Tonsils & Adenoids


ENT regionTonsils and Adenoids are aggregations of lymphoid tissue found in the ENT region. Tonsils are found at the back of your throat and adenoids are found at the back of the nose in a space called the postnasal space (figure 1). They form part of the immune system but only have an important role in the first 2 to 3 years of life. Their role in the defense against infection becomes less important with age.

How can Tonsils and Adenoids cause problems?

ENT Specialist | tonsilThe two most common problems arising from tonsils and adenoids are repeated infections and significant enlargement resulting in obstruction during breathing and swallowing (figure 2).

Sometimes, the infection from the tonsils can spread to the surrounding tissues forming an abscess (peritonsillar abscess or Quinsy). If not recognized or treated promptly, this is a potentially dangerous condition. Tumours can arise from tonsils but are less common.


ENT check upTonsils are easily examined by looking into the oral cavity. Adenoids are best examined using a flexible nasoendoscope (figure 3). This examination is performed with local anaesthesia and is suitable for cooperative children. X-rays can be used to determine the size of the adenoids if nasoendoscopy is not suitable. The ears and neck are also assessed during physical examination.

Tonsillitis and the Symptoms

Tonsillitis is the infection of one or both tonsils. The cause is usually bacterial and streptococcus is usually implicated. Tonsillitis usually presents with one or more of the following symptoms

  1. Sorethroat with fever
  2. Swollen and painful neck glands
  3. Redder and larger tonsils
  4. A white or yellow coating of the tonsil
  5. Halitosis (bad breath)

Large Adenoids and the Symptoms

Large adenoids can cause obstruction during breathing and also affect the function of the Eustachian tube. Symptoms of large adenoids include:

  1. Snoring and/or difficulty breathing during sleep
  2. Mouth breathing
  3. Nasal voice (rhinolalia)
  4. Recurrent middle ear infections

What are the reasons for removing tonsils and adenoids?

The two most common reasons for performing a tonsillectomy and adenoidectomy are recurrent infection and difficulty breathing during sleep.

  1. If a patient experiences more than 3 episodes of tonsillitis a year for 3 years, 5 to 6 over 2 years or 7 in one year which affects time at school or work, a tonsillectomy may be beneficial.
  2. Large tonsils and adenoids causing sleep apnea or loud snoring.
  3. One tonsil larger than the other may indicate a tumor.
  4. hearing loss | ear infectionStudies have shown beneficial effects of adenoidectomy in children with recurrent middle ear infections or fluid collection in the middle ear. (otitis media with effusion Figure 4)
  5. Collection of food debris within the crypts of the tonsils causing bad breath.

What is involved in a tonsillectomy and adenoidectomy?

The procedure is performed under General Anaesthesia and takes about 20 to 30 minutes to perform. The operation is carried out through the mouth and no incisions are made on the skin. Once the procedure is completed, the patient is brought to the recovery area and allowed fluids when awake. Most patients can return home for the night after an observation period of 6 to 8 hours in the day surgery centre. Some patients may choose to stay a night in hospital. Your doctor should prescribe medications to minimize postoperative discomfort before you go home.

There are several postoperative symptoms that the patients may experience. These include;

  1. Pain – removal of tonsils leaves a raw area in the throat. It can take up to 2 weeks before pain totally subsides
  2. Ear ache – pain from the throat can be referred to the ears. Occasionally, middle ear infections can occur after an adenoidectomy.
  3. Difficulty swallowing
  4. Bleeding – this generally occurs from the 3rd day after the operation. Your doctor should be notified immediately if bleeding occurs.

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Dr Gerard Chee

MBBS (S'pore), FRCS (Edin), FRCS (Glasg) Fellow, Otology / Neurotology (Can)

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Dr Chee’s son with his tonsils the day after surgery