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Tonsillectomy and Adenoidectomy in Children: An Overview

By Edited Nov 13, 2013 1 1

Tonsillectomy and adenoidectomy (T+A) is one of the most common surgeries performed on children in the United States. The surgery involves removal of the tonsils and adenoids.

The tonsils sit on either side of the throat behind the tongue. Most people (who haven't had them removed already) can see their tonsils by shining a flashlight in their mouth and looking in a mirror. The adenoids sit in the very back of the nose and are hidden by the soft palate (i.e. you cannot see them by looking in the mouth).

Both the tonsils and adenoids are made up of similar tissue and are a part of your body's immune system. Fortunately, removal of the tonsils and adenoids does not affect your body's ability to fight disease in any way.

The most common reasons that T+A is performed in children are 1. Obstructive sleep apnea (breathing problems while asleep) and 2. Recurrent or chronic infections (strep throat, pharyngitis, tonsillitis, etc). There are other less common reasons for the surgery as well.

The surgery usually takes less than one hour. There are various options for instruments that doctors may use to remove the tonsils and adenoids. Traditionally a scalpel and other metal instruments were used for the surgery ("cold tonsillectomy"). This still works well and many older surgeons will remove tonsils this way. Other surgeons use various electric cutting devices to remove the tonsils and adenoids. These devices include the Bovie knife, the Coblatortm, and the Harmonic scalpeltm among others. Overall, there is not a lot of difference between any of the methods; the best method is the one your surgeon is most comfortable with.

During the surgery, your child will be asleep under anesthesia and will have a breathing tube. The breathing tube will be removed after the surgery as your child is waking up. Many children are able to go home the same day as the surgery. Some children at higher risk for problems should stay overnight for observation. These include children with severe sleep apnea, very young children (under age 3), or children with other medical problems or syndromes.

Unfortunately, your child will probably have a very sore throat for about a week after the tonsillectomy and adenoidectomy. There will be raw areas in the throat where the tonsils and adenoids were removed. These areas must heal over on their own and they will be painful until healing occurs.

The most important thing to promote healing is to keep your child drinking lots of fluids after the surgery. Your child should only drink liquids and eat soft foods for 2 weeks after the tonsillectomy. Cold liquids, ice cream, and popsicles are good options. It does not matter if your child doesn't eat very much, the most important thing is to keep him or her drinking lots of fluids. Gatorade or other sports drinks work well. Avoid carbonated drinks and acidic juices (like orange or grapefruit) as these can irritate the throat.

The easiest way to tell if your child is drinking enough fluids is to see how often he or she is peeing. Your child should be going to the bathroom every few hours and the urine should be clear or light yellow. Dark yellow urine means your child is not drinking enough fluids.

You should also keep your child from participating in any strenuous physical activity or roughhousing for 2 weeks after surgery.

Your doctor will prescribe a pain medication for your child after surgery. It can be useful to schedule doses of pain medicine every 4 hours or so (read the medicine instructions to see how often). Scheduling the medicine usually will keep the pain under better control than only giving medicine when your child is complaining. Some doctors prescribe antibiotics to take after surgery but many do not.

Overall, tonsillectomy and adenoidectomy is a very safe procedure. The most common risk is bleeding from the throat after surgery. This occurs in about 5% of cases. The most common time for bleeding to occur is 7-10 days after surgery (this is when scabs start to fall off in the throat). Usually, the throat pain is also getting much better around this time, so your child will be tempted to eat solid foods. Do your best to prevent your child from eating solid foods until a full 2 weeks after surgery to minimize the risk of bleeding.

Other risks of surgery are rare. These include damage to the lips, gums, or teeth during surgery. Serious or life threatening risks are extremely rare, especially in otherwise healthy children.

The above article is for educational purposes only and should not be considered as specific medical advice.


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Comments

Jun 21, 2010 12:41am
kims3003
Well done with excellent information. You really produce some great stuff here.
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