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Adenoids and Tonsils: Why do they enlarge and bother?

Fever, difficulty in swallowing, vomiting, ear pain and sometimes breathing problems; we all have a recollection of these symptoms from our childhood, and now as parents, we see our children suffer from the same . More often than not, they exist together, like a package deal, and like millions of other parents, we feel terrified when our children recurrently suffer from this dreaded combo of symptoms. Often caused by the inflammation of Adenoids and Tonsils, this is perhaps the most common childhood problem that bothers parents all around the world.  So what are these Adenoids and Tonsils? And why do they get infected so often?

What are Adenoids and Tonsils?

Just as we have nervous, circulatory and many other systems in our body, we also have what is called the lymphatic system that runs throughout the body, circulating a fluid called “lymph”. The lymphatic system essentially helps us fight infections and build immunity.  Adenoids and Tonsils are part of this lymphatic system. They act like filters to trap the bacteria and viruses that enter our body and circulate through blood and lymph. These lymph glands not only trap the germs, but also help us fight against them by producing antibodies.

While Tonsils are located on either side of the throat, Adenoids are located on either side of the Nasopharynx, which is actually the roof of the mouth, just behind the nasal cavity. Although you can view the Tonsils directly by looking into the Childs throat, it’s hard to see Adenoids as they are far behind, at the back of the nose. Doctors use a special mirror to have a look at them. Their location explains why they make our body’s first line of defense – to attack organisms that enter through the mouth and nose.

Why do Adenoids and Tonsils enlarge?

Whenever there is an infection in the upper respiratory tract, Adenoids and Tonsils try to filter the infective organisms and fight them off. In the process, they swell temporarily and get back to normal size after the infection subsides. This is very typical of an acute infection where children present with fever and mild discomfort in the throat.
When the infection is very severe or when it becomes chronic (long lasting), the Adenoids and Tonsils may not be able to sustain the fight and they themselves might get infected with the organisms, causing massive enlargement of the glands, sometimes with pus formation from superseding bacterial infection. The massive, chronically enlarged glands can affect the child’s normal functioning. Symptoms include

  • Sore throat.
  • Difficulty in breathing.
  • Breathing through the mouth.
  • Snoring and restlessness during sleep.
  • Enlarged neck glands.
  • Difficulty or pain during swallowing.
  • Ear pain or blocked ears.
  • Constant runny nose.
  • High fever with nausea or vomiting in cases with severe infection.

What is the treatment?

Usually swollen Adenoids and Tonsils recover on their own, especially in acute viral infections.  As the child grows and gains immunity, the frequency of such infections also comes down and the Adenoids usually shrink by late childhood.

Extremes of temperature, living in artificially maintained interior temperatures like air-conditioning, chilled drinks, sugary foods and drinks, foods with additives and artificial colors and unhealthy diets, could in some way or the other increase the Childs susceptibility to infections. Hence balanced diet, physical activity and natural living will improve the immunity and also help children recover from acute respiratory infections without aggressive treatment.  However, in chronic inflammations and in severe acute bacterial infections, antibiotics are often advised.

Is surgical removal of Adenoids and Tonsils necessary?

Surgical removal of Adenoids is called “Adenoidectomy” and that of Tonsils is called “Tonsillectomy”.  One or both the surgeries can be done at the same time. Several years ago, these surgeries were a common practice, but not anymore. Even though enlarged glands are found in almost all the children, majority of them do not require any surgical removal. In a vast majority of cases, doctors adopt the wait and watch method as Adenoids shrink on their own with age. Adenoids grow during the initial few years after birth, but they may to stop growing by 3-7 years and completely shrink by adulthood.

Surgery is advised only when all other lines of treatment have failed and child’s physical and mental growth is being considerably affected by the chronic infection
Surgery is recommended by experts when:

  • There is recurrent infection despite the antibiotics.
  • There is considerable difficulty in breathing.
  • When breathing stops for a few seconds while sleeping (Sleep Apnea). Special tests are suggested to check if your child is indeed suffering from sleep apnea. If the reports indicate a severe breathing problem, surgery is often recommended.

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