Tonsil hypertrophy and adenoid hypertrophy occurs when the tonsils and the adenoids become swollen and chronically enlarged. The condition can result in nasal obstruction leading to a number of symptoms and complications. Tonsil hypertrophy and adenoid hypertrophy are medical conditions that occasionally occur in adults but most commonly affect younger children.
Both tonsils and adenoids are collections of lymphoid tissue that trap bacteria and viruses. They are part of the lymphatic system and help the body fight infections. The tonsils are located in the back of the throat and are visible through the mouth. The adenoids are located higher up and further back where the nasal passages connect with the throat. Unlike tonsils, adenoids are positioned behind the soft palate and cannot been seen through the mouth. The main function of the tonsils and adenoids is to prevent bacteria from reaching further down the throat by producing antibodies that bind to the bacteria. The adenoids and tonsils can progressively grow with ongoing infections and inflammation.
Symptoms of Tonsil Hypertrophy
Enlarged tonsils can be common in children, and in some cases, there are no apparent symptoms. However, when tonsil hypertrophy is more severe, children typically experience some of the following symptoms:
- Voice changes: As a result of swollen tissue near the vocal chords, the voice may be altered slightly.
- Difficulty swallowing: The enlarged tissue of the tonsils can become obstructive and make swallowing certain foods difficult.
- Loss of appetite: When swallowing food is difficult or painful, many children eat less and lose their appetite.
- Halitosis: Due to infections of the tonsils, bad breath often affects children with tonsil hypertrophy.
- Snoring: Hypertrophic tonsils can obstruct the airways making breathing during sleep more difficult.
- Obstructive sleep apnea: In severe cases of tonsil hypertrophy, sleep apnea, a condition indicated by pauses in breathing during sleep, can occur. This is due to blocked airways. Sleep apnea is a serious condition that can potentially cause pulmonary hypertension and hypertrophy of the right side of the heart.
- Frequent ear infections: The enlarged tonsils can block the Eustachian tubes and impede drainage. This can result in fluid build up behind the eardrum and ear infections.
- Chronic Sinusitis: Hypertrophic tonsils and surrounding tissue can prevent proper drainage from the sinus cavities. The mucous becomes trapped and infections can develop. Symptoms such as congestion, pressure and fatigue are common with sinusitis.
Causes of Tonsil Hypertrophy
The exact cause of tonsil hypertrophy is not always clear, but the enlargement is typically related to tonsillitis or infection of the tonsils and surrounding tissue. The bacteria trapped by the tonsils can sometimes lead to infections. It is possible that irritants such as second hand smoke and air pollution can also cause the tonsils to become enlarged.
Treatments for Tonsil Hypertrophy
Treatment for tonsil hypertrophy depends on the size of the tonsils and the severity of symptoms. Sometimes the enlarged tissue shrinks on its own or as the child grows, and no treatment is needed. If severe tonsil hypertrophy is not treated however, serious health conditions can result. Underlying infections can spread to other areas of the body, and untreated streptococcus bacteria (strep throat) can even damage the kidneys and heart valves.
Both medication and surgery are used to treat tonsil hypertrophy. When infection is the cause of tonsil hypertrophy, antibiotics can be effective. Once the infection is cleared, the enlarged tonsil tissue typically returns to normal size. When the tonsils are chronically enlarged, surgery may be the best treatment option. The tonsils can be removed through a surgical procedure known as a tonsillectomy.
A tonsillectomy is a simple and effective surgery. The surgeon removes the tonsils through a child’s mouth without any external incisions in the skin. The procedure takes only about 20 minutes, and many kids go home the day of surgery. Recovery time is typically 1 to 2 weeks depending on the surgical technique used. Some pain can be expected and will affect eating and drinking for a short time. By removing the enlarged tonsils, the obstruction is cleared, and symptoms are eliminated in most cases.
Symptoms of Adenoid Hypertrophy
The symptoms of adenoid hypertrophy can be similar to those of tonsil hypertrophy and occur when the enlarged adenoid tissue creates as an obstruction:
- Mouth breathing: As a result of blocked nasal airways, children with adenoid hypertrophy are often forced to breath through their mouths. If mouth breathing occurs for a prolonged period of time, orthodontic issues can arise.
- Runny nose: Because mucous cannot drain properly through the back of the nasal cavity, mucous and secretions exit through the nostrils.
- Snoring and sleep apnea: The blocked airways caused by the enlarged adenoid tissue can interfere with breathing during sleep.
- Chronic sinusitis: When enlarged adenoids block the nasal passages, the sinus cavities cannot drain properly. The buildup of mucous leads to inflammation of the lining and often infections.
- Eustachian tube dysfunction: When enlarged adenoids prevent proper drainage from the Eustachian tubes, fluid collects behind the eardrum.
Causes and Diagnosis of Adenoid Hypertrophy
Like tonsil hypertrophy, the cause of adenoid hypertrophy is not completely clear. Bacteria, irritation from nasal secretions or chronic allergies can cause inflammation of the adenoid tissue. This inflammation can lead to chronic adenoid hypertrophy. An ENT (Ear, Nose and Throat) specialist can diagnose hypertrophic adenoids by using x-ray or by performing a fiberoptic nasal exam. With a fiberoptic nasal exam, a nasal spray is first used to numb the nasal passages. Then, inserting a flexible, fiberoptic tube through the nose, the ENT can view and examine the adenoids directly.
Treatment of Adenoid Hypertrophy
In some cases, medication can be used to treat adenoid hypertrophy. Infected adenoids may respond to antibiotics and adenoids may shrink with oral steroids. When medication does not correct the enlargement of the adenoid tissue, surgery is often needed.
An adenoidectomy is a surgical procedure to remove the adenoids. It is a simple, outpatient procedure with very few side effects. The adenoids are removed through the mouth without any external incisions. Recovery for most children is about 48 hours and the result is often significant relief of symptoms and complications.
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