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The pharynx contains four types of tonsils, including the pharyngeal tonsil, which can cause obstruction and lead to conditions such as otitis media. Adenoidectomy is a common treatment, but recurrence can occur in up to 20% of cases.
The tonsils are aggregates of lymphoid tissues located in the pharynx. The pharynx, more commonly called the throat, is the highest part of the aerodigestive system that allows food to pass into the esophagus and air into the larynx. It is connected to the nose via the nasopharynx, an extension of the nasal passages. A pharyngeal tonsil is a type of tonsil located on the roof and back walls of the nasopharynx. An inflamed pharyngeal tonsil is more commonly known as an adenoid, which can cause symptoms of obstruction.
In humans, the tonsils serve as part of the lymphatic system. The four types of human tonsils are tubal tonsils located on the roof of the pharynx, palatine tonsils located between the palatopharyngeal and palatoglossal arches, lingual tonsils located behind the tongue, and pharyngeal tonsils located on the roof of the pharynx. All of these tonsils reach their largest size before puberty and undergo atrophy thereafter.
Like other types of tonsils, the purpose of pharyngeal tonsils is to improve the ability of the lymphatic system against foreign agents that enter through the mouth and nose and pass through the throat. In newborns, lymphoid tissue enlargement occurs as a defense mechanism against infection. This enlargement can cause significant airway obstruction, leading to pharyngeal tonsil problems such as mouth breathing and snoring.
A child with adenoid enlargement or hypertrophy may have an atypical appearance called an adenoid facies. Examples of adenoid facies include mouth breathing, open mouth, elevated nostrils, prominent incisors, elongated face, short upper lip, hypoplastic jaw, and high arched palate. These are obstruction adjustment measures.
Enlarged adenoids also increase pressure or block the Eustachian tubes, which connect the nasopharynx to the ears. When increased pressure or blockage occurs, the tympanic membrane of the ear can become inflamed, leading to a painful ear condition called otitis media. Untreated otitis media can cause hearing loss. Other consequences of an enlarged pharyngeal tonsil include chronic colds, sinusitis, and bronchitis. These are the reasons why an operation on the pharyngeal tonsils is recommended.
Treatment of pharyngeal tonsils is performed by adenoidectomy, after administration of a general or topical anesthetic. Surgical procedures include curettage, cauterization, laser therapy, and ablation. Despite differences in mechanisms, the purpose of these surgical procedures is to remove enlarged adenoids, although up to 20% of people who undergo adenoid removal experience a recurrence.
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