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Tonsils and adenoids are the body’s first line of defense as part of the immune system. They “sample” bacteria and viruses that enter the body through the mouth or nose, but they sometimes become infected. At times, they become more of a liability than an asset and may even cause airway obstruction or repeated bacterial infections. Your ear, nose and throat (ENT) specialist can suggest the best treatment options.

What are tonsils and adenoids?

Tonsils and adenoids are similar to the lymph nodes or “glands” found in the neck, groin and armpits. Tonsils are the two round lumps in the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth or nose without special instruments.

What affects tonsils and adenoids?

The two most common problems affecting the tonsils and adenoids are recurrent infections of the nose and throat, and significant enlargement that causes nasal obstruction and/or breathing, swallowing and sleep problems.

Abscesses around the tonsils, chronic tonsillitis and infections of small pockets within the tonsils that produce foul-smelling white deposits can also affect the tonsils and adenoids, making them sore and swollen. Cancers of the tonsil, while uncommon, require early diagnosis and aggressive treatment.

When should I see a doctor?

You should see your doctor when you or your child experience the common symptoms of infected or enlarged tonsils or adenoids.
Your physician will ask about problems of the ear, nose and throat and examine the head and neck. He or she may use a small mirror or a flexible lighted instrument to see these areas.

Other methods used to check tonsils and adenoids are:

  • Medical history
  • Physical examination
  • Throat cultures/Strep tests – helpful in determining infections in the throat
  • X-rays – helpful in determining the size and shape of the adenoids
  • Blood tests – helpful in diagnosing infections such as mononucleosis
  • Sleep study, or polysomnogram – helpful in determining whether sleep disturbance is occurring because of large tonsils and adenoids.

Tonsillitis and its symptoms

Tonsillitis is an infection of the tonsils. One sign is swelling of the tonsils. Other symptoms are:

  • Redder than normal tonsils
  • A white or yellow coating on the tonsils
  • A slight voice change due to swelling
  • Sore throat, sometimes accompanied by ear pain
  • Uncomfortable or painful swallowing
  • Swollen lymph nodes (glands) in the neck
  • Fever
  • Bad breath

Enlarged tonsils and/or adenoids and their symptoms

If your or your child’s adenoids are enlarged, it may be hard to breathe through the nose. If the tonsils and adenoids are enlarged, breathing during sleep may be disturbed. Other signs of adenoid and or tonsil enlargement are:

  • Breathing through the mouth instead of the nose most of the time
  • Nose sounds “blocked” when the person speaks
  • Chronic runny nose
  • Noisy breathing during the day
  • Recurrent ear infections
  • Snoring at night
  • Restlessness during sleep, pauses in breathing for a few seconds at night (may indicate sleep apnea).

How are tonsil and adenoid diseases treated?

Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Removal of the tonsils (tonsillectomy) and/or adenoids (adenoidectomy) may be recommended if there are recurrent infections despite antibiotic therapy, and/or difficulty breathing due to enlarged tonsils and/or adenoids. Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness, and may even cause behavioral or school performance problems in some children.

Chronic infections of the adenoids can affect other areas such as the eustachian tube – the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and buildup of fluid in the middle ear that may cause temporary hearing loss. Studies also find that removal of the adenoids may help some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).

In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For those patients, treatment with steroids (e.g., prednisone) is sometimes helpful.

How to prepare for surgery

Children

  • Talk to your child about his/her feelings and provide strong reassurance and support
  • Encourage the idea that the procedure will make him/her healthier.
  • Be with your child as much as possible before and after the surgery.
  • Tell him/her to expect a sore throat after surgery, and that medicines will be used to help the soreness.
  • Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward.
  • It may be helpful to talk about the surgery with a friend who has had a tonsillectomy or adenoidectomy.
  • Your otolaryngologist can answer questions about the surgical procedure.

Adults and children

For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye’s syndrome). Your doctor may ask to you to stop taking other medications that may interfere with clotting.

  • Tell your surgeon if the patient or patient’s family has had any problems with anesthesia or clotting of blood. If the patient is taking medications, has sickle cell anemia, has a bleeding disorder, is pregnant, or has concerns about the transfusion of blood, the surgeon should be informed.
  • A blood test may be required prior to surgery.
  • •A visit to the primary care doctor may be needed to make sure the patient is in good health at surgery.
  • You will be given specific instructions on when to stop eating food and drinking liquids before surgery. These instructions are extremely important, as anything in the stomach may be vomited when anesthesia is induced.

When the patient arrives at the hospital or surgery center, the anesthesiologist and nursing staff may meet with the patient and family to review the patient’s history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.

After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient closely until discharge. Every patient is unique, and recovery time may vary.

Your ENT specialist will provide you with the details of pre-operative and post-operative care and answer your questions.

After surgery

There are several post-operative problems that may arise. These include swallowing problems, vomiting, fever, throat pain and ear pain. Occasionally, bleeding from the mouth or nose may occur after surgery. If the patient has any bleeding, your surgeon should be notified immediately. It is also important to drink liquids after surgery to avoid dehydration.

Any questions or concerns you have should be discussed openly with your surgeon.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Las amígdalas y los adenoides son masas de tejido que se parecen a los nudos linfáticos o las glándulas del cuello, del ingle o de las axilas. Las amígdalas son las dos masas de la parte posterior de la garganta. Los adenoides se encuentran en la parte superior de la garganta detrás de la nariz y el techo de la boca (paladar blando) y no se ven por la boca sin instrumentos especiales.

Las amígdalas y los adenoides están cerca de la entrada de la vía respiratoria donde pueden atrapar los gérmenes que causan las infecciones. Agarran “muestras” de las bacteria y de los virus y pueden infectarse ellos mismos. Los científicos creen que funcionan como parte del sistema inmunológico del cuerpo al filtrar los gérmenes que tratan de invadir el cuerpo y que ayudan a desarrollar los anticuerpos contra los gérmenes.

Esta función se realiza durante los primeros años de la vida, volvíendose menos importante a medida que el niño crece. Los niños operados de las amígdalas y los adenoides no sufren ninguna disminución de la inmunidad.

¿Cuándo Debería Consultar a Mi Médico?

Ud. debe ver a su médico cuando Ud. o su niño sufre los síntomas comunes de las amígdalas o los adenoides infectados o agrandados.

¿Qué Afecta Las Amígdalas y Los Adenoides?

Los problemas más comunes que afectan las amígdalas y los adenoides son las infecciones repetidas de la garganta o del oído y la hipertrofia u obstrucción significativa que causa problemas de la respiración o la deglución.

Asimismo, los abscesos alrededor de las amígdalas, la amigdalitis crónica y las infecciones de las cavidades dentro de las amígdalas que producen materia cremosa y maloliente pueden afectar las amígdalas y los adenoides, dejándolos adoloridos e hinchados. Aunque poco frecuentes, puede haber tumores en las amígdalas.

¿Qué Debo Esperar Del Examen?

Su médico le hará preguntas sobre los problemas del oído, la nariz y la garganta y examinará la cabeza y el cuello. Para ver estas áreas, utilizará un espejo pequeño o un instrumento flexible con luz.

Para diagnosticar ciertas infecciones de la garganta, los cultivos o las pruebas de estreptococo son importantes.

Las radiografías pueden ser útiles para determinar el tamaño y la forma de los adenoides. Los análisis de sangre pueden identificar problemas tales como la mononucleosis.

El Examen

Los métodos principales de chequear las amígdalas y los adenoides son

  • La historia clínica
  • El examen físico
  • El cultivo bacteriológico y la prueba de estreptococo
  • Las radiografías
  • Los análisis de sangre

¿Cómo Se Tratan Las Enfermedades De Las Amígdalas Y Los Adenoides?

En primer lugar, se tratan las infecciones de las amígdalas, especialmente las causadas por el estreptococo, con los antibióticos. En algunos casos, se recomienda la extirpación de las amígdalas o los adenoides. Las dos razones principales para la extirpación son (1) las infecciones repetidas a pesar de la terapia de antibióticos y (2) problemas con la respiración debido a las amígdalas o los adenoides crecidos. Tal obstrucción respiratoria produce el ronquido y el sueño alterado que conducen a la soñolencia durante el día en los adultos y problemas de conducta en los niños. Algunos ortodontistas creen que la respiración bucal crónica debida a las amígdalas o los adenoides agrandados causa la malformación de la cara y la alineación mala de los dientes.

La infección crónica puede afectar a otras estructuras como la trompa de Estaquio que vincula la parte posterior de la nariz con el interior del oído, lo que conduce a las infecciones frecuentes del oído y la pérdida auditiva posible.

Los estudios recientes indican que la extirpación de los adenoides puede ser un tratamiento positivo para los niños con dolores crónicos del oído acompañado de fluído en el oído medio (otitis media con efusión).

En los adultos, la posibilidad de cáncer o un tumor también puede justificar la extirpación de las amígdalas y los adenoides.

En algunos pacientes, especialmente con mononucleosis infecciosa, el agrandamiento marcado de los adenoides puede bloquear la vía respiratoria. Para ellos, el tratamiento con esteroides—por ejemplo, cortisona—puede ser útil.

La Amigdalitis y Sus Síntomas

La amigdalitis es una infección de una o las dos amígdalas. Otras indicaciones o síntomas son

  • Amígdalas más rojas que lo normal
  • Capa blanca o amarilla en las amígdalas
  • Un cambio de la voz debido al hinchazón
  • Dolor de garganta
  • Deglución incómoda o dolorosa
  • Nudos linfáticos hinchados en el cuello
  • Fiebre
  • Hálito malo

Los Adenoides Agrandados y Sus Síntomas

Si se agrandan los adenoides, la respiración puede ser díficil. Otras señales del agrandamiento son

  • Respiración por la boca en vez de la nariz la mayor parte del tiempo
  • Nariz tapada cuando la person habla
  • Respiración ruidosa durante el día
  • Infecciones repetidas del oído
  • Ronquidos de noche
  • Paros de la respiración por unos segundos de noche durante ronquidos o respiración ruidosa (apnea)

La Cirugía

Su hijo: Converse con su hijo sobre sus sentimientos, y dele confianza y apoyo por todo el proceso. Promueva la idea que el paso beneficiará la salud. Acompañe a su hijo el mayor tiempo posible antes y después de la cirugía. Avísele que le va a doler la garganta después de la cirugía. Asegúrele que la operación no quita ninguna parte importante del cuerpo ni cambiará la apariencia. Si su hijo tiene un amigo que ha tenido esta cirugía, el hablar con ese amigo puede ayudar a su hijo.

Los adultos y los niños: Por lo menos quince días antes de cualquier cirugía, el paciente debe dejar de tomar aspirina u otros medicamentos que contienen aspirina. (AVISO: Nunca se debe dar aspirina a los niños dado el riesgo del síndrome de Reye.)

Si el paciente o algún familiar ha tenido problemas con la anestesia, se debe informar al cirujano. También, se le debe avisar si el paciente está tomando otra medicina, tiene anemia o hemorragia, está embarazada, está preocupado por la transfusión de sangre, o ha utilizado esteroides durante el año anterior.

Se puede exigir una prueba de sangre y posiblemente de orina antes de la cirugía.

Generalmente, antes de la cirugía y después de medianoche, no se debe ingerir nada, inclusive chicle, gárgaras, pastillas para la garganta, pasta de dientes y agua. Cuando se inicia la anestesia, cualquier contenido del estómago puede producir vómitos, y esto es peligroso.

Cuando el paciente se interna, el anestesiólogo o un enfermero puede reunirse con el paciente y su familia para repasar la historia del paciente. Luego se le lleva a la sala de operaciones donde se le da la anestesia. Generalmente, se dan sueros intravenosos durante y después de la cirugía.

Después de la operación, el paciente pasará a la sala de recuperación donde el personal le observará hasta darle de alta. El tiempo necesario para la recuperación del paciente puede variar de unas horas hasta un día. Ciertos casos pueden necesitar cuidado intensivo.

Su médico le proporcionará todos los detalles de su tratamiento antes y después de la cirugía, y contestará todas sus preguntas.

Después de la Cirugía

Hay varias síntomas que pueden surgir después de la operación, inclusive problemas para tragar, vómitos, fiebre, dolor de garganta y dolor del oído. En algunos casos, puede haber desangramiento después de la cirugía. En tal caso, hay que avisar al cirujano en seguida.

Se debe conversar abiertamente cualquier pregunta o preocupación con el cirujano, que está para ayudarle.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

The tonsils are two clusters of tissue located on both sides of the back of the throat. Adenoids sit high in the throat behind the nose and the roof of the mouth. Tonsils and adenoids are often removed when they become enlarged and block the upper airway, leading to breathing difficulty. They are also removed when recurrence of tonsil infections or strep throat cannot be successfully treated by antibiotics. The surgery is most often performed on children.

The procedure to remove the tonsils is called a tonsillectomy; excision of the adenoids is an adenoidectomy. Both procedures are often performed at the same time; hence the surgery is known as a tonsillectomy and adenoidectomy, or T&A.

T&A is an outpatient surgical procedure lasting between 30 and 45 minutes and performed under general anesthesia. Normally, the young patient will remain at the hospital or clinic for several hours after surgery for observation. Children with severe obstructive sleep apnea and very young children are usually admitted overnight to the hospital for close monitoring of respiratory status. An overnight stay may also be required if there are complications such as excessive bleeding, severe vomiting or low oxygen saturation.

When the tonsillectomy patient comes home

Most children take seven to ten days to recover from the surgery. Some may recover more quickly; others can take up to two weeks for a full recovery. The following guidelines are recommended:

Drinking: The most important requirement for recovery is for the patient to drink plenty of fluids. Starting immediately after surgery, children may have fluids such as water or apple juice. Some patients experience nausea and vomiting after the surgery. This usually occurs within the first 24 hours and resolves on its own after the effects of anesthesia wear off. Contact your physician if there are signs of dehydration (urination less than 2-3 times a day or crying without tears).

Eating: Generally, there are no food restrictions after surgery, but some physicians will recommend a soft diet during the recovery period. The sooner the child eats and chews, the quicker the recovery. Tonsillectomy patients may be reluctant to eat because of throat pain; consequently, some weight loss may occur, which is gained back after a normal diet is resumed.

Fever: A low-grade fever may be observed the night of the surgery and for a day or two afterward. Contact your physician if the fever is greater than 102º.

Activity: Activity may be increased slowly, with a return to school after normal eating and drinking resumes, pain medication is no longer required, and the child sleeps through the night. Travel on airplanes or far away from a medical facility is not recommended for two weeks following surgery.

Breathing: The parent may notice snoring and mouth breathing due to swelling in the throat. Breathing should return to normal when swelling subsides, 10-14 days after surgery.

Scabs: A scab will form where the tonsils and adenoids were removed. These scabs are thick, white and cause bad breath. This is normal. Most scabs fall off in small pieces five to ten days after surgery.

Bleeding: With the exception of small specks of blood from the nose or in the saliva, bright red blood should not be seen. If such bleeding occurs, contact your physician immediately or take your child to the emergency room.

Pain: Nearly all children undergoing a tonsillectomy/adenoidectomy will have mild to severe pain in the throat after surgery. Some may complain of an earache (so called referred pain) and a few may have pain in the jaw and neck .

Pain control: Your physician will prescribe pain medication for the young patient such as acetaminophen, ibuprofen, acetaminophen with codeine, or acetaminophen with hydrocodone. The pain medication will be in a liquid form or sometimes a rectal suppository will be recommended. Pain medication should be given as prescribed. Contact your physician if side effects are suspected or if pain is not well-controlled. If you are troubled about any phase of your child’s recovery, contact your physician immediately.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Could Your Medication Be Affecting Your Voice?

Some medications including prescription, over-the-counter and herbal supplements can affect the function of your voice. If your doctor prescribes a medication that adversely affects your voice, make sure the benefit of taking the medicine outweighs the problems with your voice.

Most medications affect the voice by drying out the protective mucosal layer covering the vocal cords. Vocal cords must be well-lubricated to operate properly; if the mucosa becomes dry, speech will be more difficult. This is why hydration is an important component of vocal health.

Medications can also affect the voice by thinning blood in the body, which makes bruising or hemorrhaging of the vocal cord more likely if trauma occurs, and by causing fluid retention (edema), which enlarges the vocal cords. Medications from the following groups can adversely affect the voice:

  • Antidepressants
  • Muscle relaxants
  • Diuretics
  • Antihypertensives (blood pressure medication)
  • Antihistamines (allergy medications)
  • Anticholinergics (asthma medications)
  • High-dose Vitamin C (greater than five grams per day)
  • Other medications and associated conditions that may affect the voice include: Angiotensin-converting-enzyme (ACE) inhibitors (blood pressure medication) may induce a cough or excessive throat clearing in as many as 10 percent of patients. Coughing or excessive throat clearing can contribute to vocal cord lesions.
  • Oral contraceptives may cause fluid retention (edema) in the vocal cords because they contain estrogen.
  • Estrogen replacement therapy post-menopause may have a variable effect.
  • An inadequate level of thyroid replacement medication in patients with hypothyroidism.
  • Anticoagulants (blood thinners) may increase chances of vocal cord hemorrhage or polyp formation in response to trauma.
  • Herbal medications are not harmless and should be taken with caution. Many have unknown side effects that include voice disturbance.

NOTE: Contents of this page are based on information provided by The Center for Voice at Northwestern University.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Snoring is a sound produced by vibration of the soft tissues of the upper airway during sleep and is indicative of increased upper airway resistance. Studies estimate that 45% of men and 30% of women snore on a regular basis. It can affect not only the snorer’s sleep but also the sleep of a spouse or other family members nearby. In fact, snoring causes many couples to sleep in separate rooms and often places strain on marriages and relationships. Recent evidence suggests that snoring may even cause thickening of the carotid arteries over time and potentially increase risk of stroke.

Snoring also may be a sign of a more serious health condition known as obstructive sleep apnea (OSA), characterized by a repetitive stopping or slowing of breathing that can occur hundreds of times through the night. Most patients who snore should receive a comprehensive sleep evaluation, by a trained physician, that often includes sleep testing either done in the home or sleep laboratory.

1) Palatal stiffening procedures

  • Palatial Implants: – Palatal implant therapy, also known as the Pillar procedure, involves the placement of three polyester implants into the soft palate under local anesthesia in the office. The implants, in conjunction with the body’s scarring response, result in stiffening of the palate, and subsequently, less vibration and flutter that causes snoring. Potential benefits of this method include ease of application, minimal discomfort, fast recovery and potentially more long-term benefit. Complications are rare but include implant extrusion requiring replacement. The primary drawback for many patients considering this option is the relatively high cost of the implants.
  • Injection Snoreplasty: – In this method, also done under local anesthesia in the office, a chemical is injected into the soft palate. The subsequent inflammation and scar tissue stiffen the palate, therefore decreasing vibration and snoring. The most commonly used agent is Sodium tetradecyl sulfate which has been used in the treatment of varicose veins. Injection snoreplasty has the advantage of lower cost than other methods but is associated with more pain and recovery time. Some patients may also require additional injection treatments to achieve optimal results.
  • Radiofrequency: – Radiofrequency treatment, also an office-based procedure performed under local anesthesia, uses heat to stiffen portions of the soft palate. Multiple treatment sessions may be required to achieve the desired results. Discomfort and recovery are generally less than injection snoreplasty but more than palatal implants. Cost of radiofrequency also usually falls in between the other two options.

2) Tonsillectomy/Adenoidectomy

Enlarged tonsils and adenoids are a common cause of snoring and sleep disruption in children. The tonsils are clusters of lymphoid tissue in the back of the throat while the adenoids are a similar mound of tissue in the back of the nose. Although less commonly a problem in adults, some adults can receive excellent resolution of snoring through removal of enlarged tonsils and/or adenoids.

As opposed to the above office-based procedures, tonsillectomy/adenoidectomy is an outpatient surgery performed in the operating room under general anesthesia. Most patients require a recovery time at home of approximately one week but may continue to experience a sore throat for two weeks. The most common complication is bleeding, often occurring over a week after the surgery. Serious bleeding is rare.

3) Nasal Surgery

Increased nasal congestion has been shown to cause or contribute to snoring. Nasal obstruction may result from many causes, including allergies, polyps, septal deviation and turbinate hypertrophy. Medical treatment options, such as a nasal steroid spray or allergy management may be helpful in some patients. Structural problems, such as a deviated septum, often benefit from surgical treatment.

One surgical option, known as radiofrequency turbinate reduction (RFTR), can often be performed in the office setting under local anesthesia. RFTR uses radiofrequency heat to shrink swollen tissues in each side of the nose. Other nasal surgeries, including septoplasty and polyp removal, are usually performed in the operating room under general anesthesia. In select patients, treatment of nasal congestion can result in improvement or resolution of snoring.

What else should I know?

There are also other available treatments such as oral appliances, nasal devices, positional therapy and a variety of over-the-counter products. Careful patient and procedure selection is critical to successful management of snoring. Talk to your ear, nose and throat doctor for a complete evaluation and to learn what treatment may be best for you.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Tonsils and adenoids are the body’s first line of defense as part of the immune system. They “sample” bacteria and viruses that enter the body through the mouth or nose, but they sometimes become infected. At times, they become more of a liability than an asset and may even cause airway obstruction or repeated bacterial infections. Your ear, nose and throat (ENT) specialist can suggest the best treatment options.

What are tonsils and adenoids?

Tonsils and adenoids are similar to the lymph nodes or “glands” found in the neck, groin and armpits. Tonsils are the two round lumps in the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth or nose without special instruments.

What affects tonsils and adenoids?

The two most common problems affecting the tonsils and adenoids are recurrent infections of the nose and throat, and significant enlargement that causes nasal obstruction and/or breathing, swallowing and sleep problems.

Abscesses around the tonsils, chronic tonsillitis and infections of small pockets within the tonsils that produce foul-smelling white deposits can also affect the tonsils and adenoids, making them sore and swollen. Cancers of the tonsil, while uncommon, require early diagnosis and aggressive treatment.

When should I see a doctor?

You should see your doctor when you or your child experience the common symptoms of infected or enlarged tonsils or adenoids.

Your physician will ask about problems of the ear, nose and throat and examine the head and neck. He or she may use a small mirror or a flexible lighted instrument to see these areas.

Other methods used to check tonsils and adenoids are:

  • Medical history
  • Physical examination
  • Throat cultures/Strep tests – helpful in determining infections in the throat
  • X-rays – helpful in determining the size and shape of the adenoids
  • Blood tests – helpful in diagnosing infections such as mononucleosis
  • Sleep study, or polysomnogram – helpful in determining whether sleep disturbance is occurring because of large tonsils and adenoids.

Tonsillitis and its symptoms

Tonsillitis is an infection of the tonsils. One sign is swelling of the tonsils. Other symptoms are:

  • Redder than normal tonsils
  • A white or yellow coating on the tonsils
  • A slight voice change due to swelling
  • Sore throat, sometimes accompanied by ear pain
  • Uncomfortable or painful swallowing
  • Swollen lymph nodes (glands) in the neck
  • Fever
  • Bad breath

Enlarged tonsils and/or adenoids and their symptoms

If your or your child’s adenoids are enlarged, it may be hard to breathe through the nose. If the tonsils and adenoids are enlarged, breathing during sleep may be disturbed. Other signs of adenoid and or tonsil enlargement are:

  • Breathing through the mouth instead of the nose most of the time
  • Nose sounds “blocked” when the person speaks
  • Chronic runny nose
  • Noisy breathing during the day
  • Recurrent ear infections
  • Snoring at night
  • Restlessness during sleep, pauses in breathing for a few seconds at night (may indicate sleep apnea).

How are tonsil and adenoid diseases treated?

Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Removal of the tonsils (tonsillectomy) and/or adenoids (adenoidectomy) may be recommended if there are recurrent infections despite antibiotic therapy, and/or difficulty breathing due to enlarged tonsils and/or adenoids. Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness, and may even cause behavioral or school performance problems in some children.

Chronic infections of the adenoids can affect other areas such as the eustachian tube – the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and buildup of fluid in the middle ear that may cause temporary hearing loss. Studies also find that removal of the adenoids may help some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).

In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For those patients, treatment with steroids (e.g., prednisone) is sometimes helpful.

How to prepare for surgery

Children

  • Talk to your child about his/her feelings and provide strong reassurance and support
  • Encourage the idea that the procedure will make him/her healthier.
  • Be with your child as much as possible before and after the surgery.
  • Tell him/her to expect a sore throat after surgery, and that medicines will be used to help the soreness.
  • Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward.
  • It may be helpful to talk about the surgery with a friend who has had a tonsillectomy or adenoidectomy.
  • Your otolaryngologist can answer questions about the surgical procedure.

Adults and children

For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye’s syndrome). Your doctor may ask to you to stop taking other medications that may interfere with clotting.

  • Tell your surgeon if the patient or patient’s family has had any problems with anesthesia or clotting of blood. If the patient is taking medications, has sickle cell anemia, has a bleeding disorder, is pregnant, or has concerns about the transfusion of blood, the surgeon should be informed.
  • A blood test may be required prior to surgery.
  • •A visit to the primary care doctor may be needed to make sure the patient is in good health at surgery.
  • You will be given specific instructions on when to stop eating food and drinking liquids before surgery. These instructions are extremely important, as anything in the stomach may be vomited when anesthesia is induced.

When the patient arrives at the hospital or surgery center, the anesthesiologist and nursing staff may meet with the patient and family to review the patient’s history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.

After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient closely until discharge. Every patient is unique, and recovery time may vary.

Your ENT specialist will provide you with the details of pre-operative and post-operative care and answer your questions.

After surgery

There are several post-operative problems that may arise. These include swallowing problems, vomiting, fever, throat pain and ear pain. Occasionally, bleeding from the mouth or nose may occur after surgery. If the patient has any bleeding, your surgeon should be notified immediately. It is also important to drink liquids after surgery to avoid dehydration.
Any questions or concerns you have should be discussed openly with your surgeon.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

What is an Oral Appliance?

Oral appliances are one of the treatment options for snoring and obstructive sleep apnea (OSA). These devices are similar to mouth guards or orthodontic retainers that are worn in the mouth during sleep. They are designed to prevent soft tissue in the airway from collapsing and causing obstruction. These appliances can be used alone or in combination with Continuous Positive Airway Pressure (CPAP) or surgery.

How do Oral Appliances Work?

Oral appliances work by repositioning the lower jaw and/or pulling the tongue forward. Mandibular-repositioning devices keep the lower jaw in a protruded position during sleep. This keeps the airway open by preventing the tongue and soft tissue in the throat from collapsing. Tongue-retaining devices hold the tongue with a suction bulb, preventing the back of the tongue from obstructing the airway during sleep.

What are the Indications for Oral Appliances?

Oral appliances are most effective in treating snoring and mild to moderate sleep apnea. These appliances are recommended for patients who are non-compliant with CPAP and fail positional and weight loss therapy. They can also be used for patients with moderate to severe OSA who cannot tolerate CPAP use. Oral appliances are also recommended for patients who fail, refuse or are otherwise not candidates for surgical treatment.

What are the Advantages of Oral Appliances?

Oral appliances provide a non-invasive alternative for treatment of snoring and sleep apnea. In comparison to CPAP, they have a higher compliance rate, are more compact and less cumbersome.

What are the Disadvantages of Oral Appliances?

With the use of oral appliances, patients may develop excessive salivation, dry mouth, tooth and jaw discomfort, permanent changes in occlusion, and temporomandibular joint disorder. Some patients discontinue the use of oral appliances due to these side effects.

What are the other Treatment Options for Obstructive Sleep Apnea?

Treatment options for OSA include lifestyle modifications, weight loss, sleep positioning, CPAP and various surgical procedures to reduce airway obstruction.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Improving Form and Function of the Nose

Each year thousands of people undergo surgery of the nose. Nasal surgery may be performed for cosmetic purposes, or a combination procedure to improve both form and function. It also may alleviate or cure nasal breathing problems, correct deformities from birth or injury, or support an aging, drooping nose.

Patients who are considering nasal surgery for any reason should seek a doctor who is a specialist in nasal airway function, as well as plastic surgery. This will ensure that efficient breathing is as high a priority as appearance.

Can Cosmetic Nasal Surgery Create a “Perfect” Nose?

Aesthetic nasal surgery (rhinoplasty) refines the shape of the nose, bringing it into balance with the other features of the face. Because the nose is the most prominent facial feature, even a slight alteration can greatly improve appearance (some patients elect chin augmentation in conjunction with rhinoplasty to better balance their features). Rhinoplasty alone cannot give you a perfect profile, make you look like someone else or improve your personal life. Before surgery, it is very important that the patient have a clear, realistic understanding of what change is possible as well as the limitations and risks of the procedure.

Skin type, ethnic background and age will be among the factors considered preoperatively by the surgeon. Except in cases of severe breathing impairment, young patients usually are not candidates until their noses are fully grown, at 15 or 16 years of age. The surgeon will also discuss risk factors, which are generally minor, as well as where the surgery will be performed – in a hospital, freestanding outpatient surgical center or a certified office operating room.

To reshape the nose, the skin is lifted, allowing the surgeon to remove or rearrange the bone and cartilage. The skin is then re-draped and sutured over the new frame. A nasal splint on the outside of the nose helps retain the new shape during healing. If soft, absorbent material is placed inside the nose to stabilize the septum, it will normally be removed the morning after surgery. External nasal dressings and splints are usually removed five to seven days after surgery.

When Should Surgery Be Considered to Correct a Chronically Stuffy Nose?

Millions of Americans perennially suffer the discomfort of nasal stuffiness. This may be indicative of chronic breathing problems that don’t respond well to ordinary treatment. The blockage may be related to structural abnormalities inside the nose or to swelling caused by allergies or viruses.

There are numerous causes of nasal obstruction. A deviated septum (the partition between the nostrils) can be crooked or bent as the result of abnormal growth or injury. This can partially or completely close one or both nasal passages. The deviated septum can be corrected with a surgical procedure called septoplasty. Cosmetic changes to the nose are often performed at the same time, in a combination procedure called septorhinoplasty.

Overgrowth of the turbinates is yet another cause of stuffiness. (The turbinates are the tissues that line the inside of the nasal passages.) Sometimes the turbinates need treatment to make them smaller and expand the nasal passages. Treatments include injection, freezing and partial removal. Allergies, too, can cause internal nasal swelling, and allergy evaluation and therapy may be necessary.

Can Surgery Correct a Stuffy, Aging Nose?

Aging is a common cause of nasal obstruction. This occurs when cartilage in the nose and its tip are weakened by age and droop because of gravity, causing the sides of the nose to collapse inward, obstructing air flow. Mouth breathing or noisy and restricted breathing are common.

Try lifting the tip of your nose to see if you breathe better. If so, the external adhesive nasal strips that athletes have popularized may help. Or talk to a facial plastic surgeon/otolaryngologist about septoplasty, which will involve trimming, reshaping or repositioning portions of septal cartilage and bone. (This is an ideal time to make other cosmetic improvements as well.) Internal splints or soft packing may be placed in the nostrils to hold the septum in its new position. Usually, patients experience some swelling for a week or two. However, after the packing is removed, most people enjoy a dramatic improvement in breathing.

What Treatment Is Needed for a Broken Nose?

Bruises around the eyes and/or a slightly crooked nose following injury usually indicate a fractured nose. If the bones are pushed over or out to one side, immediate medical attention is ideal. But once soft tissue swelling distorts the nose, waiting 48-72 hours for a doctor’s appointment may actually help the doctor in evaluating your injury as the swelling recedes. (Apply ice while waiting to see the doctor.) What’s most important is whether the nasal bones have been displaced, rather than just fractured or broken.

For markedly displaced bones, surgeons often attempt to return the nasal bones to a straighter position under local or general anesthesia. This is usually done within seven to ten days after injury, so that the bones don’t heal in a displaced position. Because so many fractures are irregular and won’t “pop” back into place, the procedure is successful only half the time. Displacement due to injury often results in compromised breathing so corrective nasal surgery, typically septorhinoplasty, may then be elected. This procedure is typically done on an outpatient basis, and patients usually plan to avoid appearing in public for about a week due to swelling and bruising.

Will Insurance Cover Nasal Surgery?

Insurance usually does not cover cosmetic surgery. However, surgery to correct or improve breathing function, major deformity or injury is frequently covered in whole or in part. Patients should obtain cost information from their surgeons and discuss with their insurance carrier prior to surgery.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Why Do We Suffer From Nasal and Sinus Discomfort?

The body’s nasal and sinus membranes have similar responses to viruses, allergic insults and common bacterial infections. Membranes become swollen and congested. This congestion causes pain and pressure; mucus production increases during inflammation, resulting in a drippy, runny nose. These secretions may thicken over time, may slow in their drainage, and may predispose to future bacterial infection of the sinuses.

Congestion of the nasal membranes may even block the eustachian tube leading to the ear, resulting in a feeling of blockage in the ear or fluid behind the eardrum. Additionally, nasal airway congestion causes the individual to breathe through the mouth.

Each year, more than 37 million Americans suffer from sinusitis, which typically includes nasal congestion, thick yellow-green nasal discharge, facial pain and pressure. Many do not understand the nature of their illness or what produces their symptoms. Consequently, before visiting a physician, they seek relief for their nasal and sinus discomfort by taking non-prescription or over-the-counter (OTC) medications.

What is The Role of OTC Medication for Sinus Pain?

There are many different OTC medications available to relieve the common complaints of sinus pain and pressure, allergy problems and nasal congestion. Most of these medications are combination products that associate either a pain reliever such as acetaminophen with a decongestant or an antihistamine. Knowledge of these products and of the probable cause of symptoms will help the consumer to decide which product is best suited to relieve the common symptoms associated with nasal or sinus inflammation.

OTC nasal medications are designed to reduce symptoms produced by the inflammation of nasal membranes and sinuses. The goals of OTC medications are to: (1) reopen to nasal passages; (2) reduce nasal congestion; (3) relieve pain and pressure symptoms; and (4) reduce potential for complications. The medications come in several forms.

Nasal Saline Sprays: Non-Medicated Nasal Sprays

Nasal saline is an invaluable addition to the list of over-the-counter medications. It is ideal for all types of nasal problems. The added moisture produced by the saline reduces thick secretions and assists in the removal of infectious agents. There is no risk of becoming “addicted” to nasal saline. It should be applied as a mist to the nose up to six times per day. Nasal saline can also be made at home: contact your otolaryngologist for details.

Nasal Decongestant Sprays: Medicated Nasal Sprays

Afrin® nasal spray, Neo-Synephrine®, Otrivin®, Dristan® nasal spray and other brands decongest the swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating the initial stages of a common cold or viral infection. Nasal decongestant sprays are safe to use, especially appropriate for preventing eustachian tube problems when flying, and to halt progression of sinus infections following colds. However, they should only be utilized for 3-5 days because prolonged use leads to rebound congestion or “getting hooked on nasal sprays.” The patient with nasal swelling caused by seasonal allergy problems should use a cromolyn sodium nasal spray. The spray must be used frequently (four times a day) during allergy season to prevent the release of histamine from the tissues, which starts the allergic reaction. It works best before symptoms become established by stabilizing the nasal membranes and has few side effects.

Decongestant Medications

Pressure and congestion are common symptoms of nasal passage swelling. Decongestant medications are OTC products that relieve nasal swelling, pressure and congestion but do not treat the cause of the inflammation. They reduce blood flow to the nasal membranes leading to improved airflow, less breathing through the mouth, decreased pressure in the sinuses and head and subsequently less discomfort. Decongestants do not relieve drippy noses. Their side effects may include light headedness or giddiness and increased blood pressure and heart rate (patients with high blood pressure or heart problems should consult a physician before use). In addition, other medications may interact with oral decongestants, causing side effects. Both of these are available as single products or in combination with a pain reliever or an antihistamine. They are labeled as “non-drowsy” due to a side effect of stimulation of the nervous system.

Decongestant-Combination Products

Some medications are combined to reduce the number of pills. Tylenol® Sinus or Advil® Cold and Sinus exemplify products that join a pain reliever (acetaminophen or ibuprofen) with a decongestant (pseudoephedrine). These products relieve both sinus and cold/flu symptoms yet retain all the attributes of the individual drug, including side effects.

Antihistamine Medications

Antihistamines combat allergic problems leading to nasal congestion. OTC antihistamines such as diphenhydramine (Benadryl®), or clemastine (Tavist®) may be used for relieving allergic symptoms of itching, sneezing and nasal congestion. They relieve the drainage associated with the allergic inflammation, but not obstruction or congestion. Antihistamines have a potential for sedation, causing grogginess and dryness after use. Newer non-sedating antihistamines are available.

Antihistamine-Decongestant Combination Products

Antihistamines and decongestant products are often combined to relieve multiple symptoms of congestion and drainage and reduce the side effects of both products. Antihistamines produce sedation; decongestants are added to make them “non-drowsy.” The combined allergy product then relieves congestion and a runny nose.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

What is CPAP?

The most common and effective nonsurgical treatment for sleep apnea is Continuous Positive Airway Pressure, or CPAP, which is applied through a nasal or facial mask while you sleep. The CPAP device does not breathe for you. Instead, it creates a flow of air pressure when you inhale that is strong enough to keep your airway passages open. Once your otolaryngologist determines that CPAP is the right treatment, you will need to wear the CPAP mask every night.

How Do You Know if You Need CPAP?

When evaluating sleep apnea, your otolaryngologist may ask the following questions:

  • Does your snoring disturb your family and friends?
  • Do you have daytime sleepiness?
  • •Do you wake frequently throughout the night?
  • •Have you had episodes of obstructed breathing during sleep?
  • •Do you have morning headaches or tiredness?

After a review of your medical history and an examination of your airway, your otolaryngologist will order an overnight sleep study. A CPAP recommendation is made after your otolaryngologist reviews the results of the study.

How Do You Get CPAP?

If your otolaryngologist recommends CPAP, you may be scheduled for a second sleep study during which you will be fitted for a mask and CPAP device. The level of air pressure will be adjusted during the study to eliminate the airway obstruction. Alternatively, you may be placed on a self- adjusting CPAP machine which will determine the pressure needed to keep the airway open.

What are the Advantages of CPAP?

CPAP is the most effective means of treating snoring and sleep apnea. It keeps airway passages open which prevents pauses in breathing and helps you to get better sleep. This, in turn, reduces daytime sleepiness, fatigue and other sleep apnea related health problems such as high blood pressure, heart disease, diabetes and stroke.

What are the Disadvantages of CPAP?

The CPAP device needs to be used every night. Some patients complain of mask discomfort, nasal congestion, and nose and throat dryness when using CPAP. Others find the device to be too constrictive and cumbersome, particularly when traveling. Unfortunately, these complaints sometimes lead to inconsistent use or abandonment of the device altogether. Proper mask fitting and use of a humidifier can resolve these issues.

What are the Alternative Treatments for Sleep Apnea?

Lifestyle change including weight loss and exercise can help to improve sleep apnea and its related health problems. Sleep positioning and oral appliances have also been found to be effective. In cases when non-invasive treatments fail, a surgical solution might be necessary. Your otolaryngologist will be able to advise you on the treatment options.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery