March 18, 2022 The tonsils and adenoids are structures that are part of the upper airway lymphoid system . Its function is to protect against harmful substances that can be inhaled and swallowed. The tonsils are visible when the mouth is opened, located at each side next to the posterior portion of the tongue. Adenoids cannot be seen by direct observation as they have a higher location. Infections of the tonsils are called tonsillitis and those of adenoids are called adenoiditis. These are usually acute infections, but they can also be chronic. Tonsillitis The most common tonsillitis has a viral cause and usually appear simultaneously with an inflammation of the remaining upper airway (tonsillopharyngitis). The main symptoms of tonsillitis are: Sore throat; Fever; Difficulty in swallowing; Food refusal (in children); Reflex otalgia; Nasal secretions increase; Nasal obstruction; Cough; General malaise. Most cases of viral tonsillitis are self-limiting and require only symptomatic therapy for pain and fever . Acute tonsillitis can also be bacterial , which is usually caused by beta-hemolytic streptococci. Typically, whitish plaques can be seen on the surface of the tonsils. In these cases, it is necessary to add an oral antibiotic to the treatment. Some systemic diseases can be associated with tonsillitis, such as mononucleosis. The irregularity of the tonsils surface can form more or less deep crypts. These crypts allow a greater exposure to microorganisms and favor the accumulation of colonies, food, and epithelial debris, which can contribute to chronic infection/inflammation and the appearance of caseum, a whitish to yellowish material, responsible for discomfort, foreign body sensation and halitosis. In case of recurrent tonsillitis , depending on the number of episodes per year, surgical treatment with removal of the tonsils (tonsillectomy) is often the only solution for these infections. Adenoiditis The irregular surface of the adenoids and their location allow its exposure to substances of the nasal mucus and the formation of bacterial aggregates on its surface. Adenoid hypertrophy associated with its stimulation can be significant and cause symptoms of mechanical obstruction of the nasal passages or even Eustachian tube dysfunction. These effects are more frequently in children due to the smaller dimensions of the pharynx and to the particular characteristics that the Eustachian tube has at this age. Adenoid hypertrophy is an inflammatory reaction and is therefore called adenoiditis . When the symptoms of adenoiditis are prolonged and there are no acute inflammatory symptoms or signs (fever and pain), adenoiditis is classified as chronic . If, on the other hand, the onset is rapid, in days or hours, with sore throat, fever and purulent nasal secretions, it is classified as acute . The treatment of acute adenoiditis is similar to that of acute tonsillopharyngitis. Chronic adenoiditis has a benign course , although it can last for months or years. It should be treated when symptoms impact quality of life with: Snoring; Tubal dysfunction / serous otitis (with hearing loss); Nasal obstruction with eating disorders. Treatment is with topical corticosteroids and nasal washes with saline solutions. If there is no response to medical therapy, surgical treatment , with removal of the adenoids (adenoidectomy) may be necessary. When to seek for an otolaryngologist Medical care from an otolaryngologist should be sought: For initial diagnosis of any of these situations; To e xclude complications (such as abscesses) if symptoms of acute illness persist or worsen after treatment instituted by another physician; In case of chronic or recurrent tonsillitis / adenoiditis . This article was written by the otorhinolaryngology team at Hospital da Luz Lisboa. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
