John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What are common problems affecting the tonsils and adenoids?
The most common problems occurring with the tonsils and adenoids are
recurrent or chronic infections and significant enlargement (hypertrophy).
Acute Tonsillitis
Acute tonsillitis is an infection of the tonsils caused by one of several possible types of bacteria or viruses. Acute tonsillitis is characterized by either the sudden or gradual onset of a
sore throat which is usually associated with fever. The patient may stop swallowing saliva, start to drool, complain of ear pain with swallowing, and have bad breath. The surface of the tonsil may be bright red or have a grayish-white coating (exudate). The lymph nodes in the neck may be swollen. Fever can be present.
Strep throat (tonsillitis) is a specific type of infection caused by the
Streptococcus bacteria. Strep tonsillitis can cause secondary damage to
the heart valves (rheumatic fever) and kidneys (glomerulonephritis). It
can also lead to a skin rash (scarlet fever), sinusitis, pneumonia, and
ear infections.
Acute mononucleosis is caused by the
Epstein-Barr virus,
and can lead to a very severe throat infection which is characterized by
the rapid enlargement of the tonsils, adenoids, and lymph nodes of the
neck. It also causes extreme malaise and tiredness. The sore throat and gland swelling can last for one week to a month and does not respond to the usually prescribed antibiotics.
Chronic Tonsillitis
Chronic tonsillitis is a persistent infection of the tonsils. Repeated infections may cause the formation of small pockets (crypts) in the tonsils which harbor bacteria. Frequently, small, foul smelling stones are found within these crypts. These stones (tonsilloliths) may contain high quantities of sulfa. When crushed, they give off the characteristic rotten egg smell which causes bad breath. They may also give a patient the sense of something being caught in the back of the throat.
Peritonsillar Abscess
A peritonsillar abscess is a collection
of pus behind the tonsils that pushes one of the tonsils toward the uvula
(the prominent soft tissue dangling from the back of the upper throat. It
is generally very painful and is associated with decreased ability to
open the mouth. If left untreated, the infection can spread deep in the
neck causing life-threatening complications and airway obstruction.
Enlargement of (Hypertrophic) Tonsils and Adenoids
Obstruction to breathing by enlarged tonsils and adenoids
may cause snoring and disturbed sleep patterns that may lead to sleep pauses or sleep apnea.
Other features include frequent awakening from sleep, restless sleep,
nightmares, bedwetting, mood changes, excessive sleepiness, and even heart problems. Some orthodontists believe that chronic
mouth breathing from large tonsils and adenoids causes improper alignment
of the teeth (malocclusion). Chronic enlargement and infection of the
adenoids may lead to infection of the air passages around the nose
(sinusitis) or nasal drainage/obstruction, and/or may affect the
eustachian tube of the ear, leading to
chronic ear infections.
Most sore throats are caused by viruses or mechanical causes (such as mouth breathing) and can be treated successfully at home. However, a person should be seen by a health care professional if they have a sore throat that has a rapid onset, and is associated with a fever or tenderness of the front of the neck; a sore throat that causes the person to have difficulty swallowing (not just pain swallowing) or breathing; or if a sore throat lasts for more than a week.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
Strep throat is a sore throat caused by a bacterium called streptococcus (strep) that can be treated through antibiotics. Common symptoms of strep throat include pinkeye, runny nose, skin rash, cough, hoarseness, diarrhea and more. Complications of untreated strep throat include middle ear infections, meningitis, pneumonia, rheumatic fever, and more.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
The Eustachian tube is a membrane lined tube that connects the middle ear space to the back of the nose. Problems include partial or complete blockage which can cause popping, clicking, and ear fullness. Allergies, sinus and ear infections, or the common cold can cause this blockage, while altitude changes can cause symptoms in those persons with Eustachian tube problems. Treatment includes several maneuvers (swallowing, chewing gum, yawning etc.), which can be done to improve Eustachian tube function.
Middle ear infection or inflammation (otitis media) is inflammation fo the middle ear. There are two types of otitis media, acute and chronic. Acute otitis media is generally short in duration, and chronic otitis media generally lasts several weeks. Seventy-five percent of children in the U.S. suffer from otitis media at some point. Treatment depends upon the type (chronic or acute).
Snoring, like all other sounds, is caused by vibrations that cause particles in the air to form sound waves. While we are asleep, turbulent air flow can cause the tissues of the nose and throat to vibrate and give rise to snoring. Any person can snore. Snoring is believed to occur in anywhere from 30% of women to over 45% of men. People who snore can have any body type. In general, as people get older and as they gain weight, snoring will worsen. Snoring can be caused by a number of things, including the sleep position, alcohol, medication, anatomical structure of the mouth and throat, stage of sleep, and mouth breathing.
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