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Tonsil

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Tonsil anatomy.jpg

The tonsils are components of the immune system, which are located in the back of the throat. They are composed of masses of lymphoid tissue, but play an uncertain role in the lymphatic system. Tonsillitis is a common childhood illness and can create recurrent health problems such as fever, sore throat, and ear aches. The tonsils are one of the few organs that a person safely may have removed and the removal of them poses no risk to one's medical health. Interestingly, within the first thirty minutes of the removal of the tonsils they are able to bounce higher than that of a rubber ball of similar size [1].

The medical world has yet to come to an agreement on the importance of tonsils, but has recently strayed away from the removal of them (tonsillectomy) and is now suggesting to patients with throat problems and discomfort to try to wait out the problem instead [2]. However, doctors are recommending tonsillectomies to those battling sleep apnea. The percentage of tonsillectomies performed due to an infection in the throat is currently only twenty percent, and the other eighty percent who receive tonsillectomies struggle with sleep problems. Tests are also beginning to show that a tonsillectomy may also help improve a child's behavior and focus in school. [3]

Anatomy and Physiology

The tonsils are two masses of lymphoid tissue located in the back of the mouth. Each tonsil is set in a pocket of tissue, one on the right and one on the left, on the sides of the throat. The most bottom edge of the tonsil comes into close contact with the back of the tongue. Since the tonsils are made out of lymphoid tissue this means they produce white blood corpuscles, ultimately meaning the tonsils aid in defending the body and are part of the immune system. The importance of the tonsils is a much disputed fact, but many doctors are currently becoming much more hesitant to remove a patient's tonsils than they had been previously. Some believe that the tonsils used to be an important part of the immune system, but are not much help against today's bacteria and viruses. They believe that the tonsils were better used for defending against possibly parasites and worms or other diseases which are now uncommon [4]. Others believe that the tonsils still hold an important position in the immune system. The tonsils are one of the body's first line of defenses after a foreign substance enters and it is their job to stop and identify germs [5]. Others closely compare the tonsils to the lymph nodes and state that the tonsils are used in helping with the body's detoxification and poison removal system [6]. Studies are not yet complete but there seems to be no automatic connection between an adult's health and whether they had their tonsils removed as a child or not [7]

Tonsillitis

Tonsillitis exhibited by inflamed tonsils covered in a white substance

Tonsillitis is the inflammation and enlargement of the tonsils. The tonsils usually become very red in color and can also be covered in a white, yellow or gray film. Accompanied with these symptoms a person with tonsillitis may experience throat or mouth problems such as a sore throat, difficulty swallowing, or swollen glands. They may also have a lack of appetite or a fever [8].

Tonsillitis can have one of two different causes: either group A streptococcus bacteria or a virus [9]. Streptococci are the cause for tonsillitis in about thirty percent of patients and a virus is the cause for the remaining seventy percent of patients. Very rarely a bacterium other than streptococcus is the culprit of tonsillitis. The most common viruses responsible for and related to tonsillitis include adenoviruses, enteroviruses, the flu virus, parainfluenza viruses, Epstein-Barr virus, and the Herpes simplex virus[8].

Bacterial tonsillitis is treated differently than viral tonsillitis, so the doctor must test to determine which is the cause. The doctor does this by swabbing in the back, inside of the patient's throat then testing that throat culture for strep. If it tests positive the infection is caused by the streptococcus bacteria, but if the test comes back negative it is most likely a viral infection[8]. If the infection is bacterial the doctor will usually prescribe antibiotics to the patient. If the tonsillitis is caused by a virus, as in most cases, the patient will be left to fight off the infection which the body will naturally do [9]. The length of recovery time from tonsillitis varies as by cause, but generally a virus will be cured more quickly than a strep infection. When dealing with the form caused by Streptococci the fever will leave the patient within three to five days and with proper use of antibiotics the patient will usually be healed within ten to twelve days. When dealing with a virus most patients feel completely better within a week, but certain viruses may take longer to destroy. With either case, even after the patient has no more pain or discomfort the tonsils can remain swollen and slightly discolored for up to several weeks[8].

Both forms of tonsillitis are contagious and the infected patient should remain home for a few days while they recover. Tonsillitis can be transferred through mouth or nasal fluids and is usually spread from person to person. To keep one healthy you should maintain distance between yourself and anyone who is infected with tonsillitis. Make sure to wash hands thoroughly and often before eating and after touching communal areas or items. If living with someone or taking care of someone with tonsillitis pay special care to wash that person's dishes very thoroughly in hot, soapy water [9].

It is important that a child or adult with tonsillitis gets plenty of rest and stays hydrated during their sickness and recovery process. It may be possible that it is difficult to eat or swallow foods so eating and drinking a lot of soft or liquid foods is recommended. Again, rest is highly stressed, especially if the infection is viral, so that the body can focus on killing off the virus.[9]

Removal of the Tonsils

The doctor may suggest removal of the tonsils for a variety of reasons, some of which being:

  • Enlargement to the point of blockage in the throat: If the tonsils become enlarged to the point blocking the throat many problems can incur. A person with severely enlarged tonsils will have trouble swallowing, eating, breathing, and speaking. Enlarged tonsils are also a cause of sleep apnea. A person will have trouble breathing while sleeping and often will wake up gasping or choking for air. In many cases a tonsillectomy has proven successful in curing a patient's sleep apnea. Since sleep apnea is also a cause of heart stress and problems the early removal of enlarged tonsils can prove a cautionary for the health of one's heart [4]
  • Severe and reoccurring tonsillitis: Thirty years ago almost ninety percent of tonsillectomies were performed as a result of severe bouts with tonsillitis. Currently, tonsillitis remains the cause for about only twenty percent of tonsillectomies. A tonsillectomy is a good idea if your child has had a severe case of tonsillitis several times, because it will prevent any future rounds of the disease. A tonsillectomy can also improve the amount and severity of sore throats one can have in a year [4].
  • Chronic Cryptic Tonsillitis: The tonsils can become filled with white, smelly bacteria in the cracks and spaces of the tonsils known as crypts. Along with these symptoms one will also have a sore throat. Antibiotics do not prove much long term help in getting rid of the bacteria and neither does the self removal of the bacteria through swabbing. The most reliable way to get rid of Chronic Cryptic Tonsillitis is through a tonsillectomy [4].
  • Site of a tumor: The tonsils can become sites for tumors, both those that are harmful and innocuous. Lymphoma or carcinoma can be present in a tonsil. If the tonsil has a very strange appearance, either in the area of size or color, then it should be checked out by a doctor and possible removed [4].

Tonsillectomy

A young boy with his mother right before receiving a tonsillectomy

Risks

All surgeries should be taken very seriously and be conducted in the most professional manner. Like all other surgeries, especially those requiring anesthesia, risks are present. The risk of complications with anesthesia is very low and correlates with the patient's health. Bleeding, usually effecting the patient somewhere between five and ten days after the surgery, results after a dry scab falls off and is a very common result of the surgery.
An illustration of the removal of tonsils
Adults and teenagers are more prone to bleeding than small children because the tonsils of a child are much smaller than those of an adult. There is also a risk of infection after the surgery. The tonsillar fossae, the recess in which one's tonsils previously resided, is prone and expected to become a haven for much bacteria. However, serious infections rarely materialize, but a short fever can be expected. The mortality rate of tonsillectomies is very low [4].

Process

The process of a tonsillectomy begins with the use of anesthesia. General anesthesia is most commonly used, but some doctors may choose to use local anesthesia or sedation instead. There are two different ways of removal: either through cautery or the newly introduced laser technique. The laser technique is an attempt to lessen the amount of blood lost, but is more expensive and presents more risks to the patient [4].

Recovery

The temporary scarring left by a tonsillectomy performed just a day earlier
After the surgery patients may experience nausea or vomiting, but these symptoms do not last long and are usually gone within half a day. Because tonsillectomies are painful procedures pain medicine is often prescribed, but not always. However, medicines that increase the chance of bleeding, like ibuprofen, should not be taken. Antibiotics are usually also prescribed to help aid in the recovery process. Since the throat is usually very sore it is highly recommended to drink lots of fluid and eat soft or liquid food, e.g. ice cream, Popsicles, and even bubblegum. It is very common for a patient to lose about five pounds after surgery because of discomfort while eating. A patient may experience several symptoms after surgery which include: sore throat, fever, bad breath, redness and swelling of the throat and uvula, and even ear pain. Patients usually feel better within 5-12 days after the surgery

[10].

References

  1. Tonsils. De Brain.
  2. Tonsil removal has no major benefits over watchful waiting in children with throat infections or enlarged tonsils and adenoids. The Medical News. September 9, 2004
  3. Tonsillectomy Facts in the U.S.: From ENT Doctors American Academy of Otolaryngology — Head and Neck Surgery
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Tonsils and Tonsillectomy.TEXAS PEDIATRIC SURGICAL ASSOCIATES
  5. Dr. Alan Greene on Tonsil Removal By Alan Greene. Parents
  6. THE PURPOSE AND FUNCTIONS OF TONSILS. Alfred Tienes. Heal Thyself (The Homoeopathic World) A Popular Journal of Medical, Dietetic, Social and Sanitary Science By J Ellis Barker
  7. Why do We Have Tonsils? Tricia Ellis-Christensen
  8. 8.0 8.1 8.2 8.3 Tonsillitis 24DR.com
  9. 9.0 9.1 9.2 9.3 Tonsillitis by KidsHealth
  10. Post-Tonsillectomy by Michael Poole. TEXAS PEDIATRIC SURGICAL ASSOCIATES