Tonsillectomy and Adenoidectomy

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 enlarged tonsils and adenoids may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis.

• Constant yellow or green nasal drainage
• Nasal congestion
• Low-grade fever

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:

• Nasal congestion
• 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.

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
• The extent of the infection
• The 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.

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
• Recurrent episodes of tonsillitis
• 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
• Abscesses in the throat
• Recurrent ear infection
• Shearing 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 or allergies. A T&A will not help any of these problems.

The need for a tonsillectomy and adenoidectomy (T&A) surgery 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 such as severe asthma, Down Syndrome, or obesity
• Have complications after surgery, such as bleeding or trouble breathing
• 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:

• Perioperative 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 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. 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 she can be monitored closely. Parents may come into the recovery room as soon as the child is stable. After a short stay in the recovery room, usually six hours, 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 her room. 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.

Children who have their tonsils removed will typically have a sore throat for 5 to 7 days following surgery. Recovery for adenoidectomy is often shorter.

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. The safest medication to use following surgery is Tylenol and Ibuprofen. Narcotics should be avoided if possible in children with severe sleep apnea following removal of tonsils and adenoids.
• No heavy or rough play for a duration of time recommended by the surgeon

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)