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Tonsils and adenoids: Should they stay or should they go?

It used to be that having your tonsils removed was a rite of childhood. Today, however, the surgery is far less common because throat infections such as tonsillitis can usually be treated with antibiotics. Yet, for children who suffer repeated infections and develop breathing, swallowing or hearing problems, removing the tonsils and sometimes the adenoids can be the best way to restore their health.

What do they do?

The tonsils and adenoids are types of lymph glands in the back of the throat. You can see the pink, oval-shaped tonsils on either side. You can’t see the adenoids, clusters of spongy tissue that sits in the back of the nose above the roof of the mouth. Your doctor can view the adenoids with a special mirror or instrument.

Experts believe the tonsils and adenoids are part of the body’s immune system because they trap inhaled bacteria and viruses and make antibodies to fight infections. The tonsils and adenoids usually swell when fighting an infection and then return to normal size. Sometimes they become infected themselves, such as with tonsillitis.

When infections occur

Telltale signs of tonsillitis include a sore throat; red, swollen tonsils; a white or yellow coating on the tonsils; a raspy voice; swollen glands in the neck; uncomfortable or painful swallowing; fever; and bad breath. If your child has tonsillitis, your doctor will likely prescribe antibiotics if bacteria caused the infection. Infections caused by a virus merely need to run their course. In either case, offer your child plenty of warm, soothing liquids such as soups, broth and tea. Give acetaminophen or ibuprofen to reduce fever and pain. Keep your child home until he or she feels better and has no fever.

If your child’s adenoids are enlarged or infected, he or she may find it difficult to breathe through the nose, which may sound blocked when speaking. Other symptoms include a sore throat, swollen glands in the neck and difficulty swallowing. Your child may also suffer frequent sinus or ear infections; snore at night; or have sleep apnea, a condition in which he or she stops breathing for a few seconds. This can impair a child’s sleep so much that it causes daytime sleepiness or behavior problems. Your doctor will likely treat swollen adenoids with antibiotics or a penicillin injection.

Should they come out?

Doctors are reluctant to remove the tonsils or adenoids, since kids tend to outgrow the problems. The tonsils and adenoids usually shrink during the teen years, reducing the conditions associated with them. However, your doctor may suggest surgery to remove the tonsils or adenoids if your child suffers from:

  • repeated bouts of tonsillitis over a certain period, such as seven infections in one year, five infections a year for two years or three infections a year for three years
    • tonsillitis that recurs despite antibiotics
    • frequent sinus and ear infections
    • sleep apnea
    • breathing, swallowing and hearing difficulties

    If surgery is needed, reassure your child that the procedure will help him or her feel better soon—and that staying home from school and eating plenty of ice cream is part of the deal.