Third tonsil hypertrophy causes a slew of issues for both children and parents. It is not an uncommon condition, but rather one of the most common laryngological complaints in children. More than 30% of them are affected. Many parents are concerned about the removal of the third tonsil. Some believe that after the surgery, the child's infections will "go lower," resulting in more frequent bronchial or lung diseases. And, because the third almond is part of the immune system, there are concerns that the child's immunity will deteriorate and he will become more susceptible to infections.
The third tonsil protects against infections, but sometimes causes problems
The third tonsil (adenoid) is a lymph tissue cluster located in the nasopharynx. The so-called Waldeyer's ring, which belongs to the mucosal immune system, is part of the extensive lymphatic system of the nose and throat. The nasopharyngeal lymphatic system protects against the entry of viruses, bacteria, and other pathogens into the body by releasing immune cells that attack hostile microorganisms. The Waldeyer ring also contains palatine tonsils, lingual tonsils, lymph nodules throughout the pharyngeal mucosa, and lymph tissues on the pharyngeal posterior wall.
In children, the third tonsil is the most developed, and it is in them that adenoid enlargement occurs, which is a natural phenomenon. This process begins around 2 months after birth and lasts until the child is 8 years old. The adenoid then begins to fade. When the third tonsil grows too large, it causes a variety of problems, including difficulty breathing through the nose, difficulty swallowing, snoring, sleep apnea, and frequent respiratory infections. Recurrent respiratory infections or chronic inflammations of the throat and nose are the causes of third tonsil hypertrophy (e.g. due to allergies).
Removal of the third tonsil may affect immunity
There are no studies that show that removing the third tonsil causes the infection to spread lower, to the bronchi or lungs. No such tendency has been observed in doctor's offices. However, new research casts doubt on doctors' previous claims that such a procedure has no effect on lowering immunity.
The University of Melbourne, the University of Copenhagen, and Yale University discovered that surgery to remove the third tonsil was associated with a roughly two-fold increase in the risk of chronic obstructive pulmonary disease, upper respiratory diseases, and conjunctivitis. The findings were derived from an examination of data on up to 1.2 million Danes aged 10 to 30, some of whom had their tonsils, third or adenoids, and third tonsil removed before the age of nine.
Removal of the tonsils was also found to almost triple the risk of upper respiratory disease later in life. And removal of the tonsils and third tonsil together resulted in a 17% increased risk of infectious disease.
There are also analyses that reach different conclusions. One Chinese study looked at the short- and long-term effects of removing the third tonsil (with or without adenoids) on immunity in children under the age of three. Scientists demonstrated that while such a procedure may result in a short-term decrease in the amount of certain antibodies, it has no effect on the body's level of immunity. The procedure was also found not to increase the risk of upper respiratory tract infections in these children.
The study is not conclusive, but it encourages us to look more broadly at the issue of immunity after tonsil removal. In many cases, postponing surgery is advised. However, when such an operation is required, it must be carried out. The health risk associated with discontinuing treatment is greater than the risk associated with tonsil removal.
Is removal of the third tonsil necessary?
Adenoidectomy (removal of the third tonsil) is not always required in cases of hypertrophy. Sleep apnea, nasal obstruction, and constant mouth breathing during sleep and wakefulness are absolute indications for the procedure.
It is not explicitly advised to remove the third tonsil if the throat and lower respiratory tract are frequently infected. This is known as a relative indication. It all depends on the circumstances. Other indications for the procedure include recurrent otitis, sinusitis, malocclusion, or an abnormal shape of the facial skeleton caused by mouth breathing.