Tonsillectomy and Adenoidectomy

What is a tonsillectomy and adenoidectomy?

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

Tonsils and adenoids are often removed when they become large and inflamed and begin to cause frequent infections. The procedure to remove tonsils is known as a tonsillectomy, and removal of the adenoids 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.

What is a tonsillotomy?

A tonsillotomy is the partial removal of the tonsils. Studies have shown that, compared to a full tonsillectomy, children often recover more quickly with less pain after a tonsillotomy. Both procedures relieve upper airway obstruction, however, some children’s tonsils grow back after a tonsillotomy, and their symptoms return.

Why would my child need a T&A?

A T&A may be recommended if your child has repeated tonsil and adenoid infections caused by inflammation — known as tonsillitis and adenoiditis — that do not respond to more conservative treatments.

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

obstructive sleep apnea
recurrent infections
tonsil stones
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 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
three sore throats in each of three years

The sore throats may be associated with the following:

Fever above 101°F
discharge on the tonsils
positive strep throat culture

What happens during T&A?

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 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. 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 stay the night in the hospital, your child will be brought from the recovery room to their room.

Tonsillectomy and Adenoidectomy | In Depth

What are tonsillitis and adenoiditis?

Adenoiditis happens when adenoids become inflamed from infection.

The symptoms of tonsillitis vary greatly depending on the cause of the infection, and can occur either suddenly or gradually. The following are the most common symptoms of tonsillitis. However, each child may experience symptoms differently. Symptoms may 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 tonsillitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

The symptoms of adenoiditis vary greatly depending on the cause of the infection, and can occur either suddenly or gradually. The following are the most common symptoms of adenoiditis. However, each child may experience symptoms differently. Symptoms may include:

breathing through the mouth
noisy breathing
snoring
nasal speech
periods at night when breathing stops for a few seconds

The symptoms of adenoiditis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

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, but, sometimes, only one is removed. Your child's physician will discuss this with you.

Tonsillectomy and Adenoidectomy | Tests & Diagnostics

What are the reasons to have a tonsillectomy and adenoidectomy?

The reasons for this surgery are not well defined, and physicians may differ in their views. The following are some of the more widely accepted reasons for having a T&A:

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 may be associated with the following:

fever above 101°F (Fahrenheit)
discharge on the tonsils
positive strep throat culture

Here are some additional reasons for removing the adenoids and tonsils that are more controversial:

bad snoring
recurrent infections or abscesses in the throat
recurrent ear infections
hearing loss
chronic sinusitis, or infection in the sinuses
constant mouth breathing
frequent colds
cough
bad breath

What happens during tonsillectomy and adenoidectomy?

Tonsillectomy and adenoidectomy (T&A) surgery is a common major 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. This means that 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 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 he/she 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.

Bleeding is a complication of this surgery and should be addressed immediately by the surgeon. If the bleeding is severe, your child may return to the operating room.

Tonsillectomy and Adenoidectomy | Treatments & Care

How do I care for my child after a tonsillectomy and adenoidectomy?

We recommend the following:

increased fluid intake
pain medication, as prescribed
no heavy or rough play for a duration of time recommended by the surgeon

What are the risks of having a tonsillectomy and adenoidectomy?

Any type of surgery poses a risk to a child. About 5 percent 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. The following are some of the other complications that may occur:

bleeding (may happen during surgery, immediately after surgery, or at home)
dehydration (due to decreased fluid intake; if severe, fluids through an intravenous, or IV, catheter in the hospital may be necessary)
fever
difficulty breathing (swelling of the area around the surgery; may be life threatening if not treated immediately)