The tonsils are soft tissue masses that reside at the back of the throat on the lateral walls, situated between the back of the tongue and the lateral limits of the soft palate. They are part of the immune system, and are involved with scanning the environment and initiating an immune response if needed. The adenoid, also known as the nasopharyngeal tonsil is a single tissue mass located in the space behind the nasal cavities. When these entities are functioning normally, they are only noticeable when there is an active infection. There are disease states, however, when removal of these tissues is necessary.
Recurrent tonsillitis exists when the tonsils are becoming infected by bacteria repeatedly over a period of time. Infection causes the tonsils to become enlarged, reddened and often coated with whitish material. The generally accepted indications for removal of the tonsils for recurrent infection is 7 infections in one year, 5 per year for 2 years or 3 or more per year for 3 or more years. Other factors, such as unusually severe infections or the development of an abscess next to a tonsil will accelerate the decision for surgery. Because of its proximity and essentially identical makeup to the tonsils, the adenoid will usually be considered for removal as well.
Obstructive tonsils and adenoid exists when these structures have become enlarged to the point that significant airway blockage occurs. In the case of the adenoid, nasal obstruction is the primary symptom, although a nocturnal cough or the accumulation of fluid in the middle ears can occur as well. When the tonsils or tonsils and adenoid become enlarged, varying degrees of obstructive signs and symptoms can occur. Severity varies from simple snoring (snoring without obstruction) to the point of gasping or temporary stoppages in breathing. An apnea occurs when there is a stoppage in breathing for 10 seconds or longer. A patient with documented Obstructive Sleep Apnea Syndrome (OSAS) has undergone a sleep study, generally in a sleep lab, and has been found to have enough frequency of events to receive this diagnosis. Children with OSAS are frequently obligate mouth breathers, are frequently tired or more irritable than usual, and may assume odd positions during sleep. These children may have other sleep issues such as bedwetting or sleep walking, and in the severest cases their growth may slow down considerably from their previous growth curves.