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Tonsils and Adenoids

Tonsils and Adenoids - Doctor feeling patient neck

Tonsils are bilateral structures that are located in the back of the throat. Adenoids are made of similar tissue that lies at the back of the nose above the palate (roof of the mouth). They are part of the immune system that is the bodies first line of defense against pathogens that are inhaled or swallowed.

Tonsillitis is a term used to describe when the tonsils are sore and swollen. Often this is caused by a bacterial or viral infection. Sore throat, fever, purulent exudate (white or yellow spots on the tonsils) and painful enlarged neck lymph nodes are some of the signs and symptoms of tonsillitis. Viral infections are usually treated with anti-inflammatory drugs such as ibuprofen or naproxen. Bacterial infections are treated with antibiotics.

Tonsils and adenoids may become enlarged without being infected. Both reach their largest size before puberty (5-6 years old) and then slowly shrink in size into adulthood. Enlargement of the tonsils and adenoids may obstruct the airway and may be a cause of snoring and sleep apnea.


Tonsillolith or “tonsil stones” is material that accumulates in the crypts (crevices) of the tonsils. They appear as small white or yellow spots or “grains of rice” in the tonsil. These are relatively common and consist of minerals and bacteria. The bacteria may produce volatile sulfides that cause a bad odor and sometimes halitosis or bad breath. They may be asymptomatic or cause a sensation of a foreign body in the throat. They may be treated with manual removal, gargling and rarely with laser therapy to remove the crypt, or tonsillectomy.

Indications for Tonsillectomy:

  1. For adults, three or more episodes of severe sore throat/year despite adequate medical therapy. For children, 7 episodes/year in the past year, 5 episodes over the past 2 years or 3 episodes/year over the past 3 years.
  2. Hypertrophy or enlargement of the tonsils or adenoids resulting in airway obstruction or sleep apnea, inability to swallow or cardiopulmonary complications.
  3. Peritonsillar abscess not responsive to medical therapy and incision and drainage. Recurrent acute peritonsillar abscesses are another relative indication for tonsillectomy.
  4. Unilateral tonsil enlargement to rule out malignancy such as carcinoma or lymphoma.
  5. Persistent halitosis (bad breath) and foul taste due to cryptic tonsillitis and not responsive medical therapy is a relative indication.
  6. Chronic tonsillitis secondary to being a streptococcal carrier, not responsive to antibiotic therapy is another relative indication.
  7. Adenoidectomy may be indicated in children for chronic sinusitis and recurrent acute or chronic otitis media (middle ear infections).

Tonsillectomy – Procedure:

Tonsillectomy and/or adenoidectomy is usually performed on an outpatient basis in a surgery center under a general anesthetic. The procedure usually takes under an hour to perform and most patients are discharged within a few hours of their surgery to return home.

A sore throat is expected after surgery and is treated with pain medications. This usually lasts 5-10 days following surgery.

Dehydration secondary to inadequate oral intake of fluids may occur and is usually treated at home but may require admission to the hospital for intravenous fluids. Reactions to anesthetics are known to exist but are rare. Airway obstruction from swelling or because of anatomic or physiologic respiratory co-morbidities is also rare but may require monitoring in the hospital.

Bleeding occurs in 1-3% of patients and most commonly occurs 5-10 days after surgery when the scabs come off. The bleeding may be controlled in the office or emergency department and may require a return to the operating room. Rarely is a blood transfusion required.

Precautions following surgery include rest and avoiding strenuous activity x 2-3 weeks until the scabs have fallen off. Most individuals will need to remain home from work or school for 7-10 days. Maintaining adequate hydration is also important. Increased pain, bleeding and fever may occur if one becomes dehydrated. Absolute avoidance of aspirin, non-steroidal anti-inflammatory medications such as ibuprofen and naproxen and other blood thinning medications is important until authorized by your surgeon. Avoiding sharp foods such as crackers and chips and maintaining a soft, bland diet is also important.

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