Tonsils and Adenoids

Charles W. Gross; Scott E. Harrison

doi:10.1542/pir.21-3-75

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Charles W. Gross, MD^*
Scott E. Harrison, MD^†

^*Professor of Otolaryngology-Head and Neck Surgery and Pediatrics.
^†Instructor, Otolaryngology-Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville, VA.

OBJECTIVES

After completing this article, readers should be able to:

Describe the structures generically termed “tonsils” and “adenoids.”
Explain the repercussions of the differences between the bacterial pathogens on the surface of the tonsils or adenoids and those deep within the folds or crypts of these structures.
List the percentage of children who have adenotonsillar disease that will yield beta-lacatamase-producing bacteria.
Delineate the sequelae of severe, longstanding upper airway obstruction.
Describe velopharyngeal incompetence and the management of those at risk.

Introduction

Almost every parent has a familiarity with tonsils and adenoids. They or their children may have had tonsillitis or sore throats, may snore, may have difficulty breathing, or may know someone who has undergone a tonsillectomy or adenoidectomy. Suspected tonsillar or adenoidal abnormalities prompt frequent visits to physicians. Because tonsils and adenoids are addressed so frequently, it is important to understand these structures, possible abnormalities and potential sequelae, and management options.

Definitions

“Tonsils” and “adenoids” are generic terms applied to the lymphatic tissues located within the oral cavity. In reality, they are part of a ring of lymphatic tissues around the nasopharynx and oropharynx at the entry point to the upper aerodigestive tract. Several separate structures form this ring, classically known as the Waldeyer ring. Adenoids or pharyngeal tonsils are the superior extent of the ring and are located within the nasopharynx. They are a diffuse or nodular collection of lymphoid tissue that forms a number of folds within the mucosa of the roof and posterior wall of the nasopharynx. The adenoids receive blood supply from branches of the external carotid artery. Venous drainage goes through the pharyngeal plexus into the internal jugular vein, and innervation originates from the glossopharyngeal and vagus nerves. Hypertrophy of the adenoids commonly results in snoring, rhinorrhea, or both; may cause otitis media or obstruction of the …