TL;DR:
- Third tonsil, or adenoid, is a lymphatic tissue located at the back of the throat; it’s not visible without specialized tools.
- Part of the immune system (Waldeyer's ring), which helps recognize and neutralize antigens; peaks in size at ages 3–7 and shrinks after puberty.
- Causes of overgrowth include frequent infections and allergies, leading to breathing, swallowing, and hearing problems.
- Symptoms: snoring, sleep apnea, open-mouth breathing, nasal speech, frequent ear/sinus/throat infections, and fatigue.
- Diagnosis involves ENT exams, X-rays, fibroscopy, and sometimes allergy tests.
- Treatment includes conservative methods for younger children (e.g., medication) or surgical removal (adenotomy), a safe 30-minute procedure under anesthesia.
- Adenotomy improves breathing, reduces snoring, lowers infection rates, and minimizes antibiotic use.
Problems with the anatomy of the tonsils are a common occurrence in young children. The third tonsil is otherwise known as the pharyngeal tonsil or adenoid, which is located on the back wall of the throat – just above the palatine tonsils and behind the soft palate. It is very often mistakenly confused with the uvula hanging at the entrance to the throat. However, unlike the palatine tonsils, which can be seen when the mouth is opened wide, the third tonsil cannot be seen. It will only be seen by a doctor using a special ENT mirror, microscope or endoscope.
What is the so-called third amygdala?
The palatine tonsils, together with the pharyngeal tonsil, are part of the Waldeyer's lymphatic ring. It concentrates lymphoid tissue, which is located at the border between the ectodermal and endodermal parts of the respiratory and gastrointestinal tract. ** Waldeyer's ring consists of the lingual tonsil, the tonsils of the trumpet, the lateral bands and the lymphoid papules, which are scattered in the mucosa of the posterior pharyngeal wall.** The tonsils are already present during fetal life, but their functional structures are formed after birth due to contact with antigens in the environment. Between the ages of 1 and 3, they become enlarged, and their maximum size is reached between 3 and 7 years of age. They then gradually undergo an involution process until the age when puberty occurs. Waldeyer's lymph ring is part of the immune system, which in turn takes an active part in general and local defense. Its placement at the intersection of the respiratory and digestive tracts puts it in constant contact with the external environment. The tonsils, on the other hand, allow the body to recognize and transmit information about antigens. They also activate the peripheral line of local and general defense, and neutralize and destroy antigens due to the development of hormonal and cellular responses. It is worth remembering that constantly recurring inflammation and ineffective treatment can affect irreversible changes in histopathological and anatomical structure. This, in turn, affects the immune function of the tonsil.
What are the causes of third tonsillectomy in children?
The tonsils in young children are the first barrier of the immune system and come into contact with bacteria and viruses that enter the body through the nose and mouth. In the lymphoid tissue of the tonsils, physiological processes begin, which are influenced by infection-fighting processes. The result of these reactions is swelling and hypertrophy of the tonsil tissue. In healthy, normal conditions, after recovery, the volume of the tonsil returns to its original size, but during frequent infections or if the child is allergic, there is constant irritation of the lymphoid tissue. As a result, the amygdala does not return to its dimensions, and even becomes enlarged. An overgrown amygdala, on the other hand, is the cause of obstruction of the mouth of the ear trumpets, which are the anatomical canal connecting the throat to the middle ear. Obstruction of the ear trumpets, in turn, is the cause of exudative otitis. The third amygdala is a fairly common problem occurring in young children. It also happens so that at one time the palatine tonsils overgrow, which in turn aggravates the child's problems with breathing and swallowing.
What are the symptoms of the third tonsil?
An oversized third tonsil is a major impediment to proper breathing. It also interferes with nasal and throat patency. Then the child may start snoring involuntarily. A similar phenomenon can be observed during a runny nose, when, as a result of a blocked nose, the child snores while sleeping. Apneas – particularly dangerous pauses in breathing of a few seconds – can also occur during snoring. A blocked nose is also a cause of impaired ear ventilation in the young patient. This, in turn, results in hearing deterioration in the youngest, the accumulation of fluid in the middle ear. This is also the reason for exudative otitis media along with recurrent acute otitis. The third tonsil is not easy to diagnose and impossible to diagnose on its own. An ENT examination is performed. However, typical symptoms indicating the presence of this problem include:
- frequent sinusitis,
- A runny nose that runs down the back wall of the throat,
- coughing and grunting,
- snoring,
- sleeping with the mouth open,
- nasal buzzing speech,
- frequent pharyngitis and tonsillitis,
- hearing deterioration,
- constant feeling of fatigue.
It is worth remembering that third amygdala is primarily a childhood problem. However, it does not go away on its own with the completion of preschool age. Symptoms can persist even until the age of 12. In adults, this phenomenon is very rare and, if it occurs, is characterized by snoring with sleep apnea. Regardless of age, however, the third amygdala requires appropriate treatment.
How to cure the third amygdala?
If your child has symptoms that may indicate a third amygdala, it is necessary to quickly consult an ENT specialist to assess the patency of the upper airway. Most often, the specialist will perform X-rays or a fibroscopic examination, during which a thin endoscope with a camera is inserted through the nose. During the examination, the specialist, together with the caregivers and the patient, can proceed to assess the size of the tonsil on the screen. The child is also given a nocturnal examination, which is a non-invasive measurement of blood oxygen saturation during sleep. This helps rule out the presence of sleep apnea. Along with an assessment of the degree of worsening discomfort, the child may be referred for further observation, conservative therapy or surgery. ** Conservative treatment is mainly used in the youngest children under the age of 4. The third amygdala is a condition that increases the symptoms that are its root cause. Frequent infections contribute to the amygdala's increased activity as an element that protects the body from pathogens. An overloaded amygdala becomes enlarged, which in turn causes problems that occur in the respiratory system. This, in turn, is the cause of frequent infections. Diagnosis of the third amygdala, in addition to X-ray examination, may require allergy testing. Recurrent illness, runny nose and sore throat along with back wall discharge, may have an allergic basis. Giving the child the right medication often stops the symptoms and reduces the volume of the tonsil.
How to remove the third tonsil?
Removal of the third tonsil – adenotomy, is a very safe procedure, performed routinely. Complications are extremely rare, and the child can usually go home the same day the procedure was performed. Adenotomy requires about half an hour and is performed with an endoscope, under anesthesia. Modern radio waves or diode laser are often used. The great advantage of these techniques is that they reduce bleeding. It's also a way of faster tissue regeneration, so the little patient doesn't feel discomfort after the procedure and can quickly return to daily activities. ** When performed correctly, the procedure significantly improves a child's breathing comfort, subsides snoring and sleep apnea, reduces the frequency of respiratory infections and ear infections. It also significantly reduces the use of antibiotics in children.
Conclusion
Understanding the third tonsil is crucial for your child’s health. This lymphoid tissue plays a role in fighting infections but can cause breathing, sleeping, and ear issues when swollen. Diagnosis through an ENT specialist and choosing the right treatment—either medication or adenotomy—can prevent long-term complications. If left untreated, symptoms may persist and interfere with daily life. Acting early ensures better breathing, fewer infections, and improved overall well-being for your child.
