Enlarged Tonsils and Adenoids in Children: diagnosis & treatment

Tonsils and adenoids are like lymph nodes in the other part of the body. The tonsils can be seen in the back of our throat as two small oval lumps one on each side as in the image. The adenoids are like tonsils but at the back of the nose and hence cannot be seen through the mouth. The tonsils and adenoids are thought to help the body in fighting infections.

Why do Tonsils and adenoids enlarge in some children?
The size of the tonsils and adenoids is variable with age. The tonsils and adenoids are largest in size between the age of 2-6 years. The tonsils and adenoids may also get enlarged due to recurrent infections in children.

Enlargement usually causes no symptoms but can occasionally cause difficulty breathing or swallowing and sometimes recurring ear or sinus infections or obstructive sleep apnea.

Enlarged Tonsils and Adenoids in Children: diagnosis & treatment

What are the problems when tonsils and adenoids enlarge in size?
Enlarged tonsils and adenoids can lead to many problems in children. Enlarged adenoids and tonsils can obstruct the breathing passage in children especially during sleeping as the neck muscles relax. This leads to snoring, difficulty in breathing, mouth breathing, gasping and pauses during breathing. This condition is called obstructive sleep apnea. Enlarged adenoids and tonsils can lead to a delayed and unclear speech in children. Large adenoids and tonsils also can distort the facial features often described as adenoid facies. Enlarged adenoids can obstruct the opening of the eustachian tube (a tube connecting the nose and ears), which leads to a condition known as glue ear or serous otitis media. This can lead to hearing loss in children.

How do we diagnose an enlarged Adenoid?
Lateral Xray of the neck are useful for diagnosing large adenoids. Sometimes when the situation is unclear we need to do an examination of the back of the nose from inside with a nasal endoscope, a procedure known as nasopharyngoscopy. This can be done in the OPD in 3-5 minutes. Children having suspicion of obstructive sleep apnea need to undergo a sleep study or a polysomnography for its diagnosis.

What is the treatment of Tonsils and adenoids?
In some children enlarged tonsils and adenoids are not leading to any symptoms and no specific treatment is needed. Some children require antibiotics if enlarged tonsils and adenoids are secondary to bacterial infection. In addition, some children with enlarged tonsils and adenoids allergies play an important role and require treatment with intranasal spray. Some children with Enlarged tonsils and adenoids might need treatment for gastroesophageal reflux.

Children with enlarged tonsils and adenoids associated with obstructive sleep apnea, chronic ear infections, serous otitis media or glue ear, hearing loss, recurrent bacterial tonsillitis and adenoid facies require surgical removal of the enlarged tonsils and adenoids a procedure called as Adeno-tonsillectomy.

If your child is having enlarged adenoids and tonsils do get in touch with a pediatric pulmonologist for a proper assessment, diagnosis and treatment.

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