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Tonsillar Hypertrophy

more about Tonsillar Hypertrophy

  • The tonsils are small pieces of tissue in the back of the throat, on the right and left side.  They produce antibodies against infection.  Frequently, the tonsils enlarge in response to infection in and about the throat area.  When they enlarge, this is called tonsillar hypertrophy.
  • When the tonsils themselves have a lot of infected material inside them, the tonsils become red, painful, and often have pus collected on the surface or inside the crevices of the tonsils.  This infected situation is called Tonsillitis, which is different from simple enlargement (tonsillar hypertrophy).  Both situations can also occur simultaneously.
  • Many years ago, it was common to remove a child's tonsils if the tonsils remained enlarged for long periods of time, or if the child had recurrent Tonsillitis.
  • This is done much less commonly now, because (1) it is thought that the tonsils serve a necessary function, protecting the child against even more infections, and (2) rare episodes of severe bleeding in the back of the throat (post-operatively after tonsillecomy) makes surgeons more reluctant to do this elective procedure.

  • These are symptoms of enlarged (hypertrophied) tonsils, and not necessarily symptoms of Tonsillitis:
    1. Mouth-breathing and halitosis (bad breath)
    2. Snoring during sleep
    3. Episodes during sleep in which the child stops breathing temporarily
    4. Decreased appetite and poor weight gain
    5. Longstanding fatigue

  • The most likely cause of tonsillar hypertrophy is repeated cases of infection in and about the throat area, repeatedly stimulating the tonsils to produce antibodies against various infections.

  • Ordinarily, the tonsils are small patches of tissue that sit in the back of the throat, with a tonsillar pillar (which looks like a bedpost) on each side of the tonsil.
  • In tonsillar hypertrophy, the tonsils are very prominent, often bulging forward from the point where the tonsillar pillars sit.  The tonsils can be so large that they touch or almost touch each other ("kissing tonsils").

  • Familial tendency
  • Chronic illness

  • Just because the tonsils are large, this does not necessarily require their surgical removal.  Preschool children often have very large tonsils that cause no medical problems.
  • Before recommending surgery, it is desirable for the physician to examine the tonsillar size on several occasions, since the hypertrophy might just be a response to a recent infection.
  • The usual reasons for removing the tonsils currently are: (1) chronically (longstanding) enlarged tonsils that obstruct swallowing, or (2) chronically enlarged tonsils that obstruct the breathing (especially during sleep).
  • Another common reason for removing the tonsils is recurrent Tonsillitis, over and over again, making the child quite ill with each occurrence.  One example of a rule of thumb is 6 episodes of Tonsillitis in a year.

  • Complications of large tonsils:
    1. Tonsillar enlargement can be so large that the tonsils obstruct the airway, and not enough oxygen is passing through the back of the throat into the windpipe (trachea).  This makes the child fatigued and short of breath.
    2. Tonsillar enlargement can be so large that the tonsils obstruct solid food as it is being swallowed.  This makes the child gag on his or her food during the act of swallowing.
  • Complications of tonsillectomy surgery:
    1. Severe bleeding in the back of the throat during or after surgery
    2. Severe swelling in the back of the throat during or after surgery

  • If your child's tonsils appear quite large on a long-term basis, it is desirable for the parent to keep a record of the dates of throat infections, and the dates of any episodes when the child gags on food; or has breathing difficulty; or has pauses in the breathing (while sleeping at night).
  • It is also desirable to keep a record of any signs that the child is fatigued all the time.
  • Bring all this information to your child's physician for a discussion of enlarged tonsils.
  • Be prepared for several visits, so the physician can view the size of the tonsils over several visits.

more about Tonsillar Hypertrophy

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