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Tonsillectomy and Adenoidectomy

What are the Tonsils?

The tonsils are round pieces of tissue that are located in the back of the mouth on either side of the throat. The tonsils can usually be seen in the throat of your child by using a light.

Tonsillitis occurs when the tonsils become inflamed from a viral or bacterial infection.

What are the Symptoms of Tonsillitis?

The symptoms of tonsillitis vary greatly depending on the cause of the infection, and can occur either suddenly or gradually. The following are the most common symptoms of tonsillitis. However, each child may experience symptoms differently. Symptoms may include:

  • Sore throat
  • Fever (either low-grade or high-grade)
  • Headache
  • Decrease in appetite
  • Not feeling well
  • Nausea and vomiting
  • Stomach aches
  • Painful swallowing
  • Visual redness or drainage in the throat
  • Bad breath
  • Skin rash

The symptoms of tonsillitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

 

What are Adenoids?

Adenoids are similar to the tonsils. The adenoids are made up of lymph tissue and are located in the space above the soft roof of the mouth (nasopharynx) and cannot be seen by looking in your child's nose or throat. Adenoids may cause problems if they become enlarged or infected.

Adenoiditis is when the adenoids become inflamed from infection.

What are the Symptoms of Adenoiditis, or Enlarged Adenoids?

The symptoms of adenoiditis vary greatly depending on the cause of the infection, and can occur either suddenly or gradually. The following are the most common symptoms of adenoiditis. However, each child may experience symptoms differently. Symptoms may include:

  • Breathing through the mouth
  • Noisy breathing
  • Snoring
  • Nasal speech
  • Periods at night when breathing stops for a few seconds
  • Clear or cloudy nasal drainage

The symptoms of adenoiditis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

Treatment for Tonsillitis and Adenoiditis:

Specific treatment for tonsillitis and adenoiditis will be determined by your child's physician based on:

  • Your child's age, overall health, and medical history
  • Extent of the infection
  • Type of infection
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the infection
  • Your opinion or preference

Your child's physician will decide the best treatment for your child. Treatment depends on the cause of the infection, the severity of the infection, and the number of times the child has developed infections. Your child's physician may order antibiotics and/or steroids to help with the infection.

Some children may be referred to an ear, nose, and throat surgeon to have the tonsils and adenoids removed. This surgery is called a tonsillectomy and adenoidectomy. Often, the tonsils and adenoids are removed at the same time, but, sometimes, only one is removed. Your child's physician will discuss this with you.

Download our teaching sheet to learn more.

What are the Reasons to have a Tonsillectomy and Adenoidectomy?

The reasons for this surgery are not well defined, and many surgeons differ in their views. The following are some of the more widely accepted reasons for having a tonsillectomy and adenoidectomy:

  • Sleep apnea, or periods at night when your child stops breathing
  • Trouble swallowing
  • Tumor in the throat or nasal passage
  • Bleeding from the tonsils that cannot be stopped
  • Significant blockage of the nasal passage and uncomfortable breathing

The following are tonsillectomy and adenoidectomy guidelines from the American Academy of Otolaryngology:

  • Seven sore throats in one year
  • Five sore throats in each of two years
  • Three sore throats in each of three years

The sore throats may be associated with the following:

  • Fever above 101º F
  • Discharge on the tonsils
  • Positive strep throat culture
  • Skin rash

The following are additional reasons that are more controversial regarding the removal of the adenoids and tonsils:

  • Bad snoring
  • Recurrent infections or abscesses in the throat
  • Recurrent ear infections
  • Hearing loss
  • Chronic sinusitis, or infection in the sinuses
  • Constant mouth breathing
  • Frequent colds
  • Cough
  • Bad breath

The following are some situations that DO NOT require removal of the tonsils, although each child will be evaluated on an individual basis:

  • Large tonsils
    Some children have large tonsils. The tonsils will decrease in size after the ages of 8 to 12 years. This, in itself, is not a reason to remove the tonsils, in most cases.
  • School absence
    If your child seems to miss a lot of school due to different symptoms, such as a sore throat, removing the tonsils will not increase school attendance.
  • Allergies, or seizures
    A tonsillectomy and adenoidectomy will not help any of these problems.

What happens during Tonsillectomy and Adenoidectomy?

The need for tonsillectomy and adenoidectomy surgery will be determined by your child's ear, nose, and throat surgeon and discussed with you. Most tonsillectomy and adenoidectomy surgeries are done on an outpatient basis. This means that your child will have surgery and then go home the same day. Some children may be required to stay overnight.

During the surgery, your child will be under general anesthesia in the operating room. The surgeon will remove your child's tonsils and adenoids through the mouth. There will be no cut on the skin.

In most cases, after the surgery your child will go to a recovery room where he/she can be monitored closely. After the child is fully awake and doing well, the recovery room nurse will bring the child back to the day surgery area.

At this point, if everything is going well, you and your child will be able to go home. If your child is going to stay the night in the hospital, the child will be brought from the recovery room to his/her room. Usually, the parents are in the room to meet the child.

At Home after a Tonsillectomy and Adenoidectomy:

The following are some of the instructions that may be given to you to help care for your child:

  • Increased fluid intake
  • Pain medication, as prescribed
  • No heavy or rough play for a duration of time recommended by the surgeon
  • A soft diet for a duration of time recommended by the surgeon

What are the Risks of having a Tonsillectomy and Adenoidectomy?

Any type of surgery poses a risk to a child. About 5 percent of the children begin bleeding from the surgery site about five to eight days after the surgery, and may require a blood transfusion and/or surgery. Bleeding may occur up to three weeks after surgery. Some children may have a change in the sound of their speech due to the surgery. The following are some of the other complications that may occur:

  • Dehydration (due to decreased fluid intake; if severe, fluids through an intravenous (IV) catheter in the hospital may be necessary)
  • Fever
  • Pneumonia
  • Difficulty breathing (swelling of the area around the surgery; may be life threatening if not treated immediately)
  • Continued episodes of streptococcal pharyngitis (strep throat)
  • Continued obstructed breathing