Tonsillectomy 101

October 17, 2017

As parents, we want our children to grow, learn and be healthy individuals to lead happy and successful lives. We want to provide our kids with the best nutrition, education and foundation in order to accomplish this. It’s important for our children to have good sleep architecture and a restful night in order to function adequately in school. Snoring and frequent arousals could be the result of enlarged tonsils and adenoids, leading to what is called sleep disordered breathing. Texas Children’s otolaryngologists take care of children with this complaint, as well as recurrent throat infections. A tonsillectomy, with or without adenoidectomy, is one of the most common surgical procedures performed in the U.S. 

What are tonsils and adenoids?

Tonsils are part of the lymphatic system and are located in the back of the throat at either side. They are responsible for initiating immune responses against antigens entering the body. Tonsils are most active during childhood, but recurrent tonsil infections interrupt their ability to function. Very large tonsils can lead to upper airway obstruction and interfere with sleep and how one swallows. 

Adenoids are also part of the lymphatic system that helps us fight infection. They are located at the back of the nose and throat. When adenoids overgrow, they can interfere with speech and breathing. In addition, large adenoids contribute to recurrent ear infections. 

The removal of tonsils and adenoids do not cause any harm to a person’s body or their ability to fight infections. 

What is a tonsillectomy and adenoidectomy?

Tonsillectomy is the surgical removal of the tonsils with or without the adenoids. Similarly, adenoidectomy is the removal of the adenoid tissue. This procedure is offered for children suffering from sleep disordered breathing causing obstruction and recurrent tonsil infections. It is most often performed in an outpatient setting and children are able to go home the same day. Patients with complex medical conditions, younger than 3 years old, obesity and obstructive sleep apnea are hospitalized after the surgery for at least one night. This procedure typically takes an average of 45 minutes under general anesthesia. After this, your child will proceed to the recovery room. 

Tonsillectomy and adenoidectomy relieve the obstruction your child suffers from during sleep, allowing them to establish better sleep quality and improved behavior. 

What is sleep disordered breathing?

This is a condition where the adequacy of breathing and ventilation are affected during sleep. Signs of sleep disordered breathing are snoring, breathing through the mouth, gasping for air and pauses in respiration. Sleep disordered breathing can range in severity from snoring to obstructive sleep apnea. 

For children with sleep disordered breathing, the night sleep is interrupted leading to daytime sleepiness, inattention in school and hyperactivity. Moreover, children encounter difficulty concentrating and poor school performance. Enuresis, or bed wetting, is also a common finding, sometimes embarrassing to children and families.

What is obstructive sleep apnea (OSA)?

Obstructive sleep apnea is the partial or complete obstruction of the upper airway and is usually accompanied by a decrease in oxygen saturation. OSA is diagnosed via polysomnography (sleep study).  For obese children, and those suffering from other underlying medical conditions, a sleep study is used to evaluate the severity of their obstruction and also guides their treatment methods.

What is recurrent pharyngitis?

Pharyngitis is the medical term describing a throat infection. This infection can be caused by a virus or bacteria. The most common bacteria that leads to throat and tonsil infection are group A streptococcus, better known as strep throat. Recurrent throat infections cause pain, decreased appetite, missed school days and frequent antibiotic use. Other more severe complications of strep throat include scarlet fever, rheumatic heart disease and bacteremia. 

Are there any complications following a tonsillectomy and adenoidectomy?

Throat pain contributing to a decrease in appetite is common following the procedure and can promote dehydration. Pain can last seven to 14 days and it is normal to have a low-grade fever after the procedure. There’s a 5 percent chance of bleeding up to 10 days following the surgery. Blood-tinged saliva is normal. If your child has more than a teaspoon of bleeding from their mouth, we will typically suggest you return to the hospital emergency room for possible readmission or further surgery for bleeding control. 

More information regarding this surgical procedure, complications and post-operative care is provided during your office visit.

What can I expect during recovery following a tonsillectomy and adenoidectomy?

Your child will be unable to attend school for one week after surgery in order to recover. Tylenol and Ibuprofen together, every six hours for five days, will be prescribed to help with pain. It is very important to stay hydrated after the procedure. Encouraging frequent intake of liquids is crucial to prevent dehydration. Examples are water, juices and yogurt. Prune juice can help if your child is constipated. A diet consisting of softer foods is also preferred.  Additionally, no strenuous activities or participation in physical education (PE) should be performed for two weeks post op. Bad breath is a normal finding during this recovery period. You’ll be seen by your otolaryngologist for a post op checkup after four weeks.  

If any questions arise prior to your appointment, please call our office number at 832-822-3250, for guidance during this process.

For more information about important things to remember before tonsillectomy and adenoidectomy surgery, click here.

Para obtener más información sobre las cosas importantes que debe recordar antes de la amigdalectomía y la cirugía de adenoidectomía, haga clic aquí.

For more information about important things to remember after tonsillectomy and adenoidectomy surgery, click here.

Para obtener más información sobre las cosas importantes que debe recordar después de la amigdalectomía y la cirugía de adenoidectomía, haga clic aquí.

Video credit: Karina Cañadas, MD, Mark Michael and David Tsao

Post by:

Jessie Marcet-Gonzalez, CPNP

I’m a Nurse Practitioner in the Pediatric Otolaryngology Department at Texas Children’s Hospital main campus and I take care of patients with multiple ear, nose and throat concerns. My past clinical experience involves pediatric Intensive care, adult intensive care, outpatient surgery and...

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