Tonsils

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Tonsils (Enlarged) and Adenoids

The tonsils are two bean-shaped masses of lymphoid tissue situated between the soft palate and the tongue at the back of the mouth. In children, they are generally more prominent than in adults and are easily visible when the mouth is opened widely and the exclamation "ah" is made.

There is another collection of lymphoid tissue at the back and roof of the throat (naso-pharynx) called the pharyngeal tonsil or adenoid gland. Enlargement of this pharyngeal tonsil is termed adenoids, a condition which may arise between the ages of five and twelve. At puberty (12-14) the pharyngeal tonsil tends to disappear normally. It has a similar function to that of the palate tonsils and there is no doubt that together they protect against germ infection of the respiratory organs, clearly a very good reason why every one should endeavor to retain their tonsils intact and healthy if possible.

Inflammation of the tonsils and adenoid gland occurs in children debilitated through ill-nourishment, or as a sequel to some infectious disease such as measles, scarlet fever or diphtheria. The inflammation may be acute in the case of the tonsils but, very frequently, it is chronic. It is this chronic tonsillitis and " adenoids" which are the great menace to the health of the child, and which bring into being a train of morbid changes which have grave repercussions on the general health. Bad teeth, or septic conditions of the nose, a "running nose," often constitute the source of infection from which the disease germs pass to the devitalised tonsils and adenoid glands.

Symptoms

Enlargement of the tonsils, especially when associated with a similar change in the adenoid glands, gives rise to a characteristic and easily recognized group of symptoms in the case of the child. The mouth is open, with lips thickened and the lower one protruding.

The nose is small with small nostrils,which do not dilate during inspiration, while the bridge is broad and flattened. The upper jaw tends to become narrowed, causing the incisor teeth to become prominent and the bony palate acutely arched. As a consequence of this the permanent teeth become crowded owing to the deficient development of the jaw bones. Some deafness may arise from infection and catarrh of the Eustachian tube (leading from throat to ear). The breath smells badly owing to decomposing matter in the crypts of the tonsils which may be seen as yellowish patches. Cough may occur at night and snoring is a very characteristic symptom. The voice becomes nasal in tone, and difficulty is experienced in pronouncing the letters "m" and "n." Snuffing breathing may be present night and day.

A child presenting these symptoms is generally referred to as "adenoidal," but it should be remembered that tonsilar enlargement contributes considerably to their origin. If the disease process is allowed to continue grave permanent effects are produced. Owing to the obstructed breathing, the chest becomes deformed; either flat-chested or hollow or pigeon-chested. The spine becomes rounded and the shoulder blades protrude. Incidentally, the mental development as well as the physical is stunted and retarded. On top of this, such a child is prone to super-added germ infections- getting frequent sore throats, colds, catarrhs, bronchitis and even more grave disease of the respiratory organs, such as tuberculosis.

Treatment

In the case of the palate tonsils, if they are chronically diseased, it is generally recognized that the only satisfactory way of dealing with them is to remove them completely, including the tonsilar capsule. Unfortunately, it is not easy to decide just what is a chronically diseased tonsil. Mere enlargement alone is not a sufficient indicator unless the increase in size is very great, and does not disappear after sources of germ infection, such as bad teeth, have been dealt with and other hygienic measures have been adopted. It is only when the tonsils have completely lost their protective function, and on account of their septic enlarged condition have become a menace instead of being a safeguard, that they should be eradicated. The tendency to remove the tonsils from every child who shows the slightest tonsilar enlargement is most definitely to be deprecated. It is a quite unjustifiable mutilation and is robbing the child of one of the most valuable germ barriers of the body.

All physicians recognize that in children, in certain circumstances, removal of chronically unhealthy tonsils is an operation which gives very beneficial results. If the mechanical effects of enlargement seem likely to induce the projecting teeth, open mouth, pinched nostrils, poorly developed chest and other structural deformities, or if the infection is generally poisoning the body system, then operation is clearly indicated. These changes must be avoided at all costs— even at the cost of the loss of the protecting functions of the tonsils.

In the case of adenoids, the indications for operation are similar to those in the case of the diseased tonsils, and the operation is generally carried out for "removal of tonsils and adenoids." It may be said that when the adenoids are causing ill-effects to the general health or where they are associated with discharge, removal without delay is the wisest course. The dangers which attend their presence are too great to delay action. The results of removal of the adenoid mass are highly satisfactory, and the operation risks are very small, especially with modern methods of anesthesia. Age, too, is no bar to operation: adenoids may be removed in the infant of a few days old with complete safety. Do adenoids return? If they have been completely removed, this should not take place, but as it is always difficult to ensure absolute removal, a small portion may remain and undergo enlargement.

To conclude: enlargement and infection of these lymphoid tissues represent a lowered vitality on the part of the child arising from ill-nourishment, lack of sunshine and fresh air. Prevention demands a revolution in the popular conception of the dietetic needs of the child. Highly concentrated sugar foods must be replaced by an abundance of raw fruits and vegetables and fresh milk. Let parents realize these simple facts and they would spare their children much suffering and unhappiness in the present and in the future.

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