The Throat

Enlarged Adenoids

Adenoids (also known as “pharyngeal tonsils”) are lymphoid tissue located in the back of the nose above the palate.   Adenoids act like tonsils and can get enlarged and/or infected.  Because of their location near the Eustachian tube opening, adenoids can cause chronic ear problems.  Furthermore, they can block the nose and cause nasal congestion.  Adenoids do occasionally respond to medications but can be removed as an outpatient procedure.  An adenoidectomy is combined with a tonsillectomy, if indicated.  Adenoids usually regress and go away during the mid-to late- teen years but can be seen in adults, infrequently. 


The tonsils are located in the back of the mouth below the roof of the mouth (palate) and are made up of “lymphoid” tissue.  The tonsils do not combat infection but rather react to infections by producing a certain type of antibody, which is also made by several other areas of the body. Tonsillitis is very common, especially in children. The symptoms of infected tonsils include fever, sore throat, foul breath, difficulty swallowing, painful swallowing, tender lymph nodes, mouth breathing, snoring and/or sleep apnea.  Most of the symptoms will usually resolve within three to four days but may last up to two weeks. 

Tonsillitis is typically treated with antibiotics.  When the condition is recurrent or becomes chronic, a surgical procedure to remove the tonsils (and possibly the adenoids), is often recommended. (See below)


The tonsils (and adenoids) work as part of the body’s immune system by “filtering” germs that attempt to invade the body. Actually, the tonsils are no longer helpful when they become chronically infected. In general, it is recommended that a tonsillectomy be performed for patients that have three or more tonsillar infections per year.  Another reason for tonsillectomy and adenoidectomy is sleep apnea or airway blockage due to large tonsils and adenoids.  Sleep apnea responds very well to this surgery in children.

A tonsillectomy may be combined with an adenoidectomy, if indicated. The surgery is usually done in an outpatient surgical facility under general anesthesia.  The surgeon uses special instruments to cut the tissue around the tonsils (and adenoids) to remove them completely. The surrounding blood vessels are then sealed to control bleeding.  Risks with this surgery include bleeding, which can be minor or significant.  Most of the time there is no bleeding at all after surgery. It is important for patients to keep well hydrated after a tonsillectomy.  Other post-operative symptoms that may occur include difficulty in swallowing, vomiting, fever, throat and/or ear pain. Typically, patients are able to return to normal activities in one to two weeks.

Children who must have their tonsils (and adenoids) removed suffer no loss in their resistance to germs.  Actually, the performance of a tonsillectomy can help to decrease the incidence of further infection and illness.

Hoarseness & Laryngitis

There are many causes of hoarseness. Acute laryngitis is temporary and is often due to a cold virus or other upper respiratory infection or from the irritation caused by excessive voice use, such as screaming at a sporting event. However, for persistent hoarseness (hoarseness lasting more than two weeks), a complete ENT exam is needed.

Causes of hoarseness include vocal cord swelling, laryngeal polyps or nodules, postnasal drainage, reflux, and tumors. Swelling, polyps, and nodules, which are callous-like growths, are usually due to long-term voice abuse and irritation of the vocal cords. These can respond to medical treatment, voice therapy, or occasionally to surgery.

Laryngeal Reflux

Laryngeal Reflux is a very common cause of prolonged hoarseness. It is caused by stomach acid or other stomach enzymes coming up into the throat and is usually NOT accompanied by heartburn or other stomach symptoms. This condition is known as laryngopharyngeal reflux, (LPR) or “silent” reflux. Patients with LPR may experience a cough, sore throat, a tickle, or a “lump” in their throat, mucous sticking in their throat or an excessive desire to clear their throat. Typically, the hoarseness is worse in the morning and improves during the day. LPR can respond to dietary changes and/or medications. Even with medications, it often takes increased doses and prolonged courses of treatment.

Unfortunately, tumors also present in hoarseness. These are not as common in the general population, but of more concern in adult smokers and drinkers. Cancers of the voice box or vocal cords are treated in different ways (surgery, radiation, chemotherapy) depending on how advanced the tumor is when it is diagnosed. 

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