Tonsils and adenoids

Tonsils are two round lumps located at the back of the throat. Tonsils can be seen by opening the mouth wide and sticking the tongue out. Adenoids are glands located above the roof of the mouth, behind the nose and cannot be easily seen.

Tonsils and adenoids are part of everyone’s immune system and serve an important purpose. Both help to trap bacteria and viruses that enter through our mouth and throat. They contain antibody producing immune cells that kill the bacteria and viruses before they enter our body. Tonsils and adenoids often become enlarged when they are warding off pathogens. As they trap the germs they can also get infected causing swelling, soreness and pain. Swallowing may hurt in such a situation.

Tonsillitis is the infection of the tonsils. Though it is common in children, but it can infect people of all ages. An ENT examination of the throat and tonsils is done. If tonsillitis is diagnosed, then a throat culture is done to determine if the infection is viral or bacterial.

Adenoids can become infected and can block a child’s airway. Children can have breathing problems, ear infections, and at times chronic infections can lead to snoring, sleep apnea, fluid in the ear. A physical exam by the ENT and an X-ray would determine the diagnosis and mode of treatment.

Removal of tonsils (tonsillectomy) and/or adenoids (adenoidectomy) is recommended if infections become chronic and persistent and cause blockages that cause snoring or sleep apnea. Surgery is a common procedure and one can expect a full recovery.


The thyroid gland is an organ located at the front of the neck, just below the larynx or the voice box. It is wrapped around the windpipe, almost like a butterfly with wings spread. Thyroid makes hormones that are responsible for controlling the metabolism of our body. Hypothyroidism (less hormones) and Hyperthyroidism (excess of hormones) are the two main indications of a thyroid disease.

The entire hormonal production and activity is controlled by the pituitary gland, located in the center of the skull below the brain. Either condition of thyroid produces different symptoms that are managed differently. Blood tests, imaging tests are some of the ways of diagnosing thyroid diseases.

Thyroid conditions like thyroiditis, thyroid nodules, thyroid cancer, compressive thyroid mass, that may or may not require surgery, are best treated by an ENT specialist.  Surgery may cause the voice to change and the ENT doctor is trained to manage it because ENT doctors are voice surgeons as well. Thyroid function tests, thyroid scans and ultrasonography are some of the tools that an ENT doctor uses to diagnose the condition and severity of nodules.


Larynx is the ‘voice box’ and inflammation of the larynx is called laryngitis.

Inside the larynx are the vocal cords that open and close smoothly, helping us speak or form sounds through their movement and vibration. Overuse, irritation or infection can cause the vocal chords to become inflamed resulting in a hoarse voice. Laryngitis may be short-lived (acute) or long lasting (chronic). Viral or bacterial infections, vocal strain, smoking, acid reflux are some of the causes that trigger laryngitis. An ENT doctor examines your vocal cords by doing laryngoscopy to decide the course of treatment.

Tonsils and adenoids grow to their largest size between the ages of 2 to 8. Some may be naturally born with large adenoids and tonsils. Repeated throat infections, allergies can cause them to become enlarge. Severe gastroesophageal reflux of stomach contents up to the back of the nose may also worsen the swelling.  Having said this even small tonsils and adenoids can cause problems when they become the focus of infection.

Unresolved or enlarged tonsils and adenoids can cause blockage in the nose and mouth breathing airway. The airway obstruction can cause snoring and obstructive sleep apnea. Long term airway blockage in a growing child can result in poor lower jaw growth with giving a dental overbite and more dental caries. They can also affect swallowing. Frequent coughs and colds can result in poor concentration, irritability, poor weight gain. 

Parents and patients often worry about impairing their immunity with adenoid and tonsil removal. They can be reassured as long-term research has shown that adenoidectomy and tonsillectomy surgery does not decrease one’s immunity nor does it increase the risk of infections or cancers.

The enlargement of the thyroid gland irrespective of its pathology is called goiter. It can also be defined as the uneven growth of the thyroid gland. It has several possible causes and may or may not be associated with abnormal thyroid hormone levels. It’s treatable. On the other hand thyroid disease is dependent on either too much or too little production of the hormone produced by the thyroid gland. 

The most common cause of hypothyroidism (less thyroid hormone) around the world is still iodine deficiency. However, in iodine-sufficient populations, thyroiditis is the most common cause of hypothyroidism. This is due to progressive destruction of thyroid follicular cells by antibodies directed towards specific parts of the cells that produce thyroid hormones. This condition often develops very deceptively over years and may not produce any signs or symptoms until the person becomes overtly hypothyroid.

In the most likely situation, where thyroid problem is created by a nodule, surgeons can sometimes, be able to remove part of the thyroid and leave the other part so that it can continue to create and release thyroid hormones. About 75% of people who have only one side of the thyroid removed are able to make enough thyroid hormone after surgery without hormone therapy. But this varies from person to person and some do have to take medication for proper thyroid functioning.

Pharyngitis is a medical term for a sore throat and it refers to an inflamed pharynx. The pharynx starts behind the nose and ends just above the voice box. Inflammation of the voice box is referred to as laryngitis. Larynx is the medical term for voice box. The larynx is near your pharynx, just above your windpipe.

Most acute cases of laryngitis can be managed by resting your voice and staying hydrated and this resolves them on their own within a couple of days. However, if your laryngitis symptoms last longer than two weeks, one should visit the doctor. Other signs that one requires medical attention are constant fever, worsening throat pain, difficulty breathing or coughing up blood.

Whispering, in principle, is ok. But when we have laryngitis doctors advice is to not “put weight” on the larynx by avoiding speaking. It is always tempting to whisper, but this puts more strain on the vocal cords. When most people whisper, they want to be heard, so they strain to produce sound by squeezing their vocal cords together more tightly to produce the whisper, which is more traumatic. It can be as bad for your voice as shouting. So, if you are trying to rest your voice, it is recommended you not talk, not even in a whisper.