Adenoids and Tonsils (cont.)

How is tonsillitis and adenoid infection treated?

Bacterial infections of the tonsils and adenoids are treated with various antibiotics. Tonsillitis caused by the streptococcus bacteria can lead to serious complications, and must be treated. Often the diagnosis of strep throat is confirmed by a throat culture or rapid-strep tests in the doctors office. Once treatment begins, it is important to take the full course of antibiotics as prescribed because premature discontinuance of therapy can lead to adverse consequences and regrowth of the bacteria. Surgical removal is considered in situations resistant to medical therapy or in frequently recurrent infections.

Viral causes of tonsillitis are often treated with only supportive care (hydration and control of fever). Antibiotics are not effective for viral infection of the tonsils.

A peritonsillar abscess should be drained either by removal of fluid with a needle and syringe (needle aspiration), cutting open with a scalpel (incision), or tonsillectomy. Chronic stones in the tonsil can be removed with a clean finger or with a blunt probe. Massive enlargement of the tonsils and adenoids causing airway obstruction may be treated with a long course of antibiotics, or even a brief course of steroids (cortisone-related medications, such as prednisone and prednisolone).

When should the tonsils and/or adenoids be removed?

Tonsillectomy and adenoidectomy are indicated in persons with repeated or persistent infections, particularly if they interfere with everyday activities. In general, repeated infections in children are defined as six to seven episodes in one year, or four to five episodes in each of two years, or three episodes in each of three years.

A significant episode of tonsillitis is defined by one or more of the following criteria: (1) a temperature greater than 101°F; (2) enlarged or tender neck lymph nodes; (3) pus material coating the tonsils; or (4) a positive strep test.

In adults, the severity, frequency, and hardship associated with repeated infections are considered more important than the absolute number. Chronic infections characterized by bad breath and/or tonsillar stones causing significant disability are also indicators for tonsillectomy.

Tonsillectomy and adenoidectomy are strongly considered in those patients who are suffering, or may suffer serious complications of infection. These include peritonsillar abscess, history of streptococcal complications (rheumatic heart disease, glomerulonephritis), or neck abscess. Suspicion of malignancy or tumor is a definite reason for surgery.

Tonsillectomy and adenoidectomy are also warranted in situations where there is enlargement of the tonsils and adenoids to such an extent that it causes severe sleep problems (snoring and breath holding), sleep apnea, dental abnormalities, and difficulty swallowing. Adenoid enlargement alone, or in combination with tonsillar enlargement, can cause nasal obstruction, recurrent ear infections, or sinusitis. If these conditions are resistant to medical therapy, surgery is indicated.

In should be emphasized that all decisions for or against surgery are dependent upon the individual patient's particular situation. Additional factors, such as tolerance of antibiotics, concurrent medical problems, school achievement/progress, and family preferences are also important in the decision process.

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