Tonsils: when to have surgery?
Tonsils: when should they be removed and when is it better to follow other therapies? In the past, tonsil and adenoid surgery was very common in pre-school and school-age children, so much so that it seemed almost a compulsory transition to adolescence. Today, “guidelines and good medical practice” inspire medical and surgical indications in relation to which tonsils and adenoids are removed when they are the cause of recurring infections, even in borderline areas – paranasal sinuses and middle ear – or if they are associated with sleep disorders
Voice: can removing tonsils change it?
The tonsils occupy the area of the oropharynx between the anterior and posterior palatine pillars.
The oropharynx contributes to voice amplification, the voice being different depending on whether or not the oropharyngeal region is occupied by tissue that modifies its size and volume, just as happens when speaking in a large furnished or unfurnished room.
What changes, therefore, is not the “harmonics” resulting from the vibration of the vocal cords, but the overall amplification of the voice and its subjective perception, which results from the air spaces above, the pharynx as well as the paranasal sinuses.
Tonsils and adenoids: is their function related?
Tonsils and adenoids and the base of the tongue are part of Waldeyer’s lymphatic ring.
In early childhood they complement the activity of the immune system, protecting us from infection.
The adenoids, located in the nasopharynx – the air space behind the nasal passages – when excessively large – adenoid hypertrophy – can cause respiratory obstruction; restrict the regular passage of mucus from the sinuses to the nasal passages and then to the pharynx, resulting in rhinosinusitis; restrict the regular passage of mucus from the middle ear to the pharynx, resulting in seromucous otitis media; alter palatal development and correct dentition.
In the course of growth, not only does the nasal and oropharyngeal air space widen, resulting in less encumbered adenoids and tonsils; the immune system also acquires autonomous competence and, as a rule, adenoids and tonsils become functionally involuted and atrophy.
Therefore, if the natural history of adenoids and tonsils is destined to involution over time and waiting in fact changes a hasty surgical indication, one often finds oneself making the decision to operate in relation to the impact on the child’s quality of life with repeated infections, repeated antibiotic treatment, loss of school days, poor night’s rest and quality of life during play and learning hours.
The quality of sleep plays a crucial role in the recovery of psychophysical daytime fatigue in both school age and adulthood.
Hypertrophied adenoids and tonsils may be involved in the development of obstructive sleep apnoea syndrome.
Polysomnography certifies the presence, type and degree of nocturnal apnoea, leading to possible therapeutic indications.
Plaques in the throat: what is the link with the tonsils?
The appearance of the tonsils is reminiscent of that of the Norwegian fjords, i.e. the surface is not regular, but fractured.
In the age of functional activity, this aspect increases the surface area of action of the tonsil, but it is also the ideal nest for bacterial replication, which is evidenced by the presence of ‘plaques’.
Care must be taken, however, not to confuse plaques with collection here of food residues – casei or tonsilloliths.
In this case it would be excessive to treat with antibiotics a problem that, although it may be uncomfortable, can be controlled by improving hygiene in the oral cavity after meals.