Tonsil diseasesThe symptoms of tonsil hypertrophyDiagnosis of the tonsil hypertrophyTreatment of the tonsil hypertrophy

Hypertrophy of the palatine and pharyngeal tonsils is a very common disease among children. Tonsils are the clusters of lymphatic tissue. Their function is to protect the body from microorganisms entering from the external environment.

Palatine tonsils are the structures of different size, often visible after a wide opening of the mouth, on the sides of the throat above the tongue. They can be practically invisible, hidden in the pharyngeal arches or significantly overgrown, touching the midline.

Pharyngeal tonsil, the so-called “third tonsil” is a cluster of lymphatic tissue located high behind the palate and the uvula and therefore is not visible during a standard medical examination. Its size also varies greatly. It may be slightly or moderately oversized, asymptomatic, but also tightly fill the nasopharynx, causing the symptoms of nasal congestion, and the eustachian tubes.
In childhood, tonsil diseases are very common. Acute viral tonsillitis can occur several times a year. Bacterial tonsillitis is rarer, it requires intensive treatment, including antibiotics, especially when it occurs with high fever and the symptoms of arthritis, heart or kidney inflammation.

Hypertrophy of the palatine tonsils and adenoid may be asymptomatic. Even the moderate tonsil hypertrophy may not cause any negative health effects in your child’s health condition. It should be noticed that the tonsil trimming or extraction operations are performed in situations where the child has symptoms, and not only the tonsil hypertrophy diagnosed in a medical examination.

One of the symptoms of tonsil hypertrophy, especially of the  “third” pharyngeal tonsil, is a nasal obstruction. The pharyngeal tonsil is located behind the palate and uvula. Due to it, while growing it causes the gradually closing of the lumen of the nostrils from behind. Therefore, the child will report that it is harder to breathe through the nose. You will notice a change in the respiratory pathway, i.e. open and ajar mouth, snoring at night, especially in the supine position. In extreme cases of hypertrophy, when the tonsil almost completely fills the nasopharynx, the child will have a constantly open mouth, snore in any position and experience the night apnea. As a result, the brain hypoxia may occur, during the day the child will be sleepy, tired and irritable.

Other symptoms include recurrent infections of the upper respiratory tract, mucous and purulent rhinitis, and drooling. The presence of the pharyngeal tonsil may interfere the nasal obstruction, the natural cleansing of the nasal cavities is disordered, the secretion remains in the nasal passages and becomes superinfected.

Often, in case of children’s tonsil hypertrophy the parents may notice a hearing loss. The child begins to speak loudly, asks to turn up the TV volume because it cannot hear. Those symptoms can also be connected with an overgrowth of the third tonsil. The mechanism is based on the pressure on the oropharyngeal openings of the Eustachian tubes by the growing tonsil. If this condition lasts long enough, speech development disorders and irreversible destruction of the middle ear components may also occur, which will require surgical treatment due to obstruction of the Eustachian tube.

To assess the presence of the pharyngeal tonsil and its size, a fibroscopic examination of the nasopharynx should be performed using a thin camera inserted through the nose.  In order to assess the pharyngeal tonsil the radiological examinations of the nasopharynx are not recommended because they do not provide more important information than a thorough otolaryngological examination, and the child may be also exposed to radiation (they are performed only in special cases, e.g. when the child is not cooperating). In diagnosis of the disease and the presence of possible systemic changes the following laboratory tests may be helpful: morphology with the blood smear, determination of the level of the so-called ASO and nasal and throat smear results.To assess the impact of tonsil hypertrophy on a child’s hearing, the doctor performs an otoscopic examination, which is a basic examination that allows you to assess the condition of the middle ear and the degree of damage to the eardrum or elements of the middle ear. 

Additional audiometric tests are also performed. The basic test performed in children is impedance audiometry. This examination allows for an accurate assessment of the condition of the middle ear and also allows the monitoring of the child’s treatment process. In order to assess the hearing of the children, the examination of the presence of the so-called otoacoustic emissions is performed. It is a quick and painless examination. To assess the degree of hearing loss among older children, a tonal audiometry test can be performed.

Treatment of the tonsil hypertrophy can be conservative, pharmacological or surgical. While observing the child, the hearing should be checked at least once, because exudative otitis media, a common illness that occurs with tonsil overgrowth, is initially asymptomatic. Surgical treatment should be considered in case of severe symptoms (nasal obstruction, night apnea, exudative otitis media, hearing loss). In each case, an evaluation by a specialist is necessary, and the decision about surgical treatment is made after a careful analysis of the course of the disease and the previous treatment.

Surgery of the pharyngeal and palatine tonsils very often removes the main cause of a child’s ailments and in the vast majority improves the patient’s general condition, reduces the frequency of infections and improves hearing among children with exudative otitis media. The adenotomy (removal of the pharyngeal tonsil) and tonsillotomy (cutting the palatine tonsils) is one of the most common surgical procedures performed among children. Children’s palatine tonsils are usually not completely removed, but only trimmed, while it is recommended that the pharyngeal tonsil should be removed completely. If there are symptoms of exudative otitis media, ear tubes are simultaneously inserted into the tympanic membrane (during one anesthesia). The tymapanastomy tube inserting is designed to remove the thick exudate from it (to properly ventilate it) and to improve the child’s hearing.

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