Tonsils & Adenoids

Tonsil and adenoid problems – tonsils and adenoids are similar to lymph nodes (sometimes called “swollen glands” when they are in the neck) in that they are part of our immune system. The tonsils are located in the back of the throat. Adenoids are located in the upper throat, behind the nose, and above the roof of the mouth.

They can’t be seen through the mouth or nose without special instruments. In combination, they help create a ring of lymphoid tissue referred to as Waldeyer’s ring. Although tonsils and adenoids are all part of the immune system, they can become infected (tonsillitis) or enlarged (tonsil and adenoid hypertrophy). These infections can cause sore throat, fever, nasal obstruction, and difficulty breathing and swallowing. Infected or enlarged tonsils and adenoids can also cause sleep disturbance due to airway blockage, snoring, or sleep apnea. Removal of the tonsils and/or adenoids, if necessary, does not create problems with immunity or the body’s ability to fight infection. In fact, the appendix also has the ability to create antibodies, as does most of the intestine, so there is tremendous redundancy in this part of the immune system.


At some point, almost every child in the United States will have at least one episode of tonsillitis. This is the most common form of bacterial pharyngitis (throat infection), especially in school-aged children. This bothersome and often painful condition occurs when the tonsils, which are lymphoid (antibody-producing) organs on the side of the throat, become inflamed due to a viral or bacterial infection.

Types Of Tonsillitis And Associated Symptoms

Acute tonsillitis – Symptoms of acute tonsillitis typically include fever, sore throat, bad breath, and difficult or painful swallowing. In some cases, tonsillitis can cause mouth breathing, snoring, sleep apnea, a “scarlatina” rash (scarlet fever), and a feeling of lethargy. These symptoms can last from three days to two weeks. By definition, acute tonsillitis lasts less than four weeks and typically responds well to oral antibiotics and hydration of the patient. A notable exception would be tonsillitis associated with the Epstein-Barr virus (aka mononucleosis), which can last many weeks and be quite severe. Epstein-Barr viral infections do not typically respond well to antibiotics. In severe cases, hospitalization may be required due to dehydration or the need for a tonsillectomy surgery.

Recurrent tonsillitis – Recurrent tonsillitis is the diagnosis for patients with multiple episodes of acute tonsillitis in a single year. An ENT doctor should be consulted if a patient experiences five or more episodes of acute tonsillitis in a 12-month period.

Chronic tonsillitis – Symptoms of chronic tonsillitis usually include all symptoms of acute tonsillitis, including frequent sore throats, bad breath, and persistently tender cervical nodes. Chronic tonsillitis is often associated with a related condition called tonsillar cryptitis, with or without cryptic debris (persistent infection of the pockets of the tonsils, with or without a buildup of organic material, sometimes inaccurately called “tonsil stones” or tonsilloliths). Tonsil stones and chronic tonsillitis are among the most common reasons adults seek to have their tonsils removed.

Peritonsillar abscess – Severe throat pain, fever, drooling, foul breath, difficulty opening the mouth (trismus) and muffled voice are typical symptoms of a patient with a peritonsillar abscess. This condition is extremely uncomfortable and usually develops rapidly over a few days. It often occurs in patients with no prior history of recurrent tonsillitis. Patients with a peritonsillar abscess invariably have pain much worse on one side of the throat than the other, and the tonsil is pushed medially toward the uvula with a firm area of fullness lateral to it. Diagnosing a peritonsillar abscess can be difficult, so if a peritonsillar abscess is suspected, the patient should immediately seek the care of an ENT or emergency department physician.

Enlarged Tonsils And Adenoids

Enlarged tonsils and adenoids usually make it difficult to breathe through the nose and cause breathing disturbances during sleep. Other symptoms of this condition can include:

  • Breathing through the mouth most of the time
  • Sounding “nasally” when speaking, as if you have a cold
  • Chronic runny nose
  • Noisy breathing during the day
  • Recurring ear infections
  • Snoring

Adenoid Infections

Chronic infection or inflammation of the adenoids can lead to frequent ear infections. A buildup of fluid in the middle ear can even cause temporary hearing loss. Chronic adenoiditis is generally a diagnosis made by inference in children requiring a second set of tubes in the ears.

Treatment Of Tonsil And Adenoid Problems

Antibiotics are the standard initial treatment for most tonsil and adenoid problems. If the problem is chronic or recurrent, surgery to remove the tonsils (tonsillectomy) and adenoids (adenoidectomy) are often recommended. In the case of a peritonsillar abscess, drainage via incision or needle aspiration is almost always necessary. In severe cases, a tonsillectomy may be recommended.

Historically, electrical cautery or a cold steel knife have been the most common methods for the removal of tonsils and adenoids. The process of electrical cautery burns the tissue at very high temperatures, effectively creating a third-degree burn in the throat of the patient and subsequently thick eschar (scabs) that must heal.

The physicians of CornerStone Ear, Nose & Throat exclusively use an alternative device that has proved to be much less painful for the patient. Our ENT physicians remove tonsils and adenoids with a Coblation® device, as opposed to using an electrocautery device or cold steel knife. We prefer this method of tissue removal because the traditional electrocautery device operates at several hundred degrees Celsius (and leaves a third-degree burn in the throat). In contrast, the Coblation device works at about only 70 degrees Celsius and is used under a constant cool saline (saltwater) irrigation. With Coblation, the tissue is cut and cooled simultaneously, avoiding the deep thermal burn that can lead to higher rates of dehydration and bleeding during the healing process.

The Coblation procedure typically results in a much lower risk of bleeding and significantly less pain for the patient. According to multiple published studies, as well as our many years of personal experience performing this procedure, Coblation allows patients to tolerate fluids and solid food more quickly, and recover in less time, with fewer complications and less discomfort than the more traditional methods.