Sometimes, at a pediatrician's appointment, parents hear that their child has enlarged tonsils. Many questions arise as to why this is happening. But the treating doctor does not always have enough time to answer all the questions of each patient. That is why the famous pediatrician and TV presenter Yevgeny Komarovsky undertook to clarify the question.
What are tonsils and why are they enlarged?
Tonsils in medicine are called formations that consist of lymphoid tissue. This tissue is made up of cells of the immune system, which are known to have protective functions. Lymphoid tissue is found in different parts of the body, but the tonsils are located in the mouth. That is why such a conclusion as "hypertrophy" is made by the pediatrician after he examines the baby's throat. These tonsils are called the palatine tonsils, and there is also the pharyngeal tonsil. People still call them "tonsils".
The tonsils may simply enlarge, or they may also become inflamed. In the first case, they talk about hypertrophied tonsils, and in the second, about tonsillitis.
If the palatine tonsils are clearly visible with the naked eye, then the pharyngeal tonsils can only be seen when examined by a doctor, who will use special instruments, since it is located near the back wall of the nasopharynx. It can also grow and become inflamed.
When this happens, the diagnosis is different: "adenoiditis" or simply "adenoids".
The palatine tonsils can become enlarged and inflamed for a variety of reasons. Most often this happens during tonsillitis or chronic tonsillitis. The fact is that the mouth is the entrance hole, and the tonsils perform the function of border guards. If a virus or bacterium enters, the tonsils immediately respond to this with an increase, and sometimes inflammation, if the causative agent of the disease is present in large quantities.
The pharyngeal tonsil enlarges and becomes inflamed for the same reason. But to see her without a special mirror used by doctors is not possible. With adenoiditis, the pharyngeal tonsil does not decrease after enlargement for the duration of the disease, it remains overgrown, completely or partially blocks nasal breathing.
If the doctor says that the child has loose tonsils, this also indicates contact with a virus, fungus or bacteria.
What symptoms to look out for?
With an increase and inflammation of the palatine tonsils, parents themselves can easily see a sore throat in a child, enlarged tonsils, which turn red, on which ulcers can be observed in some forms of tonsillitis, and purulent plugs, white or yellowish plaque. As for the pharyngeal tonsil, it is also difficult to confuse here if you know what symptoms accompany the adenoids.
Since the pharyngeal tonsil is located at the very base of the nasopharynx next to the auditory tube, a child who has increased lymphoid tissue in this place will have a violation of nasal breathing and a decrease in auditory function.
Depending on how severe the symptoms are, three degrees of adenoiditis are distinguished: at the first, the nasal passages are closed by almost a third and breathing is generally preserved, like hearing, at the second degree, the lumen is half closed, and at the third, two-thirds of the miscalculation is blocked and it is almost impossible to breathe through the nose. There is also a complete closure due to overgrowth, in which nasal breathing is absent. In this case, they also put the third degree, although some experts tend to call it the fourth.
The danger lies in the fact that the child begins to experience oxygen starvation due to an insufficient number of full breaths, he inhales through the mouth, the air does not warm up and is not sufficiently humidified, which increases the likelihood of diseases of the bronchi and lungs.
The nose is swollen inside, there are stagnations in it, the child's voice becomes nasal. The frequency of otitis media increases and hearing decreases. Even in sleep, the child continues to breathe with his open mouth.
If inflammation and enlargement of the palatine tonsils occurs at any age, then the pharyngeal is a typical children's problem, which mainly affects babies from 4 to 7 years old. It is at this age that the lymphoid tissue grows the most, but with age it tends to decrease.
What to do?
What to do with enlarged and inflamed tonsils depends on why and how much they have enlarged. Physiological reversible increase, which is often observed during a viral or cold illness, as well as for some time after the baby's illness, does not need treatment or other intervention. If the baby has a sore throat, it is imperative to undergo antibiotic treatment, gargle, strengthen the child's immunity so that tonsillitis does not become chronic. With chronically enlarged palatine tonsils, surgical removal of the overgrown lymphoid tissue (tonsillectomy) is also practiced.
In the case of the pharyngeal tonsil, conservative treatment is possible at 1 and 1-2 transitional stages of the disease. In other cases, surgical intervention is recommended - cutting or removing the tonsil (adenotomy). Komarovsky recommends treating adenoids with medications, if the stage allows, refrain from various folk and homeopathic remedies - the behavior of the lymphoid tissue can be too unpredictable and the consequences can be severe.
Conservative therapy is prescribed by the attending physician. These are various vitamins and stimulants of children's immunity, nasal rinses and drops with anti-inflammatory, antibacterial effect (if there is inflammation).
But if there is no effect or the stage is higher than the second, it is worth considering surgical treatment, not to abandon it. And the point is not what stage, what matters is how much adenoids interfere with a child's normal life. It also happens that at the first degree of the problem, hearing loss is observed, and then surgery is indicated.
Surgical treatment, says Yevgeny Komarovsky, is carried out under both local and general anesthesia. It lasts no more than 3 minutes. There is nothing complicated about it, but the apparent simplicity should not mislead about security. As after any other operation, complications are not excluded, an inadequate reaction of the child's body to the injected drugs for anesthesia, nosebleeds.
A well-known doctor advises to carefully prepare for the operation - to undergo an examination, to try not to get sick with colds and viral ailments for at least a couple of months. Recovery happens quickly - in a few days.
Komarovsky draws the parents' attention to the fact that it is impossible in principle to completely remove the lymphoid tissue, and therefore the probability of a new growth is always there.
Relapse prevention
First of all, says Evgeny Olegovich, after the operation, you need to change the baby's lifestyle. Large tonsils do not arise only due to viruses and bacteria, there must be a predisposition to the disease. If you do not take into account heredity (which, by the way, plays an important role here), the risk factors are quite obvious:
- dusty dry air;
- reduced immunity;
- inhalation of chemical vapors, aerosols;
- low physical activity of the toddler and poor nutrition.
To prevent the disease from returning after treatment, you need to create conditions for the child to exclude the development of allergies, contact with chemicals, house dust. The air at home should be sufficiently humid.
You can increase immunity by playing sports, hardening, giving up the weekend in front of the computer and replacing such leisure with family outdoor recreation, active games.
Doctor Komarovsky will tell you when children need to cut out tonsils in the next video.
