Lam experienced recurrent tonsillitis, with her tonsils now severely swollen, causing fever, sore throat, loud snoring, and gasping for air while sleeping. Dr. Nguyen Thi Huong, a first-degree specialist at the Department of Ear, Nose, and Throat at Tam Anh General Hospital, TP HCM, performed a pharyngeal endoscopy. The examination revealed enlarged, congested tonsils occupying about 75% of the pharyngeal space. The doctor diagnosed grade 4 enlarged tonsillitis and enlarged adenoids. Adenoids are lymphoid tissue located in the nasopharynx, behind the nasal cavity, which develop in young children to support immunity.

Polysomnography results indicated Lam suffered from severe obstructive sleep apnea. This condition involves repeated upper airway obstruction during sleep, which reduces or completely stops airflow for over 10 seconds, disrupting breathing and decreasing blood oxygen levels, forcing the brain to briefly awaken the body to restore breathing.

According to Dr. Huong, adenoids typically reach their maximum size when children are 5-7 years old, then gradually shrink. By adolescence (12-16 years old), most adenoids naturally regress and disappear. However, Lam's tonsils and adenoids experienced continuous reinfection, causing their regression to be slower than normal.

Grade 4 enlarged tonsils nearly obstruct the entire pharynx, and combined with enlarged adenoids, they cause airway obstruction at two points. The already narrow airway due to grade 4 enlarged tonsils, coupled with muscle relaxation during the deep sleep (REM) stage, causes the pharyngeal walls to collapse, completely blocking airflow for several seconds to dozens of seconds, leading to obstructive sleep apnea.

Dr. Huong performing a tonsillectomy on Lam. Photo: Tam Anh General Hospital

Lam was scheduled for a tonsillectomy and adenoidectomy to prevent recurrent tonsillitis.

Dr. Huong performed Lam's tonsillectomy using Coblator plasma technology. After removing two tonsils, each about 4 cm (normally 1,5-2 cm), the doctor performed an adenoidectomy endoscopically and pharyngoplasty of the soft palate and uvula.

Post-surgery, Lam recovered well and was discharged after 24 hours. A follow-up examination one week later showed good wound healing, and her snoring and sleep apnea significantly improved more than three weeks after surgery.

The surgical team performing an endoscopic adenoidectomy on Lam. Photo: Hospital provided

Chronic tonsillitis often recurs when exposed to irritants, eventually leading to hypertrophy. Common symptoms include fever, sore throat, and swollen tonsils. These symptoms are similar to acute tonsillitis but persist longer.

Dr. Huong stated that tonsillectomy is indicated when tonsillitis causes airway obstruction, recurs frequently, or limits daily activities. If tonsillitis is grade one or two, patients may receive medical treatment and home monitoring.

To prevent tonsillitis, individuals should rinse their throats daily with physiological saline solution, wear masks outdoors, keep their throats warm, limit cold foods and drinks, drink enough water, avoid irritants, and boost immunity.

Uyen Trinh

*Patient's name has been changed