Chronic Adenotonsillitis

Chronic adenotonsillitis is recurrent or persistent infection of the tonsils and adenoids. The tonsils are lymphoid organs located in the back of the mouth on either side of the throat. The adenoids are lymphoid organs located in the back of the nose. Both are factories for the production of immunologic white blood cells to fight infections in the upper aerodigestive tract. They can become a problem when they become infected themselves. This generally leads to severe sore throat, whitish exudate (little white spots on the tonsils that may become dislodged and coughed up), nasal congestion, difficulty swallowing, bad breath, disorders of speech, and/or airway obstruction. Chronic adenotonsillitis can present in two ways. The first is recurrent acute adenotonsillitis and the second is true chronic adenotonsillitis. The major difference is whether or not the infection gets better between episodes. Although either entity may present at any age, recurrent acute adenotonsillitis is usually a problem in children, while true chronic adenotonsillitis is usually a problem in adults.

Recurrent acute adenotonsillitis is the condition of frequently recurring infections of the tonsils and adenoids. This may be due to streptococcal bacteria (strep throat) or bacteria draining from the nose and sinuses. The infections are generally treated with an antibiotic. Penicillin or Amoxicillin are the first choices in non-allergic individuals, with Erythromycin or Bactrim reserved for Penicillin allergic individuals. The hallmark of recurrent acute infections is that the symptoms improve with the antibiotics, only to recur again shortly after stopping the medications. For subsequent infections, progressively broader spectrum antibiotics should be used (i.e. Cedax or Suprax, Augmentin or Zithromax). Tonsillectomy and adenoidectomy should be considered when one of the following occurs: seven infections in one year, five infections per year for two years, three infections per year for three or more years, ten or more days missed from school or work, two or more peritonsillar abscesses.

Chronic adenotonsillitis is the condition of a persistent infection of the tonsils and adenoids. Again this may be due to streptococcal bacteria (strep throat) or bacteria draining from the nose and sinuses. The hallmark of chronic adenotonsillitis is a failure of the symptoms to resolve with adequate antibiotic therapy. Again Penicillin or Amoxicillin are the first choices in non-allergic individuals, with Erythromycin or Bactrim reserved for Penicillin allergic individuals. When the first line antibiotics fail, progressively broader spectrum antibiotics should be used (i.e. Cedax or Suprax, Augmentin or Zithromax). Tonsillectomy and adenoidectomy should be considered when at least three different antibiotics, including a broad spectrum choice, have been tried for at least two weeks each, and symptoms still persist.

Although the tonsils and the adenoids were treated together in this discussion, it should be noted that the adenoids usually shrink away after puberty. Surgery in children usually involves removing both the tonsils and the adenoids, while surgery in adults usually involves removing just the tonsils. Exceptions to this rule do exist, therefore the tonsils and the adenoids will continue to be addressed together.

It should also be noted that there are indications for adenoidectomy alone. Among these are placement of a second set of myringotomy tubes (to unblock the eustachian tubes) and persistent nasal obstruction with purulent rhinorhea. In these cases, the adenoids are causing the problem, but there is no evidence of infection in the tonsils.