Enlarged tonsils in a child - what do they indicate?

Enlarged tonsils in a child may indicate that the body is fighting some kind of infectious carrier, or some other pathologies. With this symptom, it is necessary to treat the underlying pathology in the body.

Author:

Oganesyan Tigran Sergeevich
ENT pathology expert

3.86 (Votes: 7)

Tonsils (tonsils) are a collection of lymphoepithelial tissue, which is the point of contact of the immune system with the external environment. Thanks to this, the body produces protective immunoglobulin proteins in response to bacteria, viruses, fungi and other foreign microorganisms. Thus, the formation and maturation of immunity occurs. Located at the border of the respiratory and digestive tracts, the tonsils promptly intercept viruses and bacteria that enter the body with inhaled air, water and food.

Enlarged tonsils in a child are not a separate disease. They say:

that the body is fighting some kind of infectious carrier;
about genetically determined proliferation of lymphoepithelial tissue without an infectious agent;
about possible blood diseases (oncohematological diseases), autoimmune diseases and diseases of the endocrine system.

The problem is that tonsil hypertrophy progresses quickly, and it is important not to miss the moment when the painful condition begins to cause severe discomfort to the child, but to treat the underlying pathology in a timely manner. Only an experienced doctor, whose specialization is children's ENT diseases, can correctly determine the true factor in the appearance of the symptom and choose competent therapy to eliminate it.

Symptoms of tonsil cancer

Dysphagia (difficulty swallowing) – the tumor interferes with swallowing, causing difficulty swallowing.
Odynophagia (pain when swallowing) – the tumor grows, leads to the formation of ulcers, grows into the nerves, which leads to pain.
Lump – spread of cancer to the lymph nodes makes the tumor clinically noticeable: the patient may notice a firm, palpable mass in the neck.
Otalgia (ear pain) - the innervation of the oropharynx and ear has some connection, which means that the brain can “replace” pain in the oropharynx with pain in the ear (referred pain). The most alarming is pain in the ear on one side, without any other ear problems, not going away, unexplained by other diseases. It is important to understand that most causes of ear pain are associated with middle ear infection, eustachian tube dysfunction and other diseases of the ENT organs. But a combination of several symptoms may indeed indicate an oncological process.
Trismus (spasm of the pterygoid muscles, causing difficulty opening the mouth).
Feeling of a lump in the throat.
A sore throat.
Bleeding from the mouth.
Change in speech (muffled voice).
Weight loss.

Medial pterygoid muscle. getbodysmart.com

White plaque and plugs on the tonsils

04.09.2021

The tonsils are the tonsils on the roof of your mouth that are located close to the larynx. They consist of lymphoid tissue. They belong to paired human organs.

The tonsils perform functions such as protective and hematopoietic. In addition, they take part in the development of the immune system . Surface of the tonsils

has a cavernous character. These depressions are called crypts or lacunae. Inflammation of the organ causes it to become covered with pus,

which clogs the crypts. Because of this, traffic jams form. Next, let's look at information about what diseases inflammation is a symptom of.

tonsil , and what needs to be done.

Causes of white plaque and plugs on the tonsils

In most cases, inflammation of the tonsils indicates a disease called tonsillitis . It can be either acute or chronic.

In addition, the appearance of purulent plaque may be caused by the following reasons:

• frequent ARVI; • runny nose , which lasts a long time; • dental ( caries ); • diphtheria; • scarlet fever; • infectious mononucleosis, etc.

Food can also cause clogging of lacunae. Products such as cheese, cottage cheese, nuts, seeds can cause specified consequences.

Treatment of inflammation of the tonsils

Inflammation the tonsils is accompanied by bad breath , a feeling of constant sore throat , pain during swallowing and changes in the voice.

But these are not all the consequences. Much more serious is the appearance of problems with important vital organs, namely the heart , kidneys and liver .

Such occurrences occur due to the fact that toxins enter the circulatory system, which are a consequence of the occurrence of pathogenic

bacteria in the clogged cavernous bodies of the tonsils . Therefore, treatment of the tonsils should not be delayed. To do this, first of all, you need to see a doctor.

for the correct diagnosis and explanation of the treatment method.

Very often, the only correct treatment for frequent inflammation of the tonsils is considered to be their surgical removal . However, it is increasingly being argued that

This is not the only way out of the situation; a conservative method can also achieve positive results.

Contrary to the opinion of doctors who insist on removal , other doctors and researchers consider the tonsils to be a very important organ. He not only performs

function of protecting the immune system , but even resists the appearance of malignant tumor cells.

Chronic inflammation of the tonsils is treatable, but it takes a long time. To achieve this, there is a set of measures that must be periodically

repeat. These are measures such as:

• physiotherapeutic procedures, for example, UHF, ultrasound and others; • use of medicinal solutions for mouth ; • lubricating the tonsils with antibacterial agents and injecting with anti-inflammatory drugs; • use of drugs to strengthen the immune system .

Removing purulent plugs from the tonsils

Sometimes it happens that cleansing occurs naturally. At the same time, dense lumps enter the oral , improving the patient’s condition. But if inflammation

caused by tonsillitis , then pus is constantly released, without giving time for cleansing. The hospital may remove the pus plugs. To do this, they are washed with a special

solution. In this case, vacuum suction can also be used under local anesthesia.

Under no circumstances should you attempt to remove traffic jams yourself. Pressing fingers or other objects can only aggravate the condition, pus can

penetrate even deeper into crypts.

Prevention of congestion in the tonsils

To prevent the occurrence of purulent plugs on the tonsils , after meals you need to gargle with a solution of soda (a teaspoon in a glass of warm water).

to treat sore throat :

• furatsilin or streptocid (in the ratio of 20 g of the drug per 100 ml of hot water); • solution of chlorophyllipt in alcohol • infusion of chamomile (1 teaspoon of flowers per glass of boiling water, wait 20 minutes for it to stretch).

Published in Otorhinolaryngology Premium Clinic

Diagnostics

Anamnesis collection, visual examination and palpation of the mucous membranes of the floor of the mouth, the anterior two-thirds of the tongue, the tonsils and base of the tongue, the mucous membrane of the palate, cheeks and gums, and the posterior wall of the pharynx.
Diagnosis of HPV infection: immunohistochemical determination of the surrogate marker p16 in tumor tissue.
Computed tomography of the chest and abdominal cavity to exclude metastatic lesions.
Biopsy – cancer can be diagnosed only by taking a tissue sample from a growth that is suspicious for a malignant process.
MRI of the soft tissues of the neck provides more accurate detail of the soft tissues compared to CT. Performed to assess the prevalence of the process.
Ultrasound of the lymph nodes of the neck to determine their structure (if there is metastasis in the lymph nodes, they may not change their size, but the structure of the lymph node changes).
PET-CT may be ordered if occult distant metastases are suspected in some situations.
Fibercolonoscopy, fibrogastroduodenoscopy, laryngoscopy and some other studies may also be prescribed.

HPV-associated squamous cell carcinoma of the right tonsil (A) demonstrating p16 overexpression by immunohistochemistry (B) and evidence of high-risk HPV by in situ hybridization (C). Patients with HPV-related tonsil squamous cell carcinoma rarely harbor oncogenic HPV infection at other pharyngeal sites, SelvamThavaraj et all., ELSEVIER April 2014

Determination of stage

Determination of the stage of cancer is carried out according to the TNM system (T - tumor, N - nodulus, M - metastasis), including the size of the primary tumor, the spread of tumor cells to regional (located next to the primary tumor) lymph nodes and to distant areas (lungs, liver) . Today, the Russian Federation has adopted the seventh classification of tumors (the newest is the eighth). The connection between tonsil cancer and HPV infection is also taken into account during staging (but only for the eighth classification) - with similar morphological data of the tumor and its distribution, the stage of tonsil cancer associated with HPV infection is often lower, in contrast to cancer associated with other factors . In general, the prognosis for tonsil cancer associated with HPV infection is more favorable.

Tonsil cancer staging based on tumor size is “T”. headandneckcancerguide.org

When should you see a doctor?

Even slightly enlarged tonsils in a child are a signal to contact a pediatric otolaryngologist. However, mild hypertrophy of the glands often does not manifest itself in any way, so it cannot be noticed visually. A visit to the doctor is required if the child, in addition to enlarged tonsils, has:

classic signs of a cold: pain when swallowing, redness of the throat, cough, nasal congestion, fever, uncharacteristic weakness, headache;
white plaque on the tonsils;
swollen lymph nodes;
pustules, ulcers in the larynx;
swelling of the neck.

Treatment

Early tonsil cancer can be treated with radiation therapy or surgery: small tumors confined to normal tonsil tissue can be cured by removing the tonsil (tonsillectomy). If the tumor extends beyond the tonsil itself, then the soft palate and the wall of the pharynx may need to be removed. Depending on the presence of tumor cells in the lymph nodes, lymphatic dissection may be performed - removal of regional lymph nodes (for head and neck tumors, they are located in the neck). Otherwise, the tumor can be treated with radiation without the need for surgery. The effectiveness of radiation therapy and surgery is similar.

So, for the treatment of early tonsil cancer there are two approaches:

surgical treatment, which, depending on the results of pathomorphological examination, may be continued with a course of radiation therapy (adjuvant radiation therapy) either alone or simultaneously with chemotherapy;
radiation therapy – alone or simultaneously with chemotherapy (simultaneous chemoradiotherapy).

Late cancer of the tonsils, growing into the peripharyngeal space, penetrating into the bones, base of the skull, and medial pterygoid muscle may be accompanied by symptoms such as temporal pain and trismus (spasm of the masticatory muscles, leading to difficulty opening the mouth). Treatment of advanced cancer is often accompanied by chemoradiotherapy. An option is surgical treatment of advanced cancer followed by chemoradiotherapy.

When performing surgical intervention, the decision on the need for subsequent treatment is made on the basis of a pathomorphological examination of postoperative material. Spread of the tumor beyond the capsule of the lymph node, removal of the tumor outside of healthy tissue (the tumor is not removed radically, that is, not completely), significant spread of the tumor to the lymph nodes and a large size of the primary lesion, as well as tumor invasion of nerves, lymphatic and blood vessels - all these characteristics are predictors of an unfavorable course of the tumor process and may require additional postoperative treatment in the form of reoperation (if the tumor is not completely removed), chemotherapy and/or radiation therapy.

For the treatment of metastatic tonsil cancer (M1), surgical treatment and radiation therapy are not indicated. In this case, the main approach is systemic therapy, the choice of which will be based on the presence/absence of previous systemic treatment, the patient's condition, certain tumor characteristics (PD-L1 expression), the rate of disease progression and some other factors. Options for systemic therapy include chemotherapy drugs: platinum drugs (cisplatin, carboplatin), fluorouracil and taxanes (docetaxel, paclitaxel); targeted drugs (cetuximab); immunotherapy drugs (pembrolizumab, nivolumab). The combination of drug groups is determined by the above characteristics.

In the presence of a single distant metastasis, metastasectomy may be offered in addition to systemic therapy, which is likely to prolong the time to eventual disease progression.

Regardless of the extent of tonsil cancer, patients may be offered participation in clinical trials.

Patients with severe comorbidities and/or poor health status are best treated with supportive care.

Types of pathologies

Tonsils are the first barrier that traps pathogenic microorganisms. Therefore, inflammatory and infectious lesions of the tonsils are quite common, especially among children from 5 to 10 years old.

Angina

The term tonsillitis (acute tonsillitis) refers to acute inflammation of the palatine or pharyngeal tonsils. The main signs of the disease are dry, sore and sore throat, hyperemia and enlargement of the tonsils, increased temperature, and symptoms of intoxication.

There are several forms of angina, most often diagnosed:

Catarrhal. The symptoms are mild and, with appropriate treatment, disappear within 3-5 days.
Follicular. Follicles are affected. A characteristic symptom is pain when swallowing, radiating to the ear. The temperature can rise to 38 degrees or higher; upon examination, enlarged tonsils with whitish-yellow dots are visible.
Lacunarnaya. The manifestations are similar to follicular, however, the symptoms of intoxication can be more pronounced. A yellowish-white coating covers most of the inflamed tonsils.

Treatment of sore throat involves the use of antibiotics, frequent gargling, and lowering the temperature if necessary. In the first days of acute inflammation, bed rest is necessary; compliance with it reduces the risk of complications.

Chronic tonsillitis

Most often it is a consequence of an untreated form of acute tonsillitis. It occurs with periods of relapses and remissions. A chronic focus of infection often becomes the cause of the development of dangerous diseases such as rheumatism, lupus erythematosus, and nephritis.

The treatment is complex. Antibiotics and drugs that enhance immunity are selected for the patient. If there is no effect from conservative therapy, partial or complete removal of the tonsils is recommended.

Hypertrophy

Tissue proliferation in most cases is characteristic of the nasopharyngeal tonsil. The disease is otherwise called adenoiditis and young children who often suffer from ARVI are susceptible to it. Primary signs are a frequently recurring runny nose, noisy breathing and snoring during sleep, a cough that gets worse at night, and mucous discharge from the nose.

Advanced forms of adenoiditis lead to chronic hypoxia, which causes lethargy and inattention. Lack of timely treatment can cause improper formation of the bones of the facial skull. Depending on the severity of hypertrophy, treatment can be medicinal or surgical.

Abscesses

They are characterized by the formation of cavities filled with pus near the tonsils. Most often, abscesses occur against the background of a sore throat. Symptoms are severe pain on the affected side, fever, high temperature, intoxication of the body. Abscesses are opened surgically.

Neoplasms

Cysts can form on the tonsils. A malignant lesion cannot be excluded, which at an early stage is manifested by tissue enlargement and periodic pain.

There are many reasons for the development of tonsil diseases. The main ones are infection with staphylococci, streptococci, and E. coli. Inflammation can be caused by hypothermia, mechanical injury, or chemical burn. The likelihood of pathologies increases with hypovitaminosis and low immunity. Pathogenic microorganisms can enter the tissues of the lymphatic ring not only directly, but also through the blood during chronic and acute diseases of other organs.

Complications of treatment

Indeed, there are two directions in the treatment of tonsil cancer with the same outcome, but different techniques: surgical treatment and radiation therapy. It is important to note that these approaches will have different complications.

Radiation therapy may be complicated by bone or soft tissue necrosis and swallowing problems, especially in patients with advanced tonsil cancer. Myelitis, trismus, hypoglossal nerve damage, and long-term risk of another malignancy are also possible.

Complications of surgery include difficulty swallowing, fistula formation, failure of flap healing, poor wound healing, and aspiration of food and saliva, sometimes leading to laryngectomy. The risk of severe and/or fatal complications after surgery is higher than with radiation therapy.

Complications of systemic therapy include fatigue, skin toxicity, mucositis, diarrhea, hepatotoxicity, pneumonitis, hypo- and hyperthyroidism, myelotoxicity, neuropathies, metabolic disorders, etc.

Forecast

The prognosis for patients with HPV-associated tonsil cancer is significantly better than for patients with other etiologies of cancer. It is impossible to predict with high accuracy the life expectancy of a particular patient, but there are average graphs that can be used to determine what percentage of patients with a certain stage are alive after n years: for example, almost 90% of patients with stage I HPV-associated oropharyngeal cancer are alive 4 years after diagnosis, while for HPV-unassociated oropharyngeal cancer at the same stage, only 80% are alive 4 years after diagnosis.

Overall survival of HPV-associated and HPV-non-associated oropharyngeal cancer according to TNM classification 7. ICON-S