Enlarged pharyngeal tonsils (polyps) in children

Enlarged (or hypertrophic) pharyngeal tonsils, colloquially referred to as polyps, develop as a result of an infection or other disorder.

These organs consist of lymphoid tissue comparable to that of the lymph nodes on the neck, and they are located at the transition from the nasal cavity to the throat.

The pharyngeal tonsils, like the palatine tonsils (tonsils), are made of lymphatic tissue and their task is to support the immune system in the fight against infections.

Children who always keep their mouths open must be examined by a doctor, because they could have inflammation of the pharyngeal tonsils.


Anatomy of the palatine tonsils and pharyngeal tonsils

The palatine tonsils (tonsils) are two organs that are located on both sides at the back of the palate, while the pharyngeal tonsils are located in the pharyngeal roof, behind the soft palate.

There are four types of tonsils:

  • Tonsilla lingualis (tongue tonsil) – lies behind the tongue.
  • Tonsilla palatina (palatine tonsil) – the paired palatine tonsils are located on the sides of the throat and you can see them when you open your mouth.
  • Tonsilla pharyngealis (pharyngeal tonsil) – located in the upper part of the nasal cavity.
  • Tonsilla tubaria (tubal almond) – located at the mouth of the Eustachian tube.

The palatine tonsils can be seen, while the pharyngeal tonsils can only be examined with special instruments.

Throat tonsils:

  • reach their maximum height in children between the ages of 3 and 5,
  • slowly regress after the age of 7.

As a rule, the pharyngeal tonsils disappear in adolescents.
In adults, these organs have become very small or have disappeared completely.

Classification of pharyngeal tonsillitis

Inflammation of the pharyngeal tonsils is classified according to the extent of obstruction of the nasopharynx:

Grade 0: no disability
Grade 1: Disability less than 25% Grade 2: 25% to 50% Grade 3: 50% to 75%

Grade 4: greatly enlarged pharyngeal tonsils with complete occlusion.

Causes of enlarged pharyngeal tonsils in children

The pharyngeal tonsils may be larger than is usually the case for the following reasons:

  1. Bacterial and viral infection
  2. Allergy
  3. Long-term inflammation
  4. Cystic carcinoma

As a rule, children whose parents suffer from hay fever are more likely to have inflamed pharyngeal tonsils.

Signs and symptoms of enlarged pharyngeal tonsils (adenoids) in children

  1. Noisy breathing
  2. Mouth breathing, this favors the occurrence of respiratory diseases
  3. Oozing language
  4. Constantly running nose
  5. Dry mouth
  6. Snore
  7. Halitosis
  8. Disturbed sleep
  9. Swollen tonsils
  10. Fever
  11. Enlarged lymph nodes
  12. Nasal congestion

Complications of enlarged pharyngeal tonsils

  1. Weight loss/developmental disorders
  2. Nocturnal breathing interruptions
  3. Sinusitis
  4. Partial and temporary hearing loss due to blockage of the Eustachian tube
  5. Obstructive sleep apnea
  6. The infection of the pharyngeal tonsils can spread to the ears and cause a middle ear infection, which can affect hearing.
  7. Stuffy ear
  8. Laryngitis
  9. Dry or mucous cough
  10. Vomit
  11. Swollen pharyngeal tonsils can completely block the natural nasal respiratory pathway
  12. In children, the polyps can cause positioning of the tongue forward, protrusion of the upper teeth and a prolonged face; the result is a dental malocclusion.

Link between ear infections and swollen pharyngeal tonsils

People whose pharyngeal tonsils are infected often also suffer from otitis media; The reason is the blockage of the
Eustachian tube – also called auricular tube.
The proximity of the pharyngeal tonsils to this structure explains the relationship between:

  • Adenoids
  • Ear infections.

The auricular tube is a long, thin tube that connects the middle ear to the nasopharynx.
By opening the tube, the pressure in the middle ear is compensated with the ambient pressure.
In addition, the mucus of the middle ear can drain through the auricular tube.
The enlargement of the pharyngeal tonsils can lead to blockage of the Eustachian tube.
The result is the accumulation of infected fluid in the middle ear.
Anyone who suffers from chronic inflammation of the pharyngeal tonsils is predestined for:

  • frequent middle ear infections,
  • Respiratory infections.

Diagnosis of enlarged pharyngeal tonsils and examinations

The doctor makes the diagnosis based on:

  • Medical history
  • physical examination.

The polyps are not visible when inspecting the neck, you have to use a nasal fibroscope (endoscope).

This device is inserted into the nose with a small movable tube; at its end are:

  • a light source,
  • a video camera.

The examination is carried out under local anesthesia; the doctor can move the tube from the outside so that he can see the nasal cavity better.

The doctor may order a blood test to determine the cause.
Rarely performed:

Treatment of childhood polyps

If bacteria are the causes, the doctor prescribes antibiotics to fight the infection.

In case of worsening of the disease, some doctors prescribe cortisone-containing agents (Betnesol or medical inhalations with Clenil), which, however, should not be taken for a long time because of the side effects.

When do enlarged pharyngeal tonsils need surgery? At what age?

Recurrent infections can lead to an enlargement of the pharyngeal tonsils.
This can obstruct the airways in:

  • Children
  • Adults.

The pharyngeal tonsils can be removed in chronic infections that could lead to:

  • Relapsive sinusitis
  • frequent ear infections.

As a rule, the polyps are removed in children from the age of 7, but in the case of major complaints, the procedure can also be done earlier.

Reasons for surgery

  1. Ear infection: Enlarged or infected pharyngeal tonsils sometimes cause earache.
    The infection adversely affects the functioning of the ear trumpet. Doctors often tend to have surgery if the children suffer from:

    • frequently recurrent ear infections,
    • severely swollen polyps.
  2. Congestion in the back of the nose: The pharyngeal tonsils sometimes swell to such an extent that they cause nocturnal breathing interruptions, snoring and mouth breathing.
  3. Nocturnal breathing interruption: Swollen pharyngeal tonsils are one of the main causes of nocturnal pauses in breathing.
    Therefore, the most common reason for removing the polyps is to improve nighttime sleep and avoid nocturnal breathing interruptions.

Surgical removal of the pharyngeal tonsils

As a rule, removal of the pharyngeal tonsils (adenotomy) is performed in children.
The procedure is performed under general anesthesia.
The surgeon:

  • introduces a mouth lock to keep the mouth open,
  • removes the polyps with a microdebrider.

The cut can be done with:

  • a knife,
  • a CO2-Laser.

Some surgeons prefer to simply cauterize the pharyngeal tonsils rather than remove them to reduce blood loss.
One of the latest discoveries is an instrument capable of transmitting high-frequency alternating current (4-16 MHz); This allows:

  • cutting away the adenoids,
  • the coagulation of the blood without burning the surrounding tissues.

The bleeding can be stopped with:

  • swabs,
  • Gauze
  • a diathermic instrument (which emits electric current),
  • by cauterization.

surgery The procedure takes about half an hour.
After waking up, the patient can:

  • suffer from stomach pain;
  • vomiting is also possible in the first 24 hours after the procedure.

1-2 days the child will have a slight sore throat.
Most patients can eat and drink again within hours of the procedure.
After surgery, the child should be encouraged:

  • drink cold liquid;
  • cold and soft spokes to eat.

The doctor prescribes antibiotics for 5-10 days after surgery.
After the procedure, neck pain may occur.
The side effects are minimal.

Complications of surgical polyp removal

  • Bleeding: In rare cases, a blood transfusion is necessary.
  • Second procedure: Sometimes complex surgery of the nose or paranasal sinuses may be required.
  • Narcosis: The risks of anesthesia include headache and dizziness. An allergy to the anesthetic is also possible.
  • Sore throat: A rare postoperative complication is a sore throat.

Natural remedies for enlarged pharyngeal tonsils

  • Honey and lemon juice:
    • Fill a glass with lukewarm water.
    • Add a teaspoon of honey and 2-3 drops of lemon juice.
    • Mix and drink.
  • Ginger and turmeric:
    • Prepare a glass of ginger tea.
    • Add half a teaspoon of turmeric powder.
    • Stir and drink once a day before bedtime for five consecutive days.
    • This drink favors the healing of enlarged pharyngeal tonsils.
  • Onions and water:
    • Extract the juice from the onion.
    • Add lukewarm water to a glass.
    • Gargle with this solution.
    • Repeat 4 to 5 times a day.
  • Rest: With swollen pharyngeal tonsils, speaking is difficult. It is advisable to refrain from speaking.
  • hot showers; this supports healing. Swimming in the swimming pool should be avoided because of the chlorine.
  • Holidays in the mountains or by the sea do the child good, it can bathe in salt water without worries.

Nutrition and diet for enlarged pharyngeal tonsils

One should avoid foods that can cause rapid deterioration:

  • spicy food,
  • acidic drinks.

Natural medicine recommends a very light diet, based on:

  • Fruit
  • Vegetable
  • nuts (in small quantities).

This guarantees fast digestion and prevents:

  • gastrointestinal fermentation,
  • Rot of protein-containing foods in the intestine.

Excessive nutrition and consumption of foods of animal origin lead to greatly slowed digestion.
If food remains for a long time in a humid environment and at a temperature of 37 ° C (as in the intestine), it begins to rot.

The consequence is the accumulation of toxins:

  • in the intestine,
  • in the blood.

The body becomes an ideal environment for the reproduction of harmful microorganisms that feed on dead or decomposing tissue.

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