Ep. 15: Untangling Truths about Tonsil Disease
Show Notes
Everyone has heard of Strep throat and often it is associated with infected tonsils. Many people have also heard of someone who had very large tonsils but”no symptoms”. Well, understanding tonsil disease can be very confusing!
I talk about this topic every single day in my practice because it is common. But each patient has a slightly different set of symptoms; therefore, each may get a different treatment approach.
First, what are tonsils?
Generally, I say they are simply lymph nodes in the back of the throat. Meaning, they are part of the immune system to help fight off disease.
But after the infection or problem has improved, the lymph nodes, and tonsils, are supposed to shrink back down. But what if they don’t?
The ongoing tonsil disease could mean it is time for medications or surgery; however, it might be time to look into the cause for why the lymph nodes are still irritated or enlarged.
It is not normal to have enlarged or inflamed tonsils. It is common, but not normal. There is always a reason why someone has persistent tonsil disease.
3 basic categories for tonsil disease
-
Infection
- Acute vs chronic
- Strep, a biggie that always needs treatment to avoid severe complications
- Bacterial, that is not strep
- Viral, the most common
-
Inflammation, but not infected
- Allergies
- Gastric acid reflux
- Mouthbreathing and dry mouth
-
Enlargement
- Different degrees ranging to most severe, kissing tonsils
- Can have no symptoms or severe sleep apnea
- Symptoms often present but just not at a level that parents think is significant
- snoring
- restless sleep
- awakening at night
- pauses in breathing
- trouble eating solid foods
- avoids hard-to-chew foods like meat
- chokes when eating hard foods
- parents must chop up food for older kids
- may spit our partial chewed food instead of swallowing
- Rare concern for cancer in kids, but in adults, may be considered
Additional common tonsil symptoms
-
Bad breath
-
Tonsil stones
- these represent chronic tonsillitis
- recently learned from a patient that Amazon sells really cool devices to dig stuff out of tonsils.
- JUST NO!! Don’t do it!
- You are NOT adequately cleaning them. Just scraping surface
- comes from deep inside tonsils
- if you clean them, this may need to be continued forever.
- these do NOT represent food trapped in tonsils
- management
- Cryptoloysis (umm, never heard of this before this post!)
- best for adults: can be done in the office
- works best when only a few involved areas
- tonsillectomy (no tonsils = no stones!)
- Cryptoloysis (umm, never heard of this before this post!)
-
Tonsil abscess
- infection no longer limited to the fleshy lymph node
- infection can spread to the areas behind the tonsil and get trapped
- usually an emergency or at least an urgent issue to treat
- can drain the abscess in the ER if old enough child or adult,
- younger kids need to go to the operating room for drainage
- if not treated, can spread deeper into the soft tissues of the neck
- huge deal when tonsil infection leads to neck abscess
- can be life-threatening
Myths about tonsils
- if they are removed, kids get sicker
- if they are removed, kids will gain weight
- will not get strep throat after removal
- will always eat, sleep etc normally after removal
- they grow back after removal…actually depends on technique for removal
- if completely removed, they are gone for good
- some surgeons perform partial removal, shrinking of tonsil tissue
- like mowing the lawn: if they are only trimmed, they will grow back!
When antibiotics are needed
- when the diagnosis is strep throat
- if rapid strep test in the office is negative, but culture grows it in 2-3 days
- some physicians give antibiotics with a negative strep test, then call to say keep taking
- others don’t give antibiotics until the culture is positive, so may call in antibiotics later
- you must know the plan!
- negative strep testing but bacterial symptoms are worsening over time
- non-strep tonsillitis
- experienced physicians can determine if following viral vs bacterial infection
- if strep culture is constantly positive, even when no symptoms
- THIS IS THE MYSTERIOUS STREP CARRIER!
- carrier means strep and you have a partnership, no one hurts the other, live in peace and harmony
- strep uses your tonsils as a staging area to attack everyone around you but spares you
- lives in the deep part of the tonsil
- have had cases of this is newborns! everyone in the family sick after the baby brought home.
- often hard to get rid of.
- may need longer and stronger antibiotics
- decision to remove tonsils can be hard
- remove from happy healthy carrier OR the sick family member?
- TIP: just because someone has strep, you does not mean you will catch it.
- Most of us resist, if you don’t, maybe you are the one with an issue.
- May YOU are the one that needs your tonsils removed! (just some food for thought)
- THIS IS THE MYSTERIOUS STREP CARRIER!
When are too many infections too much? ( like ear infections in my previous podcast, there are textbook numbers that make physicians consider tonsil removal)
- >6 in 12 months
- 5 two years in a row
- 3 every year for 3 or more years
**Always remember that surgeons weigh many factors when making a decision to remove tonsils. **
Summary:
- Tonsils help keep us healthy…until they don’t
- Acute and chronic infections can happen
- Tonsil stones may occur as part of chronic tonsillitis
- Can be enlarged with no symptoms and no treatment needed
- Can be enlarged and cause symptoms as severe as sleep apnea
- Removal does not mean that all of your symptoms will be gone
- May need to find what the underlying problem is.
Future episodes will go into more detail on separate topics, like complications of tonsillitis, complications of enlarged tonsils, different types of tonsillectomy, recovery from tonsillectomy….and any other topic that I find myself sharing frequently with my patients. Also, do not miss out on my discussion about struggling to accurately diagnose PANDAS and the controversies with PANDAS treatments.
As always, much love for supporting my work. I will be adding many more posts to highlight parenting and healthcare tips, so be sure to consider subscribing to my podcast or to my blog to avoid missing a post!
Consider saving to Pinterest for future reference!
34 comments
I love your name! Dr. Momma <3 This is such a helpful resource for families with small children 🙂
Thank you! I was hoping people who recognize from my name that I am bringing experience as a physician AND a mom.
My sister used to have tonsillitis all the time and they were the bad kind. My other sister had hers removed when she was younger because of the same problem. This is really good to know.
Many people have tonsil problems and never have them removed because they get used to it. But once they are removed, it can really improve your health.
My daughter had horrible sleep apnea and had to get her tonsils and adenoids removed this year! Such a scary procedure!
Sleep apnea and large obstructing tonsils is the most common reason I need to remove tonsils!
So informative!!! I’ve seen those tonsil cleaning products on Amazon as well, so it was good to know that they do more harm than good! Thank you for sharing!!
Oh goodness, I was shocked to see those gadgets! They might help you in the short term but understanding that the center of the tonsil has more, you will realize that you need a better long-term plan.
This is great information about the tonsils. No one thinks about them until there is a problem.
Very true. And by the time a problem is noted, it can be hard to fix without surgery. Catching symptoms early is key
Thank you so much for this informative post. I have heard so much about tonsils that it’s great to hear your facts to make an informative decision if I ever have to.
Most people have heard of someone who had their tonsils removed but they often do not understand why or what might have been done earlier.
Great write up about tonsil disease. I have my tonsil removed many years ago due to frequent swollen tonsil and sore throat. Glad to learn about tonsil stones too in this article.
My daughter had hers out when younger and it was one of the best things we could have done for her.
So many interesting things I didn’t know about tonsils! I still have mine but have always wondered if I really needed them.
If you have to wonder if you still need them, it means they are not sick. If your tonsils were sick, you would know! Most people don’t ever have trouble with them.
Love your blog. You give very in depth information on the topic. But most importantly very easy to understand. I learned a lot about tonsils. Thank you for sharing your knowledge.
Thank you so much! I spend so much time in my office every day trying to educate parents because understanding is better than just doing what I say. I am happy to hear I have been able to make things understandable here.
This is such an informative post! I had alot of issues with mine when I was younger.
Very common for school-aged kids to have a lot of issues. Most people then outgrow the problems.
Thank you for sharing this detailed information, I remember my mom gots her tonsils removed, It was not fun.
Oh no! Adults and teens tend to do worse after surgery than the motivated and very bribable young child!
Oh no, after reading this, I’m wondering if I have an enlarged tonsil or tonsils. I snore and have the most restless sleep of anyone I know.
Snoring is not normal and having restless sleep may mean you might have a narrow airway. I would recommend you talk to your physician and see if they can treat you or refer you to a specialist.
Okay. Now i have to visit doctor you have shared so many symptoms & i have some of them. Ill check it once from doctor.
Yay! Glad this has at least encouraged you to start a conversation with your physician.
I would usually have frequent tonsillitis when I was a kid. Providing the dos and donts about it is beneficial
Thankfully, many people who have tonsil problems do outgrow them.
This is such a very informative article, Many would think there is nothing wrong with them but after reading this. We might learn something new and probably discover something wrong with us. Thanks for this.
Tonsils problems can go on for so long that many people just get used to them.
I’ll soon be having my first child so this is great information to know, thanks!
Hopefully, your child will never have the ear, sinus or tonsil problems I care for every day. But if you need information understanding them, please feel free to check back.
Never heard of tonsil cleaning products. All I know is that growing up, some of my friends had to have their tonsils surgically removed because they always get infected,
I have been an ENT physician for nearly 30 years and still cannot believe I didn’t know that Amazon was filled with tonsil cleaning devices!