The Filtering Function of Tonsils
It’s a school night, and your child begins complaining of a sore throat. You take out a flashlight and, sure enough, his tonsils are enlarged and red. Tonsil infections are common in children. Common questions that parents ask are: What is the purpose of tonsils? How can they become a problem? And when should they be removed?
What Are Tonsils?
Most people use the term tonsils to refer to the two clumps of tissue found in the back of the throat. These are actually part of a larger ring of lymphatic – infection-fighting – tissue that includes the adenoids found in the back of the nose and the lingual tonsils located at the base of the tongue.
With prime locations, the tonsils and adenoids are in a position to provide primary defense against viruses and bacteria that infect the nose and throat. Tonsils are most active in fighting infections in children between ages 4 and 10 with a decrease in their immunologic function after puberty. Although tonsils are part of the immune system, no major immune deficiency is observed after their removal. While tonsils and adenoids are helpful, they can sometimes cause problems when they become infected or get too large.
Infected Tonsils vs. Strep Throat
Tonsillitis occurs when tonsils become infected by one of several bacteria or viruses. Tonsillitis is usually accompanied by sore throat (pharyngitis) and can be associated with fever, difficulty swallowing and swollen glands or lymph nodes in the neck. Most cases of a sore throat and tonsillitis are caused by viruses, and require only supportive care. Pain can be controlled by gargling with warm salt water, drinking warm tea and taking over the counter medications, such as acetaminophen or ibuprofen. These infections typically resolve without treatment within 10 days.
Strep throat is different from tonsillitis as it is a specific type of infection caused by Streptococcus bacteria. It is important to treat strep throat with antibiotics because it can have serious consequences if left untreated, including rheumatic fever.
Sore throats and tonsillitis typically occur in school-aged children. It is difficult, even for doctors, to distinguish by symptoms and appearance between viral and streptococcal tonsillitis. Accordingly, it is important to see your physician when your child has a sore throat. A doctor can do a quick swab in the back of the throat to determine if streptococcus bacteria is the cause of the infection.
Tonsils grow and shrink throughout childhood. Enlarged tonsils without any symptoms are common in children, cause no longterm problems, and usually do not need to be treated. At times, however, tonsil and adenoid enlargement (hypertrophy) can interfere with breathing, swallowing, hearing or clear speech. This can present as chronic mouth-breathing, severe snoring or brief cessation of breathing while asleep (obstructive sleep apnea).
When Should Tonsils Be Removed?
Tonsil and adenoid enlargement causing symptoms of obstruction is one of the main reasons to have these tissues removed. A tonsillectomy is also often recommended for repeated or persistent infections, including three or more infections in each of three years, five episodes of tonsillitis in each of two years, or seven episodes of tonsillitis in one year.
Removal of the tonsils or adenoids are among the most common surgical procedures performed in the United States. These procedures may be performed together, especially in younger children. They are performed under general anesthesia and the operation typically takes between 30 and 45 minutes. Children are usually sent home the same day, but depending on your child’s age or other medical problems, it may require an overnight stay. The procedure is not without complications, and decision to perform it should be discussed thoroughly between the parent, primary care physician and an otolaryngologist (ear, nose and throat doctor).
Dr. Shareef is a pediatric resident at Levine Children’s Hospital. Dr. Neuspiel is director of ambulatory pediatrics at Levine Children’s Hospital and medical director at Myers Park Pediatrics.