A: Tonsils are part of the immune system, but when they are too large or are prone to frequent infections, then surgical removal is a consideration. One or two infections every year is not too worrisome, but having an infection every month can be debilitating for most people. For many children (and some adults), very large tonsils can lead to breathing problems at night.
More Questions About Tonsils
Q: What are tonsils?
A: Tonsils are paired lymphoid or glandular tissues that sit on the side-walls of your throat just behind your tongue. They are part of a complete circle of lymphoid tissues that is involved in programming your immune system what is foreign and what is self. The adenoids sit in the mid-line at the back of your nose and the lingual tonsils are also in the mid-line at the rear of the tongue, just above the voice box. They are most active from ages 3-5, and this is the time that most problems arise.
Q: Do you need tonsils?
A: Yes, especially when you have an infection. Most of the immune system programming occurs in early childhood. As you get older, the tonsil shrink to a much smaller size in adulthood. However, if there is chronic irritation, such as from allergies, colds or acid reﬂux, they can remain enlarged. Tonsils and adenoids are only a small part of a much larger system of lymph glands and immune mechanisms.
Q: What happens if my tonsils are too big?
A: Just because your tonsils are big does not mean they have to be removed. If you have no problems, then with time, they should shrink. But if you have signs or symptoms of a sleep-breathing disorder, such as daytime fatigue, poor concentration, memory problems, attention problems, asthma, cough, nasal congestion, or snoring, then they should be looked at by an ear, nose and throat physician. Sometimes I see young children who snore heavily, with severe asthma, attention and behavioral problems, and who are on Ritalin for ADHD. On exam they are found to have very large “kissing” tonsils. Due to the prevalent myths about tonsils and surgery, the parents refuse any form of surgical therapy. They would rather treat the end result of their child’s sleep-breathing problem (asthma, ADHD) with long-term medications, when surgery could be curative. On the ﬂip side, there are also too many people with tonsils that are taken to the operating room prematurely, with no clinical reasoning whatsoever.
Q: Can large tonsils cause snoring?
A: Yes. Anything that narrows the upper airway, from the nose to the voice box, can cause snoring or other breathing problems. In children, large tonsils are a common cause of snoring. Snoring itself in children has been linked to behavioral, memory and concentration problems, asthma, and chronic cough. A signiﬁcant number of children (and adults) who snore are also found to have obstructive sleep apnea, which can lead to fatigue, depression, high blood pressure, heart disease and many other conditions. It’s also associated with sexual dysfunction and frequent urination at night.
Q: Doesn’t undergoing a tonsillectomy hurt?
A: Yes. But with advances in technology, it doesn’t hurt as much. Traditional tonsillectomy using an electrocautery device will leave you with a very sore throat for 4-7 days. You’ll be on soft or liquid diet until the pain subsides, after which you slowly progress to foods of more solid consistency. The best part is that you can eat lots of ice cream. With newer techniques (such as the Coblator) you’ll have only 2-5 days of pain, with some people not taking any pain medications at all.
Q: What are the potential complications of tonsillectomy?
A: As with any operation, there’s always a very small chance of bleeding or infection. If it occurs, then it will be addressed appropriately. Speciﬁc to the procedure, there is a small chance that you may have persistent symptoms even after surgery. There are many reasons for this, including not taking enough tonsil tissues out, or it may be due to something entirely diﬀerent. Two common reasons include post-nasal drip and laryngopharyngeal reﬂux disease. There’s also a very small risk to general of complications from anesthesia is lower than being hit by a car.
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