Tonsils are small masses of lymphatic tissue visible on either side of the back of the mouth along the top of the throat. The tonsils trap bacteria and viruses entering through the throat and produce antibodies to help fight infections. The basic function of these tissues is to provide resistance against disease and they normally subside by the time the kids are in their teens. The problem arises when they get inflamed and enlarged and start interfering with normal swallowing and eating. Infection of tonsils is commonly seen in school going children.

Large tonsils are normal in children. Although tonsils become enlarged when fighting infection, large tonsils are not necessarily infected. Tonsils are not considered too large unless they touch each other or interfere with breathing or swallowing. Tonsils are biggest between the ages of 4 to 12, when children have frequent upper respiratory infections. As with all lymph tissues, they shrink in size each year after age 12.

The symptoms suggesting infection of tonsils are: pain at the angle of the jaw and also sometimes in the ear, difficulty in swallowing, fever is often present, foul breath, inflamed oral cavity. The most common treatment for such infection would consist of antibiotics for 7- 10 days, analgesics (pain relievers) and warm saline gargles.

Tonsils may be surgically removed because of any of the following reasons:

• They are too big and are blocking the throat passage
• The patient suffers from constant sore throat or chronic and recurrent tonsillitis that resists antibiotic treatment.
• There is chronic cryptic tonsillitis- deposition of white debris in tonsils
• They are unusually large and are infected
• The patient has difficulty breathing, swallowing, speaking, sleeping or hearing

Generally the following steps are taken during the tonsillectomy:

• Your child will receive general anesthesia and the surgery will be performed in an operating room so that an anesthesiologist can monitor your child.
• Your child will be asleep for about 20 minutes.
• The surgery will be performed by opening the mouth and there will not be any cut on the child's skin.
• The tonsils will be removed with a series of incisions and then cauterizing (or seals) the blood vessels.

Tonsils are usually removed during outpatient surgery. Immediately after anesthesia, the child may feel some nausea, and rich foods like milk may cause vomiting. However, this feeling usually goes away after a few hours. As with all operations, there is some risk. A small percentage of children have bleeding between five and eight days after surgery. Some will need a transfusion or another operation. Children who have their tonsils removed have a sore throat for up to two weeks afterward.

Since the residual tonsil tissue remains, there is a very slight chance that it can re-enlarge or become infected and require more tonsil surgery. This risk is small and occurs in less than 1% of children undergoing this procedure. In the case of a child with recurrent tonsillitis, removing the tonsils and adenoids will result in fewer episodes of sore throat.

Copyright 2001, 2004. All rights reserved. Any reproduction of this article in whole or in part without written or verbal permission is strictly prohibited. For information about reprinting this article, contact the copyright owner: Vanessa Rasmussen, Ph.D, Starting a Day Care Center, http://www.startingadaycarecenter.com.