Tonsillectomy and Adenoidectomy

What Are the Tonsils and Adenoids?

Tonsils and adenoids are masses of tissue found in the throat and similar to lymph nodes found in the neck and other areas. Tonsils are areas of soft tissue on both sides of the throat. The adenoids are the areas of soft tissue in the upper throat right behind the nose. Normally, they may have a minor roles in providing antibody production which helps the body fight off infection, as do the other lymph glands found throughout the body.

What Types of Problems Can Someone Have with Their Tonsils and Adenoids?

Diagram of TonsilsSometimes the tonsils and/or the adenoids are so enlarged that they block the throat and breathing airway. This can cause difficulty breathing and other serious health problems. A child’s doctor may call this condition tonsillar hypertrophy or obstruction. Adenotonsillar hypertrophy can lead to:

  • Snoring
  • Loud and/or labored breathing
  • Severe difficulty swallowing
  • Chronic mouth breathing
  • Sleep disturbances
  • Bad breath
  • Hyponasal speech
  • Frequent and disruptive gasping or snorting noises

While helping the body fight off germs, the tonsils and adenoids may also get infected. Chronic infection, called tonsillitis, can often involve strep and require repeated courses of antibiotics, with loss of time from school or work.

If infections recur frequently despite antibiotic therapy, or if the airway obstruction is severe enough, your doctor may recommend tonsillectomy and adenoidectomy (T&A). In some instances, particularly if ear infections are the primary problem, only adenoidectomy might be necessary.

What Is Sleep-Disordered Breathing?

Sleep-disordered breathing is a condition in which people do not breathe properly while sleeping. This may be characterized by snoring or the other symptoms of obstruction noted above. Obstructive sleep apnea (OSA) is a severe form of sleep-disordered breathing characterized by breathing that stops several times during the night. While treatment of this disorder may require more extensive tests such as an overnight sleep study, many patients, in particular, children, may benefit from adenotonsillectomy.

What Problems Can Sleep-Disordered Breathing Lead To?

If left untreated, sleep-disordered breathing problems, such as pediatric OSA, could lead to much more serious health issues such as:

Poor Growth - During sleep, the body usually releases a hormone that helps it grow. If a child is constantly waking up during the night, his or her body may not be releasing a regular amount of this growth hormone, resulting in slowed growth.

Bed-Wetting at Night - Sleep disturbances during the night could increase the amount of urine that the body makes, leading to bed-wetting.

Sleep Deprivation - If a child wakes up constantly at night, he or she may not be getting enough sleep. This could lead to mood swings, a decrease in energy and happiness, and even obesity.

Psychological, Behavioral, or Emotional Problems - Interrupted sleep caused by sleep-disordered breathing can lead to problems such as depression and attention deficit hyperactivity disorder (ADHD).

There is good news though. Studies have shown that after undergoing tonsillectomy and/or adenoidectomy for obstructive symptoms, many of these problems are resolved. One study found that children who had an adenotonsillectomy showed reduced symptoms of ADHD and daytime sleepiness and higher cognitive functioning one year following the procedure.[i]

What Is Tonsillitis?

Tonsillitis may be contagious and is spread just like a cold; that is, through coughing, sneezing, etc. Viruses and bacteria can cause tonsillitis. Almost all children get at least one tonsil infection in their lifetime.

The Symptoms of Tonsillitis Include:

  • Fever
  • Persistent sore throat
  • Redness of the tonsil area
  • Yellow discharge on the tonsils
  • Tender lymph nodes on both sides of the neck

Infections in the tonsils and adenoids that keep coming back are called chronic infections. If these infections are not stopped, they could cause more serious health problems.

A child’s doctor may first prescribe antibiotics to fight infections. If antibiotics do not work, the doctor may recommend tonsillectomy and/or adenoidectomy. Removing the tonsils and/or adenoids helps to prevent infections from coming back.

What Is Tonsillectomy/Adenoidectomy?

Diagram of tonsils being removed.Traditional ways of removing the tonsils and adenoids include cutting with a scalpel or burning with electrocautery. For younger patients, we will frequently use Coblation, a newer, more advanced technology that combines bipolar radio frequency energy with a natural saline solution to gently and precisely remove tissue. This will often lead to a faster and easier recovery.

What Can I Expect after Tonsillectomy?

Happy boy eating a hamburger.The most common problem after tonsillectomy is a very sore throat. While the average duration of the severe soreness varies with age, the duration may vary. It is important that the patient consume 1 – 1 ½ quarts of fluid per day in order to prevent dehydration. Liquids and soft diet are necessary for about 2 weeks after, although most children are able to return to school and sedentary activities after about a week. Exercise and other physical activity should be avoided for about 2 weeks following surgery.

Occasionally, particularly in older patients, there may be some post operative bleeding, sometimes as long as a week or more after surgery. This is because scabs that have formed in the throat may start to dissolve. If one of these scabs is sitting on a blood vessel, some bleeding may occur. You should contact your doctor if this occurs.

Another very common complaint is ear pain. This is actually quite normal since pain from the throat is often “felt” in the ear.

All patients are given prescription pain medicine and an antibiotic following surgery, in liquid form. Tylenol may be given instead of the prescription medicine, although ibuprofen and aspirin containing products should be avoided since these may cause bleeding. 

[i] Chervin RD, Ruzicka DL, Giordani BJ, et al. Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics. 2006;117:e769-778.