Tonsils and Adenoids

Your tonsils and adenoids are parts of your immune system. Normally, they help protect your body from disease. If you get an infection, your tonsils and adenoids step up and help fight infections.  However, they can sometimes become the problem themselves, by becoming chronically or repeatedly infected, or by becoming so large they block breathing, sinus drainage, and ear drainage.

Your tonsils include the following parts: 

  • Two palatine tonsils 
  • The adenoids 
  • One lingual tonsil 

The two palatine tonsils are the two round lumps in the back of your throat (pharynx).

The adenoids are located high in the throat behind the nose and the roof of the mouth (referred to as your soft palate). You can’t see the adenoids without using special instruments like a scope or with an x-ray.

The lingual tonsil is far back at the base of the tongue, on its rear surface. 

All of your tonsils create a ring around where your nasal cavity and mouth meet the throat. They are called the tonsillar ring due to this positioning. This ring allows your tonsils to effectively trap bacteria and viruses that enter the body through your nose or mouth.

What are the causes of tonsil and adenoid problems?

The most common cause of problems with tonsils and adenoids is infections. Infections can cause your tonsils to swell. Tonsil and adenoid infections and enlargement can contribute to other health issues, such as: 

  • Issues with breathing
  • Nasal obstruction
  • Swallowing difficulties
  • Sleeping problems

What are the most common tonsil conditions?

Several conditions can impact your tonsils. Here are the six most common tonsil conditions:

1. Acute or Chronic Tonsillitis. Tonsillitis is an inflammation of the tonsils caused by a viral or bacterial infection. The infection causes swelling and a sore throat, and the tonsils may develop a gray or white coating. Chronic tonsillitis usually results from repeated episodes of acute tonsillitis or persistent tonsils infection. It occurs most commonly in school-aged children but can affect people of all ages. 
2. Peritonsillar abscess. This is a complication of tonsillitis and is caused by a specific type of bacteria, group A beta-hemolytic streptococcus. A pocket of pus is created next to the tonsil, pushing on the tonsil. Your physician must drain the abscess immediately. By treating tonsillitis, you can avoid peritonsillar abscess.
3. Acute mononucleosis. More commonly known as mono, or the kissing disease, it is a contagious infection caused by the Epstein-Barr virus. It causes severe swelling in the tonsils, fever, sore throat, rash, and fatigue. Mono can leave you feeling sick for about a month.
4. Strep throat. Strep throat is caused by Streptococcus, a bacterium that infects the tonsils and throat, causing fever, neck pain, and sore throat.

5. Enlarged (hypertrophic) tonsils. When your tonsils become enlarged, this can lead to infection and inflammation in your body. Enlarged tonsils can lead to other health issues if left untreated, such as recurring ear infections, chronic sinus infections, and obstructive sleep apnea.

6. Tonsilloliths (tonsil stones). Tonsil stones develop when food particles, bacteria, and mucus get trapped in small pockets in your tonsils. The trapped material hardens and calcifies, causing swelling and soreness.

What are the symptoms of tonsil and adenoid problems?

Tonsillitis is an infection of the tonsils. Most common tonsil conditions, as listed above, cause similar symptoms. Symptoms of tonsil and adenoid problems may include:

  • Bad breath
  • Swelling of the tonsils
  • Difficulty or painful feeling when swallowing
  • A slight change in the voice due to the swelling
  • Tonsils that are darker and redder than normal
  • White or yellow coating on the tonsils
  • Sore throat along with ear pain
  • Swollen lymph nodes in the back of your neck
  • Fever
  • Stomachache
  • Stiff neck
  • A scratchy or muffled voice 

Enlarged tonsils or adenoids can make it difficult for you or your child to breathe through the nose, which can also cause difficulty sleeping. Additional signs of adenoid and/or tonsil enlargement include:

  • Breathing through the mouth instead of the nose most of the time
  • The nose sounds “blocked” when the person speaks, making their voice sound funny
  • A chronic runny nose
  • Noisy breathing during the day, when engaging in non-physical activities
  • Recurrent ear infections
  • Snoring at night
  • Restlessness during sleep or pauses in breathing for a few seconds at night (this may indicate sleep apnea or other sleeping disorder)

How are tonsil and adenoid problems diagnosed?

To diagnose problems of the ear, nose, and throat, your physician will start by examining your head and neck. In addition to looking at and touching your nose, ear, and throat, your physician will use a small flexible mirror and a lighted instrument to examine your ear, nose, and throat. 

In addition to a physical examination with basic instruments, there are other tests and techniques your physician may use to check your tonsils and adenoids, including: 

  • Throat culture - to identify what type of infection you have in your throat
  • Strep test - if your physician suspects you have strep throat
  • Blood test - to diagnose infections such as mononucleosis
  • Sleep study or polysomnogram - to diagnose sleep apnea caused by enlarged tonsils and adenoids
  • Small flexible scope - to visually see the size of the adenoids

How do you treat tonsil and adenoid problems?

How your tonsil and adenoid problem is treated depends upon its cause. 

Antibiotics are commonly used when you have a bacterial infection of the tonsils. Antibiotics are the first line of defense, especially with Streptococcus. 

Tonsillectomy or adenoidectomy is when your tonsils or adenoids are removed. This procedure is performed when infections keep returning even after using antibiotics. It is also an option if enlarged tonsils or adenoids are causing difficulty breathing. 

Frequently infected adenoids can lead to fluid collection in the middle ear, causing temporary hearing loss. It can also lead to frequent ear infections. Removing the adenoids (adenoidectomy) is used to help children with chronic earaches accompanied by fluid in the middle ear, referred to as otitis media with effusion. 

Another reason to remove the tonsils and adenoids is a tumor or cancer in adults.

Steroids can be useful for patients with infectious mononucleosis, where severe enlargement may obstruct the airways. In such cases, treatment with steroids (e.g., prednisone) can be helpful.

What are the complications of untreated chronic tonsillitis?

Tonsillitis can lead to serious complications if it is left untreated. This can include: 

  • Airway obstructions: Chronically enlarged tonsils can result in airway obstructions, which can lead to sleep apnea. 
  • Sleep apnea: Sleep apnea occurs when proper breathing is not possible while sleeping, disrupting one’s sleep. In children, the effects of sleep apnea may sometimes be misdiagnosed as attention deficit disorder (ADD)
  • Oral and dental issues: Tooth decay and halitosis (or bad breath) can arise. 
  • Chronic sore throat
  • Difficulty swallowing

Contact Us

If you or your child experience the common symptoms of infected or enlarged tonsils or adenoids, please contact North Dallas ENT at (214) 382-5100 to schedule a consultation for evaluation and treatment.

FAQs for Tonsillectomy

When Is a tonsillectomy medically indicated?

Tonsillitis is an infection that causes the tonsils to become swollen and painful. If antibiotics don’t clear the infection, the tonsils may need to be removed. 

A tonsillectomy is a process where the tonsils are removed. It is performed to treat recurring and severe tonsil infections. A tonsillectomy can also treat other issues caused by enlarged tonsils, such as sleep apnea.

Is a tonsillectomy an outpatient procedure?

A tonsillectomy is an outpatient procedure in most cases. Most patients can go home on the same day of the surgery. In some rare cases, patients may be kept overnight for observation.

Will adenoids be removed as well during a tonsillectomy?

Sometimes, your doctor may recommend removing obstructive adenoid tissues as well as your tonsils. Current research backs removing adenoid tissue during a tonsillectomy to reduce the risk of recurring infections and the need for additional surgery in the future.

Are there any postoperative symptoms?

Tonsillectomy surgery is safe. However, some postoperative symptoms can occur:

  • Swallowing problems
  • Vomiting
  • Fever
  • Throat pain
  • Ear pain

If bleeding from the nose or mouth occurs after surgery, you must contact your surgeon immediately. 

Are there any side effects of a tonsillectomy procedure?

There is a range of common side effects that may last 8-10 days, including: 

  • Bad breath
  • Fever
  • Ear pain
  • Sore throat
  • Change in voice
  • Swollen tongue or palate
  • Yellow, green, or gray patches in the throat are scabs that heal and disappear in time

Rarely will children have bleeding after surgery. Consistent fluid intake and minimal activity can significantly reduce the chance of this happening.

Can you drink or eat anything after surgery?

After surgery, it is essential to stay well-hydrated to help with the pain and recovery process. 

Limit your diet to softer foods, like ice cream, mashed potatoes, macaroni and cheese, and yogurt. Drink as much water as possible. Staying hydrated is extremely important.

Are postoperative medications prescribed?

Postoperative medication is all about pain management for the first 10 to 14 days after surgery. 

Generally, alternating acetaminophen and ibuprofen can help effectively treat your child’s pain.  Typically narcotics are not prescribed for children due to the risk of respiratory depression.  

Your surgeon may prescribe an oral steroid medication to help with pain and inflammation after surgery. 

Be sure to avoid aspirin. It can lead to an increased risk of bleeding.

What is the recovery time for a tonsillectomy?

It is important to give yourself time to rest and recover following a tonsillectomy. Full recovery takes up to two weeks for most patients, although most children can return to school after one week. 

For the best recovery process, follow these suggestions for the first one to two weeks: 

  • Keep hydrated
  • Eat soft foods
  • Avoid strenuous activity
  • Engage in light activity only
  • Take pain medication as scheduled

How soon after surgery do you need a follow-up appointment?

A follow-up appointment with your doctor should be scheduled two weeks after your procedure.

11970 N. Central Expressway
Suite 400
Dallas, TX 75243
(214) 382-5100
Legacy Medical Village
5425 W. Spring Creek Parkway
Suite 170
Plano, TX 75024
(214) 382-5100

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