Tonsillectomy & Adenoidectomy

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. Tonsillitis occurs when the tonsils become inflamed from infection.

Adenoids are made up of lymph tissue and are located in the space above the soft roof of the mouth. They cannot be seen by looking in your child's nose or throat. Adenoiditis occurs when the adenoids become inflamed from infection.

Symptoms of Tonsillitis

The symptoms of tonsillitis vary greatly, depending on the cause of the infection, and can occur either suddenly or gradually. The most common symptoms of tonsillitis 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

Symptoms of Adenoiditis

The symptoms of adenoiditis vary greatly depending on the cause of the infection, and can occur either suddenly or gradually. Common symptoms include:

Breathing through the mouth
Noisy breathing
Snoring
Nasal speech
Periods at night when breathing stops for a few seconds

Treatment

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 determine 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 also 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.

Reasons for a Tonsillectomy & Adenoidectomy

The reasons for T&A surgery are not well defined, and many surgeons differ in their views.

Widely accepted reasons for having a T&A are:

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 must be associated with the following:

Fever above 101 degrees Fahrenheit
Discharge on the tonsils
Positive strep throat culture

The following are more controversial reasons for recommending removal of the adenoids and tonsils:

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

Tonsillectomy & Adenoidectomy Surgery

T&A surgery is the most common surgery performed on children in the United States. 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, but some children may be required to stay overnight, such as 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 the healthcare team who handle your child's care. These may include a surgeon, nurses and an anesthesiologist. 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 they can be monitored closely. 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.

Your physician may recommend increased fluid intake, pain medication, a soft food diet and refraining from heavy play while your child recovers at home.

The Risks of Surgery

Any type of surgery poses a risk to a child. About 5% of 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. Additional complications that may occur:

Bleeding - may happen during surgery, immediately after surgery or at home
Dehydration - due to decreased fluid intake
Fever
Difficulty breathing - swelling of the area around the surgery

Related Specialties

Otolaryngology (ENT)