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What are tonsils?

Monday, 11 August 2008 06:00 | Last Updated (Wednesday, 27 May 2009 22:17)

 

 

Tonsils

When talking about tonsils we usually refer to the lumps in each side of our throat, which become visible on pressing down the tongue. There however are three, not two tonsils at the back of the mouth cavity. The third one is sealed off inside the tongue base and is not readily visible.

Tonsils are part of a body defence system known as ‘lymphoid tissue’, whose function is to produce substances called antibodies and white cells that protect us from infection. Another lump of lymphoid tissue, called the adenoid is found in the back part of the nose.

In persons with large tonsils, holes, or ‘pits’ are apparent in the surface. Pits extend into the center of the tonsil and fill up with pus during periods of inflammation. Pus on the surface of the tonsil therefore extends to the tonsil core.

Over thirty different types of microbes live in a balance with one another in the normal mouth. Problems occur when something upsets this balance. When a person gets infected with a resistant strain of microbe, the tonsils may get colonized, resulting in displacement of the normal bacteria. Repeated courses of antibiotics under these conditions may only serve to make these microbes even more resistant since antibiotics may not penetrate to the core of large tonsils in sufficient concentrations to completely eradicate these bacteria.

This situation may end up in recurrent attacks of tonsillitis, where the patient suffers from fever, severe sore throat, pus on the tonsil surface, tender glands in the neck and even earache. Harmful bacteria produce substances called toxins, which enter the bloodstream and may cause complications in other parts of the body. Areas commonly affected are the kidneys, the heart and the skin. Kidney infection, also known as glomerulonephritis, is a well-recognized complication of tonsillitis and signs include high temperature, loin pain, malaise, decrease in the volume of urine and blood in the urine.

Why are tonsils removed?

Doctors usually try to preserve the tonsils due to their protective function. Under some conditions however, it becomes more risky for us to keep them. Based on a history of recurrent tonsil infection the decision to remove tonsils is taken if it is likely that these infections would continue. Recurrent tonsil infection is the commonest indication for tonsillectomy. Removing one’s tonsils means no more episodes of tonsillitis with fever, pus, earache and enlarged neck glands but short-lived viral sore throats will still occur in conjunction with the common cold.

Another less common, but also important indication is airway obstruction.

Children occasionally have very large tonsils, which prevent them from breathing properly. During sleep, when the throat muscles relax, the airway is blocked off during inspiration. This results in significant periods of time during which there is a lack of oxygen entering the respiratory system. Removing the tonsils and adenoids helps improve the supply of oxygen that is vital to development of the brain, lungs and heart.

Tonsillectomy and asthma

Tonsillitis and asthma are two fairly common conditions and they frequently coexist. This does not mean that one leads to another. Indeed, there is no scientific evidence that tonsillectomy makes an individual more prone to developing asthma. On the other hand, tonsillectomy is often carried out in individuals with asthma who have recurrent tonsillitis to prevent throat infections from spreading to the chest.

The operation

In Western countries this operation is usually carried out under general anaesthesia and takes roughly 20 minutes depending on the speed of the surgeon and local conditions, such as bleeding, during the operation. I use a dissection technique, which, although the most traditional, according to the recent UK study on tonsillectomy, is still the safest. This technique also ensures that all tonsil tissue is removed and that tonsils do not ‘grow back’.

The modern approach is to get patients drinking and eating early, certainly the same day so as to hasten recovery. It is a good idea to avoid tomato sauces, oranges and spicy or acidic foods for the first 10 to 14 days.

Pain is the largest problem faced after the operation and can be described as that of a severe tonsillitis. Due to the nerve distribution in the head, earache may also occur. Soluble painkillers help a great deal. Bleeding is rare and in my practice less than 0.5% but may occur up to two weeks following surgery and especially if oral intake is not adequate.

By and large recovery is complete within two weeks and patients may return to their normal lives. A follow-up appointment with the surgeon is arranged between one and two weeks post-operatively.

 

Disclaimer: Patients are advised to discuss their medical condition and any indications for medical treatment or surgery with their general practitioner or the specialist who is delivering health care. This article is designed to help with frequently asked questions and does not take any responsibility for specific patients.

©Mr. Adrian M Agius