Asthma and Enlarged Tonsils

There is a lot of controversy and debate regarding the point whether tonsils should be removed or not in a person suffering from asthma. Different doctors have different opinions in this matter. Some advocate tonsillectomy (removal of tonsils) while others do not. It is therefore important to understand the role of tonsils in the human body so that adequate judgement can be made in this regard.

Tonsils make the first line of defence in the human body. They are present on either side of the pharynx. Pharynx is the middle portion of the throat. Why tonsils make the first line of defence is because they try to trap any germs and foreign bodies that may enter the body through the mouth and the nose. After trapping them the tonsils also produce protective antibodies with the help of their lymphatic cell structure that forms the main body of the tonsils. These antibodies circulate in the blood and fight the foreign organisms that somehow pass into the blood stream. So tonsils on one hand act as a mechanical guard and on the other hand they act on the molecular level also to protect the body. The antibody forming tissue is present in other parts of the body too but tonsils are first line of defence of the human system.

The body of a child is exposed to many different kinds of germs for the first time. The body is not used to these germs and needs to be protected against them. The tonsils work vigorously and in some children get abnormally enlarged in the process. If a child suffers from cough and wheezing his breathing is as it is strained. If this is due to some allergic reactions it may be accompanied with sore throat and fever as well. If the allergy persists or may subside and reappear again and again the tonsils too get infected while protecting the body.

In such a scenario the infected tonsils may need to be removed as their infection may be adversely having an impact on the body repeatedly. Also their enlarged size may be straining the breathing further in a child who is already suffering with asthma. So the children who suffer with asthma may be recommended a removal of tonsils if the asthma is of extrinsic type and is caused by allergens.

Sometimes in the children who suffer from intrinsic asthma too this may be recommended as the body becomes weakened and is susceptible to attacks from various organisms. But this is controversial because tonsils are the first line of defence and removing them may not be such a good thing to do, at least in theory. But in practice the tonsils may be a cause for many infections and it is best to get rid of the source of infections.

Some of the views regarding the question of removal of tonsils are:

1 The tonsils act at the site and later as a source of infection in the body. Their removal would influence the course of asthma favourably and even prevent its occurrence in a susceptible individual.

2 The tonsils prevent the spread of infection from the nose and throat into the bronchi and the lungs so their removal would create situations of mild asthma developing into severe one. In susceptible individuals symptoms of asthma may even precipitate due to tonsillectomy.

3 The presence or absence of tonsils actually does not make any difference over the allergic state of an individual. So technically removal of tonsils cannot precipitate the symptoms of asthma according to this view.

With reference to the varied views mentioned above it seems that the most appropriate path for the surgery for the removal of tonsils would not only be an individual choice but also may mean that a certain individual needs to be studied for previous history of infections, process of treatment and pathway of recovering from the infections before any decisions can be taken.

If there is evidence of recurring infections of throat and the infections seem to be localised in the tonsils then this may be the only option provided there are no other serious complications. Children in the younger stages are more susceptible to repeated infections of throat and the chest so to understand that the infections are localised to the tonsil area is very important before taking the decision of tonsillectomy.

Another point to be thoroughly understood is that removal of infected tonsils may have no effect whatsoever over the condition of asthma of the child. The removal of tonsils may have effect on the associated conditions of aggravation of the symptoms because of the effect that the associated allergens may be having on the situation.

This is also true only to the extrinsic type of asthma, but it shall have none or very little effect on the intrinsic type of asthma. Some doctors feel that the benefits associated with tonsillectomy are most evident in the first year of surgery and later they dissipate and after some time there remains no difference between the asthmatic children who underwent surgery and the asthmatic children who did not undergo any surgery.

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