Get to Know Your Tonsils

Tonsils are specialized organs that are part of the lymphatic system and provide your body’s first protective barrier. They protect against foreign substances that you inhale or ingest through the nose or mouth. Once trapped in the tonsils, bacteria or viruses are then transported to lymph nodes, where specialized immune cells cluster to fight infection.

However, in some cases, tonsils may become infected and need to be removed through a very common procedure called a tonsillectomy.

Three Pairs of Tonsils in the Throat

The three pairs of tonsils are:

• Pharyngeal tonsils (adenoids), which reside behind your nose
• Two palatine tonsils (what people are most commonly referring to when they use the word "tonsils"), which reside on both sides of the back of the throat
• Lingual tonsils, which are at the back of the tongue

A bit contrary to their function, the tonsils can become infected.

When examining your tonsils, a physician will ask for your medical history or your child's, perform a physical exam, and, in some cases, take an X-ray to further examine the adenoids or blood tests to determine whether mononucleosis (a contagious infection caused by the Epstein-Barr virus) is the cause of the tonsil enlargement. In adult patients, if only one tonsil is significantly enlarged, this could be a sign of cancer of the tonsil.

Tonsil enlargement is not always considered a problem. However, individuals with enlarged tonsils should be evaluated for the following possible problems related to enlarged tonsils:

• Chronic ear infections
• Hearing loss
• Frequent tonsillitis or sinus infections despite medical treatment
• Frequent nosebleeds
• Continually breathing through the mouth instead of the nose
• Abnormal speech or difficulty swallowing
• Obstructive sleep apnea (breathing that stops and starts during sleep)

Tonsillectomy

The tonsils can be surgically removed if necessary. This is called a tonsillectomy. There are two types of tonsillectomies: complete removal and partial removal.

At one time, physicians removed tonsils after just one or two infections. Due to the risks associated with removing the tonsils, surgeons have become much more conservative in offering this surgery. That said, tonsillectomy still is frequently performed in the United States, and complications are rare.

Tonsillectomy and Adenoidectomy (T&A)

The tonsils and adenoids are often removed at the same time by means of a tonsillectomy and an adenoidectomy. Combined, these procedures are referred to by the abbreviation T&A.

Most people who receive T&A are children, specifically children with either recurrent bacterial infections that can't be treated with antibiotics or children with obstructed breathing secondary to enlarged tonsils and adenoids. Typically, T&A is less painful for younger children than it is for either adolescents or adults.

Uncomplicated T&A is performed either in a hospital or clinic and is an outpatient procedure. In other words, the patient who receives a T&A doesn't need to spend a night in the hospital and can instead go home after a period of observation. However, very young children or children with severe obstructive sleep apnea may have to stay overnight.

What to Expect After T&A

Most children will take about seven to 10 days to fully recover after a T&A. Many children experience light bleeding within 24 hours following surgery, in addition to fever and inflammation after the procedure. This inflammation, or swelling, can cause short-term snoring.

Furthermore, mild pain is often experienced after T&A. Adolescents and adults, however, often experience more severe pain. Options for pain control include pain relievers, such as acetaminophen, ibuprofen, and prescription medications.

Tonsil bleeds may also occur again seven to 10 days after the surgery, when the scabs (eschar) fall off.

During recovery, it's important to drink plenty of fluids and eat a soft diet. Some people lose weight during this period of convalescence because it can hurt to eat.