Tonsils are lumps of soft tissue and are part of the immune system. You have two tonsils, one on either side at the back of the mouth.
Tonsils vary in size from person to person.
A main function of tonsils is to trap germs (bacteria and viruses) which you may breathe in. Proteins called antibodies produced by the immune cells in the tonsils help to kill germs and help to prevent throat and lung infections.
You can normally see your tonsils by opening your mouth wide and looking in a mirror. They are the two fleshy lumps that you can see at the sides and back of the mouth.
Adenoids are made of similar tissue and are part of the immune system. They hang from the upper part of the back of the nasal cavity (see diagram).
Adenoids get bigger after you are born but usually stop growing between the ages of 3 and 7 years.
You cannot see your adenoids. If needed, a doctor can look at the adenoids either by using a light and a small mirror held at the back of the mouth, or by using a small flexible telescope.
Occasionally, an X-ray is done to determine the size of the adenoids.
Like tonsils, adenoids help to defend the body from infection. They trap bacteria and viruses which you breathe in through your nose.
They contain cells and antibodies of the immune system to help prevent throat and lung infections.
Although tonsils and adenoids may help to prevent infection, they are not considered to be very important. The body has other means of preventing infection and fighting off bacteria and viruses.
In fact, the adenoids tend to shrink after early childhood, and by the teenage years they often almost disappear completely. Generally, you can have your tonsils and adenoids removed without increasing your risk of infection.
Some problems associated with tonsils
Tonsillitis is an infection of the tonsils. A sore throat is the common symptom. In addition, you may also have a cough, high temperature (fever), and headache, feel sick, feel tired, find swallowing painful, and have swollen neck glands.
Pus may appear as white spots on the enlarged tonsils. Symptoms typically get worse over 2-3 days and then gradually go, usually within a week.
Most cases of tonsillitis are caused by viruses, some are caused by bacteria. See separate leaflet called Tonsillitis for more details.
Glandular fever (infectious mononucleosis)
Infectious mononucleosis is caused by the Epstein-Barr virus. It tends to cause a severe bout of tonsillitis in addition to other symptoms.
This is also known as peritonsillar abscess. An abscess is a collection of pus. Quinsy is an uncommon condition where an abscess develops next to a tonsil due to a bacterial infection.
It usually develops just on one side. It may follow an episode of tonsillitis or may arise on its own. The tonsil on the affected side may be swollen or look normal, but is pushed towards the midline as pus forms and the abscess next to the tonsil gets bigger and bigger.
Quinsy is very painful and can make you feel very unwell. It is treated with antibiotic medicines, but also the pus often needs to be drained with a small operation.
Cancer of the tonsil
This is a rare cancer. It is more common in smokers and those who drink a lot of alcohol.
What Is the Purpose of Tonsils and Adenoids?
Tonsils and adenoids are composed of tissue that is similar to the lymph nodes or “glands” found in the neck, groin, and other places in the body.
They are part of a “ring” of glandular tissue encircling the back of the throat. The adenoids are located high in the throat behind the nose and soft palate (roof of the mouth) and, unlike tonsils, are not visible through the mouth without special instruments.
The tonsils are the two masses of tissue on either side of the back of the throat.
Tonsils and adenoids are strategically located near the entrance to the breathing passages where they can catch incoming infections.
They ‘sample” bacteria and viruses and can become infected themselves. It is thought that they then help form antibodies to those “germs” as part of the body’s immune system to resist and fight future infections.
This function is performed in the first few years of life, but it is less important as the child gets older. In fact, there is no evidence that tonsils or adenoids are important after the age of three.
One recent large study showed, by laboratory tests and follow-up examinations, that children who must have their tonsils and adenoids removed suffer no loss whatsoever in their future immunity to disease.
There is a popular myth that tonsils and adenoids filter bacteria out of what we swallow and breathe, somewhat like a kitchen strainer.
This is untrue. Any filter that could strain out microscopic bacteria would not allow the passage of any food particles and would make eating impossible.
How Does the Doctor Check Tonsils and Adenoids?
The primary methods that are used to evaluate tonsils and adenoids include:
- Medical History
- Physical examination
- Bacteriological cultures
- Blood tests
- Possible additional studies
Your physician will take a history about the patient’s ear, nose, and throat problems and perform an examination of the head and neck.
Examination of the nose and throat may be aided by the use of small mirrors or a flexible lighted instrument. The physical examination will also determine whether the lymph nodes in the neck are enlarged.
Cultures are important in diagnosing certain infections in the throat, especially ”Strep” throat. Whether or not a culture is taken will depend on your physician’s judgment and on the appearance of the throat.
Cultures for other bacteria and even for viruses can be done but are seldom necessary.
X-rays are sometimes helpful in determining the size and shape of the adenoids. These x-rays are quite safe.
What Diseases Affect Tonsils and Adenoids?
The most common problems affecting the tonsils and adenoids in children are recurrent infections (causing sore throats) and significant enlargement (causing trouble with breathing and swallowing).
Recurrent acute infections of the tonsils also occur in adults.
So do abscesses around the tonsils, chronic tonsillitis, and infections of small pockets (crypts) within the tonsils that produce bad smelling, cheesy-like formations.
Tumors can also grow in the tonsils, but they are rare.
When Should I Consult My Doctor?
You should see your doctor when you or your child suffer the common symptoms of infected and enlarged tonsils and adenoids:
Recurrent sore throats, fever, chills, bad breath, nasal congestion or post-nasal drainage or obstruction, recurrent ear infections, mouth breathing, snoring, and sleep disturbances.
Do I need my tonsils taken out?
You may be advised to have your tonsils removed in certain situations. In particular:
If you have frequent and severe bouts of tonsillitis. This usually means:
- Seven or more episodes of tonsillitis in the preceding year.
- Or, five or more such episodes in each of the preceding two years.
- Or three or more such episodes in each of the preceding three years.
And the bouts of tonsillitis affect normal functioning. For example, they are severe enough to make you need time off from work or from school.
The adenoids may also be removed at the same time for this reason. Throat infections are not totally prevented if the tonsils are removed.
However, there is a good chance that their number and severity will be reduced.
Also, the risk of developing quinsy is reduced. Many people say they generally feel better in themselves after having their tonsils removed if they previously had frequent bouts of tonsillitis.
If you have large tonsils that are partially obstructing your airway, this may be a contributing factor to a condition called obstructive sleep apnoea syndrome.
- If you develop cancer of the tonsil.
- Decision aids
- Doctors and patients can use Decision Aids together to help choose the best course of action to take.
- Compare the options
- Some problems associated with adenoids
- Swollen or enlarged adenoids are common in children. Causes include:
Infections with viruses or bacteria. Once an infection clears, the swelling often goes down but sometimes the adenoids remain enlarged.
- Often there is no apparent cause
What are the symptoms of swollen, enlarged adenoids?
Swollen adenoids may not cause any symptoms or problems. However, symptoms may develop in some cases, especially if the adenoids become very large. Possible symptoms include the following:
Breathing through the nose may be noisy or rattly. This may get worse and cause difficulty breathing through the nose. The child then mainly mouth breathes.
- A constantly runny nose.
- Snoring at night. In severe cases sleep may be disrupted by the blocked nose and there is difficulty with breathing.
- Swollen adenoids may block the entrance of the Eustachian tube. This is the tube that goes from the back of the nose to the middle ear. It normally allows air to get into the middle ear. If this tube is blocked it may contribute to the formation of glue ear (fluid in the middle ear). See separate leaflet called Glue
What is the treatment for enlarged adenoids?
In most cases no treatment is needed. Often the symptoms are mild but may flare up during a cold or throat infection.
Adenoids normally gradually shrink in later childhood and usually almost disappear by the teenage years. So symptoms tend to clear in time.
If symptoms are severe then a doctor may consider removing the adenoids. For example, if a child regularly has difficulty sleeping or disrupted nights’ sleep due to a blocked nose. Also, some children with glue ear may benefit from removal of their adenoids.
Several years ago, operations to remove tonsils and adenoids were very common. These operations are done less commonly these days and the main indications for them being advised are discussed above.
As with all operations, there is a risk involved with surgery.
For example, possible complications of surgery include infection, severe bleeding from the sites where the tonsils or adenoids were removed, and anaesthetic reactions.
Also, after adenoids are removed, there is a small risk that speech may become nasal.
That is, a child may sound as if they are speaking through their nose.
This is because after the adenoids are removed, the gap between the back part of the nose cavity and the roof of the mouth may not close properly, as it should do when we talk. If this occurs, it may only be temporary.
However, in a small number of cases speech therapy is needed, or even an operation to narrow the gap.
Therefore, before you have, or your child has, an operation it is useful to discuss with the surgeon the benefits versus the risks of the operation.