The tonsils and adenoids

Unveiling the Enigmatic Adenoids and Tonsils: Exploring Immunology, Physiology, Microbiome Dynamics, and the Transformative Power of Surgery

Within the intricate realm of the mucosal immune system resides a captivating duo: the adenoids (or pharyngeal tonsils) and the tonsils (including palatine, tubal, and lingual variations), which harmoniously form the Waldeyer's ring. As they are strategically positioned at the crossroads of the respiratory and gastrointestinal systems, these exceptional structures fulfill a vital purpose. They function as formidable "gatekeepers" by screening microorganisms-both bacteria and viruses-with the mission to vanquish local pathogens via antibody production. However, under specific circumstances, their function can take an unsettling turn, inadvertently transforming them into reservoirs for pathogen incubation. In this review, we embark on a fascinating journey to illuminate the distinctive role of these entities, focusing on the local immune system inside their tissues. We delve into their behavior during inflammation processes, meticulously scrutinize the indications for surgical intervention, and investigate the metamorphosis of their microbiota in healthy and diseased states. We explore the alterations that occur prior to and following procedures like adenoidectomy, tonsillectomy, or their combined counterparts, particularly in pediatric patients. By comprehending a wealth of data, we may unlock the key to the enhanced management of patients with otorhinolaryngological disorders. Empowered with this knowledge, we can embrace improved therapeutic approaches and targeted interventions/surgeries guided by evidence-based guidelines and indications.

Detection of adenoidal hypertrophy using acoustic rhinomanometry

Adenoidal hypertrophy is the commonest cause of nasal obstruction in the pediatric population. It may cause marked morbidity as regards respiratory physiology, facial growth and middle ear function. Determination of adenoidal presence and size is not easy. Nasal endoscopy and radiology are the most accepted modes of diagnosis and each has its disadvantages. We have used acoustic rhinometry to determine the size of adenoids. Changes in nasal volume and resistance were recorded and an easy formula was devised to determined adenoid size. This technique is easy, non-invasive and reproducible with a 93.5% predictive value.

The relationship of adenoid weight to tonsillar weight

Nearly 70 per cent of contemporary ENT consultants perform adenoidectomy as a routine when removing the tonsils. It has been stated in the literature that adenoid and tonsillar hypertrophy tend to co-exist and so a study was set up to investigate this hypothesis, with the possibility that it may be of diagnostic importance. A series of 45 children admitted for the operations of tonsillectomy and adenoidectomy was investigated. No correlation was found between adenoid weight and tonsil weight. In view of this, it was concluded that tonsil and adenoid hypertrophy do not necessarily co-exist and that tonsil size cannot be used to predict adenoid size.

How should adenoidal enlargement be measured? A radiological study based on interobserver agreement

Clinical assessment of adenoidal size is difficult, and an objective measurement is desirable. To establish the best radiological method, lateral cephalometric radiographs were taken of 38 children three days before their adenoids were removed. Two radiologists each made five measurements related to adenoidal size on ech radiograph, and the correlations between the radiological measurements and between the measurements and the volume of tissue removed at operation were calculated. Linear measurement of the palatal airway at the narrowest point between the outlines of the adenoid and soft palate is the simplest method to use and shows good correlation between observers. It is recommended for clinical use. Measurement of the nasopharyngeal soft tissue area show equally good observer correlation and better correlation with the volume of adenoid removed at operation. This method appears more suitable for longitudinal studies of adenoidal size.

Microbiology of the adenoids

The adenoids of 23 children (12 with secretory otitis media and 11 without S.O.M. who had tonsillitis or sore throats) were submitted for histopathology. All specimens showed the usual adenoid pattern with no differences in activity. The adenoids of 15 children (6 with secretory otitis media and 9 without S.O.M. who had tonsillitis or sore throats) were examined for viruses. They were all negative. The adenoids of 37 children (13 with secretory otitis media and 24 without S.O.M. who had tonsillitis or sore throats) were examined for bacterial micro-organisms. In the adenoids of the 13 children with secretory otitis media pathogenic bacteria were isolated in 6 instances, while in the 24 adenoid specimens of children without secretory otitis media pathogenic bacteria were isolated on only 3 occasions. On only one occasion was Candida albicans isolated. It is concluded that adenoids should be removed in children with secretory otitis media, but not during routine removal of tonsils in children presenting with tonsillitis or sore throats.