Tonsils & Adenoids

The tonsils are 2 structures that sit at the back of the throat either side of the soft palate (see diagram). They are part of the bodies immune system and are important in the first few years of life in sampling the environment around you. It is thought they catch incoming bacteria and viruses as they enter the mouth giving the body a chance to develop immunity to these organisms. The vast majority of the bodies exposure to new microbes occurs in the first 3 - 4 years of life and this when the tonsils are most important and therefore at their largest. Over time the tonsils usually shrink in size as they have served their purpose. We have no evidence that removing the tonsils has any long term detriment to the development of the bodies immunity

Tonsillectomy

Removal of the tonsils (tonsillectomy) is one of the commonest ENT operations performed. There are a number of reasons why we remove tonsils:

Recurrent Tonsillitis

Tonsillitis is extremely common and the majority of children grow out of it by the age of 6 or 7. Unfortunately for some people this is not the case and they continue to have significant problems with their tonsils. ENT surgeons have fairly strict criteria for taking tonsils out because of recurrent tonsillitis. A good overview can be found at the SIGN website

http://www.sign.ac.uk/guidelines/fulltext/34/index.html

Generally, a person needs to have suffered 5 or 6 significant attacks of tonsillitis over at least a 2 year period. If the symptoms have gone on longer or the patient has suffered episodes of quinsy (tonsil abscess) then they may still be elligible. A significant attack of tonsillitis would be:

Sore throat

Difficulty and pain on swallowing require strong painkillers

High temperature

Glands in neck

Needing antibiotics

Time (usually at least a week) off school or work

The reason we are much more careful about removing tonsils is because of the potential complications of the operation (see below).

Sleep Apnoea Snoring

In some children the tonsils and adenoids are so large that they cause snoring which in itself is not a problem. However, in some children that snore, the child has difficulty breathing such that they snort and grunt after holding their breath while asleep (sleep apnoea). This is very worrying for the parent who witnesses it and can have consequences on the childs health if not assessed and addressed. However, the majority of snoring children have no consequences because of simple snoring and require no treatment.

Children with sleep apnoea usually require assessment in hospital where their oxygen level is measured by a simple device that is stuck onto their skin and assesses how much oxygen is in the blood. It is totally painless and gives important information to the doctor. If the oxygen level doesn't drop during the assessment then surgery is usually unnecessary. If the oxygen levels do drop then the doctor may recommend surgery to remove the tonsils and, or adenoids. In children this usually cures the problem.

Adults with sleep apnoea also require sleep investigations, however, the role of simple tonsillectomy in adults is more controversial. (see page on snoring and sleep apnoea)Snoring and Sleep Apnoea

Tonsillolith (Tonsil Stones)

Tonsilloliths are small whiteor cream coloured pieces of tissue or debris that accumulate in the crypts of the tonsil. All tonsil by their nature have a very convoluted surface which allows the build up of debris.

It is thought that tonsilloliths are a build up of the lining of the tonsil (mucosa) that has been shed like the external skin is shed.

In addition to this large colonies of bacteria form which often make the tonsilloliths smell unpleasant such that they can cause bad breath.

Typically people producing tonsilloliths give a history of regularly coughing up these small smelly white fragments from their throat.

Tonsilloliths are completely benign and often require no treatment.

In recurrent cases, or in people who cannot tolerate the symptoms, tonsillectomy is the only surgical cure.