Synonyms.—Hypertrophy of the Tonsils; Mouth-Breathing.
Definition.—An enlargement of the glands due to repeated inflammations of the tonsils, and occurring usually in early life.
Etiology.—While chronic inflammation of the tonsils may come on insidiously, it more often is the result of frequent attacks of follicular tonsillitis.
Among predisposing causes we may mention heredity, there being a tendency for the children of parents with enlarged glands to the same disease.
Age.—The disease being most frequently found in children between the ages of five and ten years.
The Infectious Diseases, such as tuberculosis, syphilis, and especially those in which the throat is apt to suffer; such as diphtheria, scarlet fever, la grippe, and sometimes measles.
The presence of adenoids frequently precedes tonsillitis, and may be given as a predisposing cause.
Pathology.—All of the tissues of the tonsils are involved, but in varying degree. In some the lymphoid changes predominate, while in others the stroma seems more involved, and a firm, fibrous tissue is developed. In the former the gland is larger, softer, and the follicles increase in depth, while their mouths dilate, their openings revealing white or yellowish-white plugs of cheesy particles, the debris of broken-down epithelial cells or calcareous or chalky deposits; at times the contents consist of food. Where the fibrous change predominates, the tonsil becomes firm, hard, blanched, and somewhat atrophied.
Symptoms.—At first the symptoms are not pronounced, and a child may have enlarged tonsils for some time without the parents knowing of the condition; the frequent sore throat following a cold finally leads to an examination of the throat, when the hypertrophy is discovered. Usually, however, the first symptom that calls attention to the throat is the difficult breathing, especially at night, when it is observed that the child breathes with the mouth open—mouth-breathing. The child snores, chokes, and starts from sleep in a fit of dyspnea quite alarming to the parents, though it is never serious.
Inspection reveals two dusky or blanched, enlarged tonsils, covered with a profuse secretion of mucus, which necessitates a frequent hawking to clear the throat. Often white or yellowish-white cheesy deposits are seen filling the crypts. These are occasionally hawked up in the form of small, fetid, cheesy lumps, or sometimes a calcareous plug is spit up. Such material as epithelial debris, micro-organisms, and soft particles of food, give rise to a peculiarly offensive breath.
The roof of the mouth, the hard palate, is highly arched. The pressure of the enlarged tonsil on the Eustachian tube, or an extension of the inflammation along the tube, together with the pressure of the mucus from the pharynx, impedes the hearing, and sometimes renders the child quite deaf. The child contracts cold readily, when the tonsils become angry-looking, and an acute attack follows.
From the mouth-breathing the child takes on a dull, stupid, and besotted expression; the lips are thick and the eyes dull. The child is listless, apathetic, and responds slowly in speech and thought. The obstructed breathing may cause deformity of the chest, known as chicken or pigeon breast, where the sternum is prominent, with a more marked separation of the ribs anteriorly and converging posteriorly. Where the breathing is labored and asthmatic, the chest becomes barrel-shaped.
Chronic tonsillitis renders all sore throats more serious, such as scarlatina, diphtheria, pharyngitis, etc.
The general health suffers more or less. Indigestion from excess of mucus is often found, while anemia is not uncommon. Headaches are frequent, while inability to concentrate the mind renders the child backward in mental development.
Diagnosis.—Inspection reveals the character of the disease, and it can hardly be mistaken for any other trouble, unless it be that of malignant growths; and even here the mistake should not occur often. In malignant growths, it is usually confined to one side, is attended by severe pain, and presents a more angry appearance.
Prognosis.—This depends upon the character of the enlargement and the length of time involved. If the lymphoid changes predominate, the hope of recovery is far better than when the fibrous tissue prevails. These tissue changes render respiratory diseases, as well as throat troubles, more severe; hence they influence our prognosis. So far as life is concerned, the prognosis is always favorable.
Treatment.—Upon the character of tissue change largely depends the treatment. If the lymphoid predominates, and the tonsil is soft, we may expect good results from injections of thuja, or from the old application of perchlorid of iron and glycerin, equal parts. With a large camel's-hair brush, paint the tonsils twice per day. As the tonsil becomes accustomed to the iron, increase the strength of it till it is used full strength. The galvano-cautery will, however, give better results than local application.
If the bulging tumor is pale, hard, and fibrous, the most satisfactory treatment is amputation of the glands. When the general health suffers, attention must be directed to correcting the various wrongs that may be present. Good hygienic conditions are necessary, and the flushing of the neck each morning in cold water will overcome a tendency to contract colds.