Generality
By hypertrophic tonsils, we mean the increase in volume of these organs. In most cases, this condition is caused by an inflammatory process (tonsillitis).
Hypertrophic tonsils tend to appear enlarged, reddened and, in some cases, can touch each other.
The inflammation underlying the increase in tonsillar volume is often attributable to infections : being located in the oropharynx, where they participate in the immune defense of the upper airways, these organs easily come into contact with bacteria and viruses. Tonsillar hypertrophy and inflammation are disorders that occur mainly in children, but can also affect adults.
In addition to swelling, hypertrophic tonsils involve pain when swallowing ( dysphagia ) and sore throat and whitish or purulent plaques on their surface. Furthermore, it is not uncommon for general malaise, fever, swollen lymph nodes in the neck, bad breath and ear pain.
A careful clinical evaluation by the otolaryngologist allows to identify the causes and establish the appropriate therapeutic strategies. If the hypertrophic tonsils cause serious respiratory limitations or recurrent infections and are resistant to drug treatment, the indication is given to their removal ( tonsillectomy ).
What are
Hypertrophic tonsils are a clinical sign that, in most cases, results from an inflammatory process against them ( tonsillitis ) and, possibly, surrounding tissues ( adenotonsillitis or pharyngotonsillitis ). From these issues, respiratory problems and other complications can arise that should never be overlooked.
Tonsils: what they are and what functions they perform
- The tonsils are organs formed by lymphoid tissue, located on the sides of the throat, immediately behind and above the base of the tongue.
- When normal, the tonsils are barely visible and have a uniform pink color. Their ovoid shape is reminiscent of an almond.
- Being in a strategic position, the tonsils have the function of forming a first barrier against infections of the upper airways, especially important during childhood, when the immune system is still not mature. Moreover, these structures favor the immunization towards the microorganisms coming from the outside, which penetrate through the nose and the mouth: when they are inflamed, the tonsils force the body to produce antibodies capable of neutralizing viruses and bacteria. Pharyngeal tonsils, more commonly known as adenoids, also participate in this defense against respiratory infections.
- In some cases, however, the task of the tonsils is less: after repeated bacterial or viral aggressions, these can excessively increase in volume (hypertrophy), become chronically inflamed and turn, in turn, into an outbreak of infection for other organs or tissues (heart, kidneys, etc.).
Causes
The causes of hypertrophic tonsils are many.
In most cases, this manifestation results from an infection : the tonsillar tissue is easily in contact with bacteria and viruses, therefore it goes with extreme frequency to inflammatory processes. It follows the increase in volume and tonsillar congestion . Even allergies, exposure to irritants and, in some cases, gastroesophageal reflux may cause tonsillar hypertrophy. Very rarely, hypertrophic tonsils can be caused by cancer .
It should be noted that hypertrophic tonsils may depend on constitutional factors, so they are not always caused by an underlying pathology.
Hypertrophic tonsils: who is most affected?
The increase in the volume of the tonsils ( tonsillar hypertrophy ) and the inflammation of these structures are frequent pathological conditions especially in children aged between 2 and 6 years .
Risk factors
Regardless of the underlying cause, hypertrophic tonsils are favored by:
- Low temperatures: hypertrophic tonsils are a more frequent manifestation in the winter period, due to exposure to cold and the greater risk of incurring in temperature changes. Furthermore, the colder temperatures tend to weaken the immune system, allowing viruses and bacteria to multiply more easily in the throat.
- Bacterial infections: one of the pathogens most commonly involved in inflammation and hypertrophy of the tonsils is group A beta-hemolytic streptococcus. This bacterium is widespread: it appears, in fact, to be present asymptomatically in about one third of children. When the organism is weak or respiratory infections are in progress, Streptococcus multiplies causing high fever (up to 39-40 ° C), chills, bad breath, swelling, difficulty swallowing and whitish plaques in the throat.
- Colds and other viral diseases : in most cases, hypertrophic tonsils depend on Adenovirus and Rhinovirus, the most common cold virus. Tonsil hypertrophy can also be caused by Epstein Barr virus (mononucleosis). Hypertrophic tonsils due to viral infection are associated with a reddened throat, swollen lymph nodes, and a few lines of fever. Generally, the disease undergoes spontaneous resolution.
- Pediatric age : present from birth, the tonsils develop progressively and reach their maximum size at the age of 3-5 years. At the age of about 7, these organs undergo an involution process, reducing their size due to the physiological atrophy, which makes them barely visible during adolescence. In adulthood, the tonsils become practically inactive from the functional point of view. Increasing in volume, also due to their particular conformation, these structures are more likely to meet infections.
Symptoms and Complications
Hypertrophic tonsils can interfere with breathing and swallowing. Upon observation, these appear as enlarged, reddened and swollen masses .
Tonsil hypertrophy can be acute or, if not treated adequately, chronic.
In addition to hyperemia and tonsillar hypertrophy, when acute inflammation is underway, yellow pus patches or whitish plaques in the throat can be seen on the surface. In chronic forms, characterized by repeated episodes, however, these enlarged organs take on a cavernous appearance ( cryptic tonsils ).
What disorders are associated with hypertrophic tonsils?
Hypertrophic tonsils can be asymptomatic (that is, they do not cause particular disorders) or are accompanied by:
- Sore throat;
- Swallowing pain (odinophagy);
- Halitosis (bad breath);
- Swollen and painful neck lymph nodes;
- Reflex otalgia (pain radiated to the ear, supported by the common innervation);
- Noisy and predominantly oral breathing during night rest;
- Snoring;
- Contemporary inflammation of the adenoids.
Depending on the underlying cause, other symptoms associated with hypertrophic tonsils include:
- Fever more or less high (sign not always present);
- Dysphagia (difficulty swallowing food);
- Headache;
- Dyspnea (difficult breathing);
- Sleep disorders (frequent awakenings during the night, daytime hypersomnolence, bed wetting, difficulty concentrating, poor academic performance, etc.);
- Sialorrhea during sleep (loss of saliva from the mouth);
- Changes in the vocal timbre (rhinolalia);
- Anxious cough.
Usually, hypertrophic tonsils resolve completely, without leaving any damage, if diagnosed and treated properly. Other times, the repetition of this condition over time can predispose to the development of complications.
Hypertrophic tonsils: possible complications
Typically, the tonsils return to normal size when the inflammation has resolved. Sometimes, however, hypertrophy persists, particularly in children with frequent or chronic infections.
If the disease at the origin of the hypertrophic tonsils is neglected, various complications are possible, including:
- Chronic or recurrent nasopharyngitis;
- Recurrent inflammation of the ear (otitis) and hearing loss;
- Recurrent infections of the paranasal sinuses (sinusitis);
- Respiratory disorders, such as obstructive sleep apnea;
- Peritonsillar abscesses (collections of purulent exudate inside or near the tonsils);
- Septicemia (widespread infection throughout the body).
Chronically inflamed hypertrophic tonsils can represent an infectious focus that can be responsible for diseases affecting other organs, such as eyes, joints, muscles, kidneys and heart. Although they are now rare, the possible complications at a distance are glomerulonephritis, rheumatic fever and endocarditis.
Diagnosis
The evaluation of hypertrophic tonsils can be performed by your primary care physician or otolaryngologist : the associated symptomatology is easily recognizable and the diagnosis can be formulated after a complete inspection of the upper airways and digestive tracts (oral cavity and throat).
The doctor also has the task of establishing in the disorder in place which pathogens are involved or not. In general, the various symptoms of bacterial infections, unlike in viral infections, tend to worsen (and not improve) after 48-72 hours.
To identify the causes responsible for hypertrophic tonsils, the patient can be subjected to an oropharyngeal swab which usually attests to the presence of Streptococcus bacterial infection. This exam consists in taking a small amount of throat secretion with a sterile cotton coated stick: the liquid is then analyzed in the laboratory to identify the etiological agent in a few days. The request of the antistreptolysinic titre (TAS) is fundamental to exclude group A beta hemolytic streptococcus infection and can be an indicator of tonsil inflammation even after some time.
If your doctor, however, suspects that tonsillar hypertrophy is caused by mononucleosis or other viral agents, will require specific blood chemistry tests .
Hypertrophic tonsils: when to contact a doctor urgently
The doctor must be consulted in a timely manner when the following conditions are met:
- Sore throat is particularly intense and there are many difficulties in breathing or swallowing;
- Fever exceeds 39 ° C;
- Tonsillitis does not resolve and does not tend to improve after five days of its onset;
- There is pain in the ear;
- The headache is intense and associated with repeated vomiting;
- The patient shows signs of mental confusion.
Treatment
Regarding treatment, the options vary depending on the cause of the hypertrophic tonsils:
- If the basic problem is a bacterial infection, the doctor may indicate the intake of specific antibiotics aimed at selectively attacking the pathogen responsible for the disorder. An anti-pyretic drug may be associated with this therapy to combat fever. The symptoms associated with hypertrophic tonsils are attenuated in about 5 days after the start of antibiotic therapy. Normally, the antibiotics prescribed by the doctor are sufficient to treat the problem of hypertrophic and inflamed tonsils (acute bacterial tonsillitis). Sometimes, however, this therapy is not sufficient to eradicate the infection definitively and the patient may be subjected to 5-6 acute episodes (chronic tonsillitis) in the course of a year.
- When supported by a viral infection, hypertrophic tonsils regress and heal spontaneously over a period of 7-10 days (usually, a symptomatic peak occurs in the first 48-72 hours). In this case, it is possible to resort to a pharmacological treatment aimed at mitigating the symptoms. The doctor may indicate the intake of antipyretics and analgesics, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs).
To alleviate the disorders associated with hypertrophic tonsils it can be useful:
- Rinse the throat with gargling using an antiseptic mouthwash or saline solution;
- Take plenty of fluids (fruit juices and herbal teas) and soft foods, preferably warm or cold.
Did you know that…
As long as tonsillar hypertrophy persists it is good not to drink too hot foods or beverages, as they increase local inflammation. On the contrary, having dinner or having lunch with an ice cream can be a relief.
When to remove hypertrophic tonsils
Although these formations are useful during early childhood to prevent infections, the body has more effective means to fight bacteria and viruses. For this reason, if the tonsils grow in volume, are chronically inflamed and cause significant respiratory problems, the possibility of surgically removing them is considered.
Indications for tonsillectomy
- Inflammation of chronic or relapsing tonsils (more than 4-5 episodes of tonsillitis per year in school-age and adult children);
- Severe symptomatology (impediment to breathing through the nose, snoring, sleep apnea, etc.);
- Recurrent inflammation of the middle ear;
- Pharyngitis that repeats with a certain frequency;
- Risk of possible complications and suspicion of spreading the infection at a distance.
Tonsillectomy is a relatively simple operation that is performed under general anesthesia. In the week following the operation, it is normal to feel discomfort and pain in the affected area. However, if copious blood loss occurs, contact your nearest emergency room immediately.
Tonsillectomy can be associated with the removal of adenoids ( adenoidectomy ) which, like tonsils, are often subject to inflammation and enlargement.
