Your child may have been referred to an ear, nose, and throat surgeon (ENT) to have the tonsils and adenoids removed. This surgery is called a tonsillectomy and adenoidectomy. Often the tonsils and adenoids are removed at the same time. But sometimes only one or the other is removed. Your child’s ENT will discuss this with you.
The tonsils are tissue located on either side of the back of the throat. The adenoids are located behind the nose and at the top (roof) of the mouth. Both the tonsils and adenoids are part of the immune system, the part of the body that fights infection and disease.
Healthcare providers are not in complete agreement about when a child should have a tonsillectomy or adenoidectomy. But here are some guidelines that are followed.
A tonsillectomy may be recommended if your child has throat infections that keep coming back. A throat infection means your child has a sore throat with fever. Or he or she also has swollen neck glands or drainage from the tonsils. Or your child also has a positive strep test. Your child has any of the following:
- 7 or more throat infections in 1 year
- 5 or more throat infections in each of 2 years
- 3 or more throat infections in each of 3 years
A tonsillectomy may also be recommended if your child has recurrent throat infections and any of these:
- Is unable to take antibiotic medicine or has antibiotic medicine allergies
- Has episodes of fever, sores in the mouth, sore throat, and swollen neck glands
- Has had an infected area near the tonsils
A tonsillectomy may also be recommended if your child has:
- Abnormal breathing while sleeping with enlarged tonsils. This might be brief episodes where your child stops breathing.
- Very large tonsils that block breathing through the nose or cause difficulty swallowing
Adenoidectomy is recommended if your child has a lot of trouble breathing through the nose. It may also be recommended if your child has:
- A long-term (chronic) sinus infection
- Middle ear infections that keep coming back
- A chronic middle ear infection with fluid and already has ear tubes
All surgeries have risks including bleeding, infection, and complications from general anesthesia. The risks of tonsillectomy and adenoidectomy are:
- Long-term throat pain
- Excessive bleeding from the tonsils
- Damage to teeth, voice box, throat, or roof of the mouth, or other nearby tissue
- Breathing problems
After surgery, your child may have nausea, vomiting, pain, dehydration, ear pain, or throat or lung problems.
Your child’s healthcare provider or ENT may want to do some tests before surgery. If your child has problems while sleeping, a sleep study may be done.
The ENT will explain the surgery and answer any questions. Make sure you talk with your child’s ENT about:
- Any medicines that your child should not take before surgery. This includes over-the-counter medicines.
- When your child needs to stop eating and drinking. For example, it is common not to eat or drink after midnight the night before surgery.
- When your child needs to arrive at the hospital or facility
- What to expect and how to care for your child after surgery
- When your child can get back to normal activities, including returning to daycare or school
And if your child gets sick before surgery, call his or her ENT. Surgery may need to be rescheduled.
Your child will probably have the surgery as an outpatient. That means that he or she will go home the same day as the surgery. The surgery usually takes between 30 and 45 minutes. Your child will get medicine to sleep during the surgery (general anesthesia). Some children may need to stay overnight. This may include children who:
- Are not drinking well after surgery
- Have other health problems
- Have complications after surgery, such as bleeding
- Are younger than age 3
- Have sleep apnea diagnosed by a sleep study
In general, the surgery will go as follows:
- Your child will be given general anesthesia.
- Medicines and fluids will be given by IV.
- The ENT will remove your child’s tonsils and adenoids through the mouth. There will be no cut on the skin.
- After the surgery, your child will go to a recovery room where he or she can be watched closely.
- Your child will receive medicine for pain.
- After your child is fully awake, a nurse will bring your child back to the day surgery area.
Your child’s throat will be very painful for the first 2 days. Pain may last up to 2 weeks.
Instructions for caring for your child at home may include:
- Making sure your child drinks well. This helps to prevent dehydration and helps to lessen pain. Stay away from milk, orange, and other citrus juices.
- Giving pain medicine. Your child’s ENT will tell you what to give your child. Call your child’s ENT if you are unable to control your child’s pain.
- Giving your child soft, warm foods to eat. Avoid hard and spicy foods.
- Letting your child be active while at home. He or she should stay away from heavy or rough play. Your child's ENT will tell you when your child can go back to all normal activities.
- Staying away from others with colds or other respiratory infections.
Make sure you take your child to all follow-up appointments with the ENT. And call the ENT if your child is not getting better, or if you have any questions or concerns.
Before you agree to the test or the procedure for your child make sure you know:
- The name of the test or procedure
- The reason your child is having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- When and where your child is to have the test or procedure
- Who will do the procedure and what that person’s qualifications are
- What would happen if your child did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or your child has problems
- How much will you have to pay for the test or procedure
January 02, 2018
Tonsillectomy and adenoidectomy in children, Up To Date
Kacker, Ashutosh, MD,Brown, Kim, APRN