Chronic Adenoid and Tonsil Enlargement

Chronically large tonsils and adenoids in children can cause varying degrees of airway obstruction. This condition is two of the common causes of tonsil and adenoid surgery. Adenoids and tonsils are small at birth and gradually enlarge between 1 and 5 years of age. Frequently inflamed tonsils and adenoids can become a source of infection after a certain period of time. In addition to frequent infections, passive smoking may cause undesirable enlargement of adenoids and tonsils in children.


Chronically large tonsils and adenoids are one of the most common causes of upper respiratory tract obstruction in children. In very advanced cases, it can cause pulmonary diseases (cor pulmonale, pulmonary vascular hypertension, alveolar hypoventilation)

Obstructive sleep apnea

It is one of the most common conditions in patients with chronic adenoid and tonsil enlargement. Respiratory arrest during sleep, loud snoring witnessed by the family, (the family says: “This child is snoring like an adult”), mouth breathing constantly, waking up frequently at night, drowsiness during the day, bedwetting at night, having nightmares during sleep, school poor performance, speech disorders, nasal speech are symptoms due to enlargement of the adenoid and tonsil and obstruction of the airway. In addition, chronically larger than normal adenoids and tonsils may cause developmental delay in children.

Chronically larger than normal adenoids and tonsils may have negative effects on facial bones, jawbone, hard palate and tooth development in children.

In children, the diagnosis is made by history and physical examination, and sleep test is usually not needed.

Adenoid is in a difficult position to detect on physical examination. For this reason, direct lateral cervical radiography or flexible fiberoptic nasopharyngoscopy (view with a camera through the nose) are detected. However, these may not be needed in the patient with chronic adenoid enlargement complaints and symptoms.

In the preoperative evaluation

Blood tests, chest X-ray and electrocardiogram are done. In patients with a family history of bleeding-coagulation disorder, patients with easy bruising without trauma, a history of excessive bleeding in previous surgeries, a history of prolonged bleeding after tooth extraction or incisions, further hematological investigations may be required in terms of bleeding-coagulation diseases. In patients with asthma, drug therapy may be required in the preoperative period.

In which cases is tonsil surgery performed?

Having more than 6 tonsillitis in a year or more than 3 tonsillitis per year in the last two years (when evaluating patients, the severity of each infection, response to drug treatment, and how this affects the quality of life should be considered.)

In patients with heart valve disease with frequent tonsillitis,

In recurrent fever-related convulsions (seizures),

In case of bad breath due to recurrent inflammations that do not respond to drug treatment,

In streptococcus (beta) carrier that does not respond to drug treatment,

In case of recurrent peritonsillar abscess (abscess formation in and around the tonsil),

If it causes obstructive sleep apnea,

If it causes developmental delay,

If it brings to mind a unilateral enlarged and malignant tumor, tonsil surgery is performed.

How is tonsil surgery done?

Tonsil surgeries are performed under general anesthesia in children. The operation time is approximately 30-45 minutes. It can also be performed under local anesthesia in adults.

In which cases is adenoid surgery performed?

If the adenoid tissue causes chronic middle ear fluid accumulation,

In case of chronic recurrent acute otitis media attack,

If it causes chronic mouth breathing and obstructs the nasal area,

If it causes obstructive sleep apnea or sleep disorders,

If it causes developmental delay,

If it causes negativities in the development of facial bones and jawbone,

If the adenoid tissue has started to be a source of infection,

If it is thought to be the cause of chronic sinusitis, the adenoid should be operated.

Things to consider after adenoid and tonsil surgery.

Before the operation, patients are asked to fast for 8 hours and the timing of this is explained to you by your doctor.

Some medications can be used just before surgery to calm children with high fear and anxiety.

Patients can be sent home on the day of surgery, after 6-8 hours of observation, if there is no opposite, and after the patient is informed and warned against bleeding.

In case of additional disease and risk, patients are kept under observation in the hospital for one day.

You will be given a diet list after the surgery. Careful adherence to this diet reduces the risk of bleeding. It is important that you do not use drugs other than those that your doctor will recommend to you. Contact your doctor for light red bleeding.

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