Still, I recommend a tonsillectomy only after careful consideration. Most children I examine have been referred by their pediatrician because their tonsils are very swollen, causing breathing problems, or they're experiencing repeated infections that keep them from school and other activities. When antibiotics and time don't seem to help as much as we'd like and when your child's ability to breathe and function normally is impaired, it may be time to consider surgery.
Healthy tonsils are small, rounded lumps at the back of the throat on each side, visible just above the tongue. They are part of a ring of lymphoid tissue in the back of the throat that includes the adenoids. The adenoids must be checked with an angled mirror since they lie between the back of the nose and the throat. Swollen tonsils are easier to see, forming a reddish, oval mass.
I'm Dr. Cindy Gellner and we'll discuss that today on The Scope. Announcer: Keep your kids healthy and happy. Cindy Gellner on "The Scope. Gellner: So tonsils are the small glands on either side of the back part of the throat. Their main job is to help stop bacteria from getting farther down the throat.
Some people have large tonsils and some people have small tonsils. Tonsils are graded on a scale from 0 to 4. Zero means you've had them removed, 1 means they're barely visible, 2 means they're normal, 3 means they're large and just about touching that thing that hangs down at the back of your throat called the uvula, and 4 means they're ginormous.
Children with enlarged tonsils or adenoids may have an abnormally shaped palate and position of the teeth. Children may also tend to breathe through their mouth. Enlarged tonsils can also cause nosebleeds Nosebleeds Some people get nosebleeds rather often, and others rarely get them.
There may be just a trickle of blood or a strong stream. If people swallow the blood, they often vomit it because blood is Certain diseases produce substances that are detectable on the breath, but these odors are typically mild and not considered Enlarged tonsils and adenoids are considered a problem when they cause more serious problems such as the following:.
Chronic ear infections Chronic Middle Ear Infection in Children Chronic middle ear infection results from recurring infections that may damage the eardrum or lead to formation of a cholesteatoma, which in turn promotes more infection.
Chronic middle ear If children do not respond to sounds Recurring sinus infections: See Sinusitis Sinusitis Sinusitis is inflammation of the sinuses, most commonly caused by a viral or bacterial infection or by an allergy. Some of the most common symptoms of sinusitis are pain, tenderness, nasal congestion Obstructive sleep apnea Obstructive sleep apnea in children Sleep apnea is a serious disorder in which breathing repeatedly stops long enough to disrupt sleep and often temporarily decrease the amount of oxygen and increase the amount of carbon dioxide As a result, oxygen levels in the blood may be low, and children may wake up frequently and be sleepy during the day.
Rarely, obstructive sleep apnea caused by enlarged tonsils and adenoids has serious complications, such as high blood pressure in the lungs pulmonary hypertension Pulmonary Hypertension Pulmonary hypertension is a condition in which blood pressure in the arteries of the lungs the pulmonary arteries is abnormally high.
Many disorders can cause pulmonary hypertension. Weight loss or lack of weight gain: Children may not eat sufficiently because of pain resulting from infections or because breathing takes constant physical effort. Very large tonsils may be normal, and chronically infected tonsils may be normal-sized. To help determine whether infections are the cause of enlarged tonsils, doctors ask how many episodes of strep throat children have had during the past 1 to 3 years. Usually, to view the back of the nose and throat, doctors insert a flexible viewing tube through the nose called a nasopharyngoscope.
Doctors also look for redness of the tonsils, enlargement of lymph nodes at the jaw and in the neck, and the effect of the tonsils on breathing. In such cases, doctors may recommend the child undergo a sleep study polysomnography Testing The most commonly reported sleep-related problems are insomnia and excessive daytime sleepiness. Insomnia is difficulty falling asleep or staying asleep, waking up early, or a disturbance in Surgery, no matter how common or simple, can be scary for kids.
Help prepare your child by talking about what to expect. An ear, nose, and throat ENT surgeon will do the surgery while your child is under general anesthesia. This means an anesthesiologist will keep your child safely and comfortably asleep during the procedure. The surgery is done through your child's open mouth. There are no cuts through the skin and no visible scars. Usually, parents can stay with their child until the anesthesiologist gives medicine.
Then you'll go to a waiting area until the surgery is over. Your child will wake up in the recovery area. Many kids go home the same day, though some may stay overnight. In general, kids under 3 years old and those with serious sleep problems like apnea usually stay overnight. Depending on the type of surgery done, recovery after a tonsillectomy may take a week or more.
Expect some pain and discomfort after the tonsils are removed, which can make it hard for kids to eat and drink. Sometimes children get dehydrated from not drinking enough when they go home, and may need to come back to the hospital for fluids.
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