Tonsils and Adenoids

Tonsils and adenoids are on the body’s first line of defense — our immune system.  They “sample” bacteria and viruses that enter the body through the mouth or nose at the risk of their own infection.  At times, they become more of a liability than an asset and may trigger airway obstruction or repeated bacterial infections.

What are tonsils and adenoids?

The tonsils are two pads of lymphatic tissue located on each side of the back of the throat.

The adenoids are a pad of lymphatic tissue high in the throat behind the nose and the roof of the mouth and look like tiny clusters of grapes.  Adenoids are also called pharyngeal tonsils, but they are separate from the tonsils in the throat.  The adenoids cannot be seen by looking into the mouth.

Lymphatic tissue is found throughout the body and is important in the body’s defense against infection.  The tonsil and adenoid tissue may be enlarged at birth or become enlarged from infection or allergic irritation.  There is a large amount of lymphatic tissue in the upper respiratory tract, and the body will tolerate the removal of a small amount of this tissue, such as the tonsils and adenoids, with no adverse effect.

Your physician may suggest surgery because of persistent or recurring enlargement or infections of the tonsils or adenoids.

What are the symptoms of enlarged or infected tonsils and adenoids?

Tonsillitis is an infection in one or both tonsils.  One sign is swelling of the tonsils.  Other signs or symptoms are:

  • redder than normal tonsils
  • white or yellow coating on the tonsils
  • slight voice change due to swelling
  • sore throat
  • uncomfortable or painful swallowing
  • swollen lymph nodes (glands) in the neck
  • fever
  • bad breath

There are several symptoms associated with enlarged adenoids.  You may notice that your child

  • complains of difficulty breathing through the nose
  • is breathing through the mouth
  • talks as if nostrils are pinched, breathes noisily
  • snores while sleeping
  • stops breathing for a few seconds while sleeping (sleep apnea)

See your physician if you suspect your child has enlarged or infected tonsils or adenoids.

Treatment – is surgery necessary?

Surgery is no longer the standard treatment for tonsil or adenoid problems.

Your physician may wish to treat your child with antibiotics as a first line of defense. Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics.

If the adenoids are not infected, your physician may choose to wait – enlarged adenoids are normal in some people.  Your child’s adenoids may eventually shrink on their own.

Your physician may suggest tonsil or adenoid surgery if your child experiences one of more of the following:

  • sleep apnea
  • recurrent infections: recurrent infections or strep throat despite antibiotic therapy (more than 3-4 times per year) or chronic tonsil and/or adenoid infections not responsive to antibiotics.
  • distorted speech
  • upper airway obstruction: enlarged tonsils and adenoids may block the airway and cause difficulty breathing.
  • halitosis (bad breath)
  • asymmetric enlargement of the tonsils and selected cases.

Preoperative care:

No aspirin products (including Pepto-Bismol and Aspergum) or products containing Ginkgo Biloba and/or St. John’s Wort should be given for 2 weeks prior to surgery.  No ibuprofen products (Children’s Motrin, Children’s Advil, etc.) or anti-inflammatory medications (Naprosyn, Aleve, etc) should be given for one week prior to surgery.  Use of all these medications is restricted for 2 weeks following surgery.  Acetaminophen (Tylenol, Tempra, Panadol) can be given as well as over-the-counter cold medications and antibiotics.  Please notify your doctor if there is a family history of bleeding tendencies or if you or your child tends to bruise easily.

If the patient or patient’s family has had any problems with anesthesia, the surgeon should be informed.  If the patient is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the surgeon should be informed.

A blood test and possibly a urine test may be required prior to surgery.

Generally, after midnight prior to the operation, nothing may be taken by mouth (including chewing gum, mouthwashes, throat lozenges, toothpaste, water).  Anything in the stomach may be vomited when anesthesia is induced, and this is dangerous.

When the patient arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet with the patient and family to review the patient’s history.  The patient will then be taken to the operating room and given an anesthetic.  Intravenous fluids are usually given during and after surgery.

What happens during surgery?

Surgery can be a frightening experience for both children and their parents. You can help prepare your child for surgery by talking about what to expect.

The procedure to remove the tonsils is called a tonsillectomy; excision of the adenoids is an adenoidectomy. Both are usually performed concurrently; hence the procedure is known as a tonsillectomy and adenoidectomy or T&A.

T&A is an outpatient surgical procedure lasting between 30 and 45 minutes and performed under general anesthesia. Your child will wake up in the recovery area.  Children that have trouble breathing or show signs of bleeding will return immediately to the operating room.  In most cases, the total time in the hospital is 5-10 hours.  Children under 3 years of age and children with chronic disease, such as seizure disorder or cerebral palsy, will often stay overnight.

Your child may have a mild sore for 3-5 days.  Although postoperative bleeding is very rare, if any bleeding is noticed, contact your physician or go to the Emergency Room immediately.

After surgery

Most children take between 7-10 days to recover following adenotonsillectomy.  Some children feel better in just a few days, and some take as long as 14 days to recover.  Often the worst days of recovery are days 4 and 5.  Your doctor will recommend minimal activity for at least 10 days postoperatively.  This would include no school or exertional activity such as dance class, gymnastics, or other sports.

There are several postoperative symptoms that may arise.  These include, but are not limited to, swallowing problems, vomiting, fever, throat pain, and ear pain.  Occasionally, bleeding may occur after surgery.  If the patient has any bleeding, your surgeon should be notified immediately.

Nausea and vomiting:

Up to 50% of children will experience nausea and/or vomiting from the general anesthetic.  This usually occurs during the first 24 to 36 hours following surgery.  Antinausea medications may be prescribed for this.

Fever:

A low-grade fever is normal for several days after surgery and should be treated with acetaminophen or the acetaminophen/narcotic formulation which your doctor may prescribe.  The fever will usually resolve with good fluid intake.  Please call the office if temperature is in excess of 102 degrees.

Pain:

Most children experience a fair amount of throat pain after surgery.  Many children also complain of ear pain.  The throat and ears share a common nerve supply and stimulation of this nerve in the throat may therefore feel like an earache.  Some children also complain of jaw and neck pain.  This is from positioning in the operating room.  The children have trouble eating, drinking, and sleeping because of the pain.  Severity of pain may fluctuate during recovery from mild to very severe and pain may last up to 14 days.

Pain control:

Please medicate your child every 4 hours for pain with acetaminophen or the acetaminophen/narcotic preparation, which your doctor has prescribed.  Ice collar to the neck and humidifier in the child’s room has also helped relieve pain.  Increasing pain may be due to dehydration with drying of the scabs in the throat.  Increasing fluid intake will help with this.  Do not use aspirin or ibuprofen products for 2 weeks following surgery.

Breathing:

Snoring and mouth breathing are normal after surgery because of swelling.  Normal breathing should resume 10-14 days after surgery.

Scabs:

A membrane or scab will form after tonsils are removed.  Two separate scabs may be seen or the entire back wall of the throat may be involved.  The scabs are thick and whitish and cause bad breath.  This is normal.  The scabs usually dissolve at 5-10 days after surgery.

Bleeding:

Bleeding may signal the scabs have fallen off.  If there is any bleeding noted from the nose or mouth, contact the office (402-397-0670) or the physician on call (after hours 402-354-2754). Emergency room evaluation may be recommended.  Travel away from home is not recommended for 2 weeks following surgery.

Speech:

If the tonsils are very large, the sound or quality of the voice may be different after surgery.  Patient may have a nasal sounding voice for up to 2 weeks after surgery due to muscle swelling.

Any questions or concerns should be discussed openly with your surgeon.