Today, we made our umpteenth (by now i can surely refer to it as ‘monthly’?) trip to the emergency room with Kayla. Another case of ‘Pharyngitis with severe inflammation of the tonsils’. Basically, Miss Kayla has another case of Tonsillitis…
It started a couple of years back, when she was around 9 years old. The sore throat and fever was the first indication that something was wrong, but the swollen, misshapen tonsils were the real ‘give-away’… You see, when Kayla has a issue with her throat, her tonsils are the first ones to tell you. They swell up, and get covered with little red or white dots! She can’t eat, she hardly wants to drink, and, all in all, the poor child suffers through three or four days of razor-blade ‘throat torture’… By now, she’s actual begging to have her tonsils removed.
A tonsillectomy, the surgery to remove the tonsils, is a pretty serious operation, and not one that we would consider lightly. However, there are many children (and some adults) that have the surgery each year, for many different reasons. More than half a million of these surgeries are performed each year in the United States alone. The tonsils (those little bumps on both sides in the back of the throat) and adenoids (hidden up in the throat between the nose and mouth, where you can’t see them) are often removed together, because the two can affect each other, but that is something that the ear, nose and throat specialist would decide after a detailed consultation, but more on that later.
In the 1950’s and 60’s, many more tonsillectomies were carried out – in fact, if a child had more than a couple of issues with their tonsils, or even just frequent sore throats, many doctors were recommending tonsillectomies as the solution. Tonsils were seen as ‘extra appendages’ that didn’t have a specific purpose, and their removal was considered almost routine. Nowadays, we know that the tonsils and the adenoids do, in fact, have a very specific purpose to play.
Both the tonsils and the adenoids are little glands, and their job is to trap germs that enter our bodies through our mouths and our noses. When these little glands get overwhelmed by all the germs that they’ve caught – bam! Tonsil infection, or adenoid infection! While the glands are fighting the infection they swell up, which can be painful and make swallowing (or breathing) uncomfortable, especially for younger children, where the available space in their little throats will be even more limited. These are the symptoms of tonsil and adenoid infection…
Although tonsillectomies and/or the removal of the adenoids happens less frequently nowadays, here are a few of the reasons you may want to consider speaking to your paediatrician about your child’s personal situation…
1. Frequent sore throats – The Academy of Otolaryngology advise doctors to be cautious when recommending surgery as the solution to throat infections and pain in children with fewer than 5 or 6 throat infections over the course of a year, or less than 7 over the course of a couple of years. Tonsillitis is usually caused by a virus, but sometimes, the strep bacteria can cause tonsillitis too. If this is the case, you’ll probably see white dots on your child’s tonsils (like we’ve been seeing on Kayla’s). If this happens often enough, it is usually because the strep bacteria have become permanently colonized within the tonsils themselves. Every now and then, the bacteria gets a little ‘out of hand’, and causes another infection. It is important to remember that even if your child has their tonsils removed, they will still be susceptible to strep throat if they come into contact with other infected people. The major relief will be that the tonsils themselves will not be swollen or sore and your child won’t be experiencing the symptoms that are directly related to the tonsils anymore.
2. Recurring ear or sinus infections – Especially if your child is otherwise healthy, enlarged adenoids may be the culprit. A visit to the ear, nose and throat specialist (with a quick look down your child’s nose with a flexible fiber-optic scope) will tell the doctor if the adenoids are larger than normal and creating problems. If your child is having no other problem, the doctor may suggest doing only an adenoidectomy, instead of a tonsillectomy as well.
3. Breathing difficulties – A child with enlarged adenoids is going to have difficulty breathing through their nose. You’ll see, and hear, this throughout the day, but it will also ‘show itself’ in other ways. Breathing through your mouth exclusively or almost exclusively can cause dry, cracked lipped, bad breath and cavities. A child with enlarged adenoids or swollen tonsils is also not going to be able to breathe well while they sleep, and may suffer from sleep apnea. You may notice that your child that snores loudly, goes quiet for a while then gasps for breath. This is because the muscles around the tonsils and adenoids relaxing, and collapsing momentarily around the swollen tonsils. When the tonsils are enlarged, your child’s airways become blocked. If the tonsils, and adenoids if necessary, are removed, these breathing difficulties should improve immediately.
4. Snoring – Snoring is not just an ‘adult thing’… It’s due to that same action of those muscles in the throat. The amount of space for the airflow around those tonsils decreases, and the snoring starts up. A tonsillectomy may solve the problem, but would be a drastic step if this was the only reason. Good news is, tonsils and adenoids both tend to shrink as we get older (usually when a child hits their tween years) so, as your child get older, even if they haven’t had the surgery, snoring tends to decrease (at least a little 😉 ).
5. Speech troubles – Enlarged adenoids can also alter a child’s speech. This is because of of the limited air flow through the nasal passages. Also, speaking with a sore throat can make your voice sound hoarse or muffled. An adenoidectomy, or a tonsillectomy and adenoidectomy combination surgery (T & A surgery) can help with both the nasal issues, and the pain that causes the hoarseness.
6. Swollen lymph nodes – If the lymph nodes below your child lower jaw remain swollen for more than six month, even though they have taken antibiotics, you may need to consider surgery. This is not very common, and can be a sign of other issues, so should be carefully discussed with your doctor.
If you and your doctor decide that surgery is the right thing for your child’s situation, here’s what you need to know about the surgery.
If your child’s tonsils are going to be removed, chances are, the doctor might want to remove the adenoids too. Generally, if the tonsils are causing a problem, the adenoids are too. If you’ve been speaking to your doctor about the frequency of your child’s ear infections, and he finds it to be due to enlarged adenoids, with no other related tonsil issues, the doctor is probably going to perform only an adenoidectomy, and leave the tonsils alone. This is because the adenoidectomy is not as invasive, and does not carry as long a recovery time as the tonsillectomy.
Nowadays, most T & A surgeries or tonsillectomies or adenoidectomies are performed as outpatient surgeries, and last less than an hour. If your child has a tonsillectomy, expect some scabbing to occur over the area where the tonsils were removed. Your child is likely to be in pain for up to two weeks, and should take any medication that the doctor prescribes. In the past, some people thought that scratchy foods, like toast, were a good idea, but doctors warn against this, because it can cause renewed bleeding and prevent the wound from healing properly. Instead, your child should stick to soft, cool foods, such as yogurts or jellies – and drink plenty of liquids to stay well hydrated!
Has your child had their tonsils or adenoids removed? Do you have any first-hand advice for me as a ‘mom of a potential patient’?
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