Enlarged Pharyngeal Tonsils (adenoids) - Diagnosis - Therapy

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-11-27 18:19

Enlarged pharyngeal tonsils: diagnosis & therapy

Enlargement of the pharynx in itself is not a disease and is very common, especially in childhood. However, as soon as it causes discomfort, appropriate treatment should be started to avoid complications.

The diagnosis is based on the symptoms and the results of the specialist examination. Depending on the severity and duration of the symptoms, surgical removal of the tonsils may be necessary. The majority of those affected are symptom-free in the long term.

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How is the diagnosis made?

In most cases, the suspicion of almond hyperplasia arises from the symptoms and the typical facial expressions of the children concerned.

To confirm the diagnosis, the ENT doctor will carry out a reflection of the posterior nasopharynx (so-called posterior rhinoscopy). The tongue is pushed down slightly with a wooden spatula and the posterior nasopharynx is inspected with an angled mirror. This makes it easy to identify an enlarged pharynx. The doctor may also examine the nasal cavity using an endoscope; a thin tube with a small light source and a small camera attached to the end is carefully inserted into the nose.

The ears are examined with the help of an otoscope (device for viewing the ear canal and eardrum). A hearing test is also carried out.

In addition, the mobility of the eardrum can be assessed using tympanometry. The pressure conditions in the middle ear and the ability of the eardrum to vibrate are measured. The examination makes it possible to confirm the suspicion of a sound conduction disorder.

How is almond hyperplasia treated?

An enlarged tonsil in itself does not necessarily have to be treated. However, as soon as it causes symptoms, therapy is necessary.

If the nasal breathing is moderately impaired, treatment can be conservative at first: Rinsing with sea salt solutions can cause the tonsils to swell and alleviate the symptoms.

If the child does not respond to this treatment or if the symptoms are already severe, the tonsils should be surgically removed. The technical term for this is adenotomy. The doctor will recommend the procedure if:

nasal breathing is severely impaired,
the child suffers from infections of the upper respiratory tract more frequently within one year,
the middle ear ventilation is disturbed or there are ear problems
or the affected child has pauses in breathing (sleep apnea) at night.

The adenotomy is performed under general anesthesia. The pharynx is peeled out with a special instrument called a ring knife. The bleeding is stopped with a swab, a suture is not necessary. Overall, the operation only takes about ten to 15 minutes. It is often done on an outpatient basis and the child can go home after a few hours of observation.

If there is a tympanic effusion, a small incision is made in the eardrum (paracentesis) during the operation and the secretion is suctioned off. Under certain circumstances, a so-called ventilation tube is inserted into the eardrum, which allows the secretion to drain off slowly over a long period of time and the middle ear is well ventilated. The ear tube remains in the ear for about three to six months and then repels itself or is removed by the ENT doctor.

The majority of children are long-term symptom-free after an adenotomy. In rare cases, the tonsils can grow back and cause symptoms again.

The most common side effects of the surgery are difficulty swallowing and sore throat. Sometimes the children also complain of earache. An unpleasant bad breath can occur up to two weeks after the operation. In rare cases, inflammation in the wound area can occur.

The most serious complication is secondary bleeding. Overall, they are rare, with the greatest risk within the first 24 hours after the procedure. During this period, the child should never be left unattended. Important: Heavy bleeding is an emergency and must be treated immediately! If the child bleeds or vomits from the nose or mouth, go to hospital immediately. Sports and other physical exertion as well as full baths, showers with hot water or swimming should be avoided for about two weeks.

Contraindications for an adenotomy are, for example, an existing acute infection and fever as well as blood clotting disorders. The latter are associated with a high risk of bleeding and must be excluded before the operation.

The attending physician will explain the risks and possible complications in advance. The adenotomy, together with the removal of the tonsils (tonsillectomy), is one of the most common operations in children, and both operations are often combined.