ADENOIDS AND TONSILS
Why does Adenoid and Tonsil Infection occur ?
A variety of germs can cause infection of the tonsils and adenoids. Most are due to viruses but other germs called bacteria are frequent offenders. The main ones are streptococci, staphylococci and Haemophilus influenzae . These infections are more common in children than adults. Adults are less exposed to infection than school-age children and have had the chance to build up resistance to these germs over the years. Treatment Involved for Adenoid and Tonsil Infection
Tonsillitis may give rise to very slight symptoms and not require a visit to the doctor. Often, however, the sore throat is bad and the patient feels unwell. The doctor may advise rest and paracetamol or aspirin to relieve pain and temperature. Aspirin is not used in children under the age of 12 years. Sometimes an antibiotic may be prescribed. However, these may not be effective, as most infections are due to a virus which does not respond to antibiotics. Patients who get several attacks of tonsillitis every year may be referred to a specialist for consideration of tonsillectomy. TONSILLECTOMY Removal of the tonsils. Size alone is rarely a reason for removal. The main reason for surgery is frequent tonsillitis which badly interferes with the health or lifestyle of the patient. The patient may be losing time off work or study. Rarely an enlarged tonsil needs to be removed to identify the cause of the enlargement. One of the parents should be prepared to stay in hospital with a small child who needs admission. Before tonsillectomy the patient (or parents) will be asked about allergy to drugs and any history of bleeding or bruising. The tonsillectomy will be postponed if there is an attack of tonsillitis within 4 weeks of surgery, or if the patient has a cold or a temperature. A check will be made to exclude anaemia.
One should arrange to be off work or away from school for 3 weeks after surgery. The operation consists of removing the tonsils through the mouth, under a general anaesthetic. On waking, there is usually some slight oozing of blood which quickly stops. The patient has a bad sore throat which lasts for several days, slowly getting better. Children often have very little discomfort. The patient will slowly be encouraged to drink and then eat. Bleeding is the main complication after tonsillectomy. Fortunately this is uncommon and can be easily managed. Bleeding occurring in the first 24 hours is called primary or reactionary haemorrhage. Bleeding after this time (secondary haemorrhage) is due to infection and occurs in a very small number of cases. Ear infection can occur after this operation. However, if there is no deafness, any pain felt in the ear usually comes from the throat. In some patients there is a slight change in voice due to temporary swelling of the soft palate. The patient will be mobilized quickly and will go home after one day, if not done as a day case. Any pain-relieving drugs will be continued until they are no longer needed. This usually takes 7 10 days. It is important for the patient to rest at home and avoid catching infection from other people. After the first week gentle physical activity is allowed. Travelling must be avoided until the throat has healed. Any bleeding from the operation site must be reported to the surgeon and requires re-admission to hospital. ADENOIDECTOMY Removal of the adenoids. Large adenoids may be removed if they block the nose or cause glue ears because of their size. Chronic infection of the adenoids is another indication. This may result in repeated ear infection or chronic nasal discharge. Before operation, the patient (or parents) will be asked about allergy to drugs and any history of bleeding or bruising. The operation will be postponed if the child has a cold or a temperature. Under a general anaesthetic the adenoids are removed by a sharp instrument called a curette. The curette is inserted above the soft palate through the mouth.
The operation is often combined with tonsillectomy and treatment of the patient is similar to that outlined above. Most children will recover without any significant pain or complication. The patient may be kept in overnight. Paracetamol should be given as required. The cause of severe pain must be identified and treated. Haemorrhage and infection are the main complications. The child should be kept at home for 2 3 weeks after surgery, away from people who might introduce infection. Bleeding requires re-admission to hospital. Normal activities can be resumed after 3 weeks. |
