Tonsillectomy and Adenoidectomy
What are the tonsils?The tonsils are small, round pieces of tissue that are located
in the back of the mouth on the side of the throat. Tonsils are thought to
help fight infections by producing antibodies. The tonsils can usually be
seen in the throat of your child by using a light.
Tonsillitis occurs when the tonsils become inflamed from infection.
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 also help to fight infections. Adenoids may cause
problems if they become enlarged or infected.
Adenoiditis is when the adenoids become inflamed from 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
The symptoms of tonsillitis may resemble other conditions or medical
problems. Always consult your child's physician for a diagnosis.
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
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 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 (T&A). 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.
What are the reasons to have a tonsillectomy and
adenoidectomy (T&A)? 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 T&A:
- 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 T&A 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
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.
- poor appetite, allergies, or seizures
A T&A will not help any of these problems.
What happens during tonsillectomy and adenoidectomy?Tonsillectomy and adenoidectomy (T&A) surgery is the second
most common major surgery performed on children in the US. About 400,000
surgeries are performed each year. The need for a T&A will be determined
by your child's ear, nose, and throat surgeon and discussed with you. Most
T & A 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, such as, but not limited to, children who:
- are not drinking well after surgery.
- have other chronic diseases or problems with seizures.
- have complications after surgery, such as bleeding.
- are younger than 3 years of age.
Before the surgery, you will meet with different members of the
healthcare team who are going to be involved with your child's care. These
may include:
- day surgery nurses - nurses who prepares your child for
surgery. Operating room nurses assist the physicians during surgery.
Recovery room (also called the Post Anesthesia Care Unit) nurses care
for your child as he/she emerges from general anesthesia.
- surgeon - a physician who specializes in surgery of the ear,
nose, and throat.
- anesthesiologist - a physician with specialized training in
anesthesia. He/she will complete a medical history and physical
examination and formulate a plan of anesthesia for your child. The plan
will be discussed with you and your questions will be answered. This
surgery requires a general anesthesia.
During the surgery, your child will be anesthetized 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.
Bleeding is a complication of this surgery and should be addressed
immediately by the surgeon. If the bleeding is severe, the child may
return to the operating room.
At home after a T&A: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
What are the risks of having a T&A?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 additional blood and/or 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:
- bleeding (may happen during surgery, immediately after surgery, or
at home)
- dehydration (due to decreased fluid intake; if severe, fluids
through an intravenous, or IV, catheter in the hospital may be
necessary)
- fever
- difficulty breathing (swelling of the area around the surgery; may
be life threatening if not treated immediately)
More Information
Schneider Children's
Hospital Division of Otolaryngology and Communication Disorders
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