Categories: E. N. T - Paediatric

Tonsils in Children

Tonsils and Adenoids (Lymphoid tissue) (T&A) are immunity making watchdogs in the throat – they make immune cells and chemicals for the body and sample the air we breathe and the food we eat; unclean air or food gets trapped by the watchdogs and the T&A get inflamed with pain and fever warning the child and family that something’s amiss. Up to the age of 4 years, T&A accomplish the immune duty well – are usually quite large – and after that usually wilt away since other more powerful immunity organs take over.

  • Some T&A do not wilt away. In fact, they often flare up due to persistent infection from peers at school, in the park, or at daycare. Birthday parties are frequent culprits! The child gets repeated high fever, even up to 102F, throat pain, nose block. During the episodes, the child is ill and can’t eat. Often, there is a tummy upset and throwing up.
  • In some children, the T&A is just very large-humongous! The child has a ‘hot potato voice’ and is a fussy eater. Large adenoids cause nose block, runny nose, and snoring with drooling of saliva. The child tosses on the bed, sleeps poorly, and is irritable or dull during the day. Long term sleep disorders adversely tell on school performance. The child becomes a persistent mouth breather, looks pale and listless. In long-standing adenoid enlargement, cheeks are sallow and the front teeth protrude among other dental issues.
  • Food impaction in tonsils forming a ‘tonsil stone’, serious tonsil infections by rare bacteria or even tonsil abscesses cause severe throat pain, fever, and severe illness. Infrequently, the T&A is the seat of serious streptococcal infection which affects the heart or kidney.
  • Rarely T&A being part of the general immune system of the body get affected by serious cancers of the lymphoid and blood systems.

Fortunately, most children grow out of their T&A issues without much consequence. Some children are not lucky. They

  • ? get recurrent fever, throat pain and frequently miss school, sport and similar activity
  • ? suffer from constant cold, nose block and sniffles
  • ? are poor eaters and marginally stunted in growth
  • ? have sleep-disordered breathing with its consequences

Mild throat infections can be managed at home with home food, warm liquids, gargles, steam inhalations, etc. Moderate and severe cases call for antibiotics, pain killers, and fever-reducing meds; rarely need hospitalization for dehydration, fever, and toxaemia.

You may be suggested to see an ENT doctor, consider T&A surgery –

✅ frequent episodes of infection impair scholastics and regular activity

✅ very severe infections

✅ sleep issues

✅ fluid in the ear, bad breath, stone in tonsil, etc.

The ENT doctor will listen to you, examine the child, and sometimes prescribe tests to confirm the diagnosis. He may suggest ways and means of reducing the infection. Sometimes, he will suggest T&A surgery. Guidelines for surgery change often and you are encouraged to discuss the recommendation of surgery in your child’s case.

T&A surgery is the second most common operation done in the world (first is circumcision)! Good recovery and outcome is the rule and complications like bleeding are rare. The child may stay in the hospital for a night; return to normal diet and activity is within the week.

Surgery is under full general anaesthesia. Traditional surgery using instruments is the most popular and safe. At the SRCC Hospital, we suggest COBLATION SURGERY (high-frequency ultrasound plasma energy) for T&A:

✅ safe quick and bloodless

? post-operative pain is less and so is a quick return to normal diet and activity

? we perform ‘tonsillotomy’ – keep some tonsil tissue behind to continue the immune function – in selected cases

T&A issues in childhood are common. Home remedies and simple treatment with recovery is the rule. Surgery using any technique is safe. Consult your ENT doctor to help you make decisions.

ENT Department | NH SRCC Children’s Hospital, Mumbai

Narayana Health

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