Tonsillectomy & Adenoidectomy

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

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

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.

Surgery to have the tonsils and adenoids removed is the most common surgery performed on children in the United States. Often, the tonsils and adenoids are removed at the same time. 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 and take about 45 minutes. However, some children may be required to stay overnight following the procedure, 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; therea re not cuts made on the skin. 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 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

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

Once your child wakes up, we make sure they are eating, drinking and the pain is relatively controlled before you get to go home. Most kids go home the same day after surgery, but a minority are kept overnight for observation for special circumstances. 

The child may have a sore throat for one-two weeks. Every child will experience pain differently, but the recovery may be easier for younger children as their body may heal faster. 

Post-procedure pain is usually controlled with acetaminophen (Tylenol) and ibuprofen (Motrin, Advil). In most cases, children can eat whatever they prefer after surgery, but a combination of popsicles, milkshakes and ice cream may be initially recommended by the physician-surgeon. Drinking lots of liquids afterwards tends to make discomfort better.