of after the surgery?

A few days after the surgery, the child may experience a sore throat and dryness of the mouth but it will slowly improve after some time 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 aid in the recovery process.

Painkillers that have been prescribed to the child must be taken to minimise 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 the throat.

Is there any diet restrictions post-surgery?

No, there is no diet restriction post-surgery and a normal diet is greatly encouraged. After
tonsillectomy, the child is usually put on a 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?

A post-surgery follow-up date will be given upon discharge from the hospital.

Please do come for the appointment as post-surgery follow-up care is important in preventing possible complications.