Wednesday
Jan052011

Tonsils & Adenoids

What are tonsils?

The tonsils, which are located on both sides of the back of the throat, consist of lymphoid tissue (glands), which react to infections. Sometimes frequent tonsil infections occur in children, causing recurrent sore throats. Often, the tonsils will enlarge and you can see them as two "golf balls" of tissue on either side of the throat.

What are adenoids?

The adenoids are also composed of lymphoid tissue. They can not be seen by looking in the back of the throat; they are in the back of the nose above the roof of the mouth and near the opening of the (eustachian) tube that drains the middle-ear secretions into the nasal passages. Adenoids enlarge in response to infections in the respiratory tract and allergic problems.

 


Why are tonsils and adenoids removed?

A.  Infection

Tonsillectomy

  1. Frequent throat infection is an indication for tonsillectomy. It is considered for any child who has had 5 or more episodes in one year or several years of repeated infections.

Adenoidectomy

  1. Long-term or recurrent nasal or sinus infections despite adequate medical treatment.
  2. Recurrent ear infections (with or without fluid) complicated by obstruction or inflammation of adenoids.

B.  Obstruction of the airway

This can be caused by enlarged tonsils and/ or adenoids. Signs of an airway obstruction include:

1.  Loud, irregular snoring at night.

2.  Disruptive sleep pattern:

  1. Frequent waking at night occurring with snoring.
  2. Apnea (no breathing).
  3. Excess fatigue, naps during the day.
  4. Irritability
  5. Bed wetting.

3.  Chronic mouth-breathing, bad breath.  Prolonged mouth-breathing can results in changes of the position of the mandible, palate, and tongue which may lead to malocclusion of the teeth.

C.  Eating/swallowing problems
This can contribute to poor weight gain.

D.  Speech problems without other causes.
 Speech can sound mushy, garbled, or muffled. (Can commonly sound like the child speaks as though he has something hot in his mouth - "hot potato voice".

What happens when my child has this operation?
When it is decided that your child will have a tonsillectomy and/or adenoidectomy the first step is to obtain insurance authorization and the schedule the surgery. Prior to the surgery, we will give you forms and information (i.e. where to go, what’s the last time the child can eat, etc.) Unless advised by the doctor, no pre-op blood work is necessary.

We ask that you not give your child any aspirin or ibuprofen (i.e. Motrin, Advil) products 2 weeks before or after surgery. Aspirin is a blood thinner, decreasing the body’s ability to clot blood. Many over-the-counter products contain aspirin, so be sure to read labels carefully. If you feel your child needs anything before the surgery, acetaminophen is fine (i.e. Tylenol, Panhandle).

How can I prepare my child for the operation?

If it would help you or your child, you can schedule a tour of Texas Children's Hospital by calling (832) 826-1650.

General Information about the procedure:

It has not been shown that surgical removal of the tonsils and adnoids result in immunodeficiency or disease. After the operation there will no longer be tonsillitis, but viral infections of the throat (pharyngitis) may still occur.

A tonsillectomy may be done as an outpatient or require one night’s stay in the hospital. An adenoidectomy by itself is an outpatient surgery. The anesthesiologist will speak with you before the operation. We suggest that you write down your questions so that you can discuss the concerns you may have with him/her. He/She will carefully monitor your child throughout the procedure.

A tonsillectomy takes 20-30 minutes. An adenoidectomy takes 15-20 minutes. An IV will be started in the O.R. after the child is asleep. This will be used to give him/her fluids for 4-6 hours after the operation. After the procedure the child will go to the recovery room to allow him/her to wake up fully and recover from the effects of anesthesia. Then the child will go to the discharge area where you will be with him/her. The surgeon will speak to you after the operation is over.

After approximately 4 hours for a tonsillectomy and 1-2 hours for an adenoidectomy, if the child does not have problems with vomiting, he/she will be able to be discharged home. Once the child is home, we would like you to start a regular diet where chewing is necessary i.e. hamburger, pizza. The chewing and swallowing action aids is relieving the pain and in promoting quicker healing. Between meals, if your child is old enough, we encourage gum chewing.

What should I know when my child comes home:

Tonsillectomy

Pain: Children do have pain and we suggest giving Tylenol (especially ½ - 1 hour before meals). We will also provide you with a prescription for Tylenol with Codeine to help with the more significant pain in the first few days after surgery. Again, do not give aspirin. The duration of pain varies. Younger children heal more quickly and may have pain for only a few days. Teenagers may experience discomfort for up to 10 days. The sooner the child is eating and back to regular activities the quicker the pain will be gone. Occasionally, children complain of an earache. This is normal due to irritation of the nerve that services both the ears and tonsils. In the back of the throat, you may notice a white patch in the region of the tonsils. This is normal and is part of the healing process.

Bleeding: Bleeding occurs approximately 1% or less after a tonsillectomy. This most often occurs 5-10 days after the surgery when the scab falls off. It is an emergency if your child coughs or spits up blood. Do not hesitate in seeking help. The risk for bleeding is greatly reduced by regular eating/chewing behaviors. If your child is cared for or watched by someone other than yourself during this time, be sure they are aware of what to look for and who to call for assistance.

Temperature: A mild temperature can be expected but should not exceed 103o.

Diet: The child must eat a normal diet with regular chewing foods. Plenty of fluids are necessary! There is no need to restrict any type of food - let the child eat whatever they like.

Activity: Your child is to resume normal activities AS SOON AS POSSIBLE.

Including returning to school.

Adenoidectomy

You may notice that your child snores or appears congested for a short period of time after the surgery. This is due to the swelling in the back of the nose and should stop as the swelling comes down. Your child may also have bad breath post-operatively; this will settle with time.

Bleeding: This is extremely unusual after an adenoidectomy (1 in 1000) and most often occurs immediately after surgery in the recovery room.

Pain: Only Tylenol is necessary after an adenoidectomy. There may be a mild sore throat the night of the surgery.

Diet: Return to normal diet immediately after surgery.

Activity: Return to normal activities immediately. The child can return to school the next day.

I understand that you may have many questions or concerns.

Do not hesitate to give me a call!