Magnification levels and what they mean
The size of the tonsils is assessed by how much of the distance between the palatine arches they occupy. In the first degree it is about a third, in the second - up to two thirds, in the third, the tonsils almost close along the midline. The degree itself is not an indication for surgery: what matters is how the increase affects breathing, sleep, swallowing and speech. A child with the third degree can sleep peacefully, but with the second, he can suffer from nighttime respiratory arrests.
- First degree - up to a third of the lumen of the pharynx
- Second - up to two thirds
- Third - tonsils almost touching
- Often associated with enlarged adenoids
- Treatment decisions are made based on symptoms, not size
Why do tonsils grow?
The palatine tonsils are part of the lymphoid ring of the pharynx, the first barrier to microbes. In children of preschool and primary school age, this barrier works especially actively, and repeated infections stimulate the growth of lymphoid tissue. Allergies, constant mouth breathing, smokey air and reflux all contribute. By adolescence, lymphoid tissue begins to decrease. In adults, enlarged tonsils that appear for the first time, especially unilaterally, require special attention from a doctor.
- Frequent ARVI and sore throats in childhood
- Allergic rhinitis
- Enlarged adenoids and mouth breathing
- Passive smoking and air pollution
- Hereditary predisposition
- Unilateral enlargement in an adult requires exclusion of a tumor
How is it different from chronic tonsillitis?
These are different conditions that are often confused. With hypertrophy, the tonsils are simply large, but clean: they do not hurt, there are no purulent plugs in the lacunae, the lymph nodes are not enlarged, and there may be no sore throats at all. Chronic tonsillitis is a constant source of infection: recurring sore throats, congestion, bad breath, low-grade fever, pain in the joints and heart with complications. The difference is fundamental: with hypertrophy, the main goal is to restore breathing, with tonsillitis - to remove the source of infection.
- Hypertrophy - size without inflammation
- Tonsillitis - inflammation regardless of size
- Traffic jams and bad breath are characteristic of tonsillitis
- Snoring and apnea are characteristic of hypertrophy
- A combination of both conditions is possible
How to examine
The ENT doctor examines the pharynx, assesses the degree of enlargement, the condition of the lacunae and arches, and checks nasal breathing. Since enlarged tonsils are often combined with adenoids, a nasopharyngeal endoscopy or lateral X-ray is performed. If there is snoring and there is a suspicion of sleep apnea, the doctor asks the parents in detail about the nature of their sleep, and, if necessary, refers them to a sleep study. For adults with unilateral enlargement, additional examination is prescribed to exclude a tumor.
- Examination of the pharynx with determination of the degree
- Endoscopy of the nasopharynx
- Lateral x-ray of the nasopharynx
- Assessment of snoring and sleep breathing
- Complete blood count for suspected infection
- Consultation with an oncologist for unilateral enlargement in an adult
Treatment: when to observe and when to operate
If the increase does not interfere with breathing, eating and sleeping, observation is chosen: with age, lymphoid tissue decreases. At the same time, allergic rhinitis is treated, nasal breathing is restored, and passive smoking is eliminated - often this is enough. Surgery is discussed for sleep apnea, persistent difficulty swallowing, speech impairment and growth of the facial skeleton. In children, partial reduction of the tonsils is often performed while preserving their function; complete removal is used in combination with chronic tonsillitis.
- Observation in the absence of breathing and swallowing problems
- Treatment of allergies and restoration of nasal breathing
- Elimination of secondhand smoke
- Partial reduction of tonsils in children
- Complete removal when combined with chronic tonsillitis
- Simultaneous removal of adenoids when indicated
- Soft, cool food and rest in the first days after surgery
