Tonsillectomy and Adenoidectomy

Tonsils are small, round pieces of tissue located in the back of the mouth on both sides of the throat. The adenoid is similar to the tonsils but located in back of the nasal cavity.

Tonsils and adenoid are often removed when they have become large or inflamed and begin to cause airway obstructions or frequent infections. The procedure to remove tonsils is known as a tonsillectomy or tonsillotomy. Removal of the adenoid is called an adenoidectomy. Because they are often removed at the same time, the procedure is referred to as a tonsillectomy and adenoidectomy, or T&A. The surgery is most commonly performed in children.

Your child’s surgeon or doctor may suggest either a tonsillectomy or a tonsillotomy to remove the tonsils. Both procedures relieve upper airway obstruction in children. Unlike a tonsillectomy, a tonsillotomy (also known as intracapsular tonsillectomy) preserves a layer of tissue (capsule) that separates the tonsils from the muscles of the throat. Children often recover more quickly with less pain and lower risk of bleeding after a tonsillotomy. There is, however, a small risk that some tonsil tissue will remain.

Your child’s doctor may recommend a T&A for these reasons: obstruction, infection, or both. Children with obstructed tonsils or adenoid often have signs of sleep disturbance, such as snoring and mouth breathing. Children with inflamed tonsils and adenoid may have repeated infections that do not respond to more conservative medical treatments.

Your doctor may decide a T&A is the best option if the tonsils and adenoid are causing a functional problem, such as:

• Snoring and obstructive sleep apnea
• Recurrent infections
• Tonsil stones
• Trouble swallowing
• Significant blockage of the nasal passage and uncomfortable breathing
• Tumor in the throat or nasal passage

The American Academy of Otolaryngology offers these guidelines to determine if a child should have a T&A.

• Seven sore throats in one year
• Five sore throats in each of two years
• Four sore throats in each of three years

The sore throats may be associated with:

• Fever
• Discharge on the tonsils
• Positive strep throat culture

Most T&A surgeries are done on an outpatient basis. This means your child will have surgery and then go home the same day. During the surgery, your child will be anesthetized in the operating room. The surgeon will remove your child's tonsils and adenoid 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. After your child is fully awake and doing well, the recovery room nurse will bring your child back to the day surgery area.

At this point, if everything is going well, you and your child will be able to go home. If your child is going to spend the night in the hospital, they will be brought from the recovery room to their room.

Any type of surgery poses a risk to a child. A small number of children experience bleeding after a T&A. This can happen up to two weeks after surgery and may require a follow-up surgery.

Other risks include:

• Change in the sound of speech
• Dehydration due to decreased fluid intake: If severe, your child may need to return to the hospital for fluids through an intravenous (IV) catheter.
• Fever
• Difficulty breathing: This may be a sign of swelling around the surgical site and may be life threatening if not treated immediately.
   

We recommend the following:

• Pain medication as prescribed by your child’s surgeon
• Maintain fluid intake
• No heavy or rough play for a duration of time recommended by the surgeon

• Home care instructions after a tonsillectomy and adenoidectomy family education sheet
• Home care instructions after an adenoidectomy family education sheet