Enlarged Tonsils and Adenoids
The tonsils and adenoids are fleshy patches of lymphoid tissue within the throat and sinuses that aid the body in fighting infection. The tonsils can be seen in the back of the throat on either side of the uvula, and the adenoids are located near the area where the throat connects to the nasal passages. While their job is to trap germs and bacteria and prevent them from entering the body, their tendency to hold onto these germs can oftentimes lead to viral or bacterial infections. These infections are what cause the swelling and inflammation of the tonsils and adenoids.
When the tonsils are infected (tonsilitis), they can become swollen and red and are often accompanied by a sore throat, fever, and swollen lymph nodes in the neck. Tonsillitis is generally viral in nature (such as when it is the result of a cold) but can be the result of a bacterial infection as well. A common example of a bacteria that effects the tonsils is streptococcal bacteria, leading to what most people call strep throat. It is important to note that having enlarged tonsils and having tonsillitis are not the same thing. A formal diagnosis is required to confirm the existence of tonsillitis.
Enlarged adenoids (adenoid hypertrophy) can be an indication that an infection has become lodged in the lymphoid tissue, which may or may not result in recurrent illness. After the age of five most people’s adenoids begin to shrink and no longer play much of a role in the body’s immune system. Because of this, adenoid complications and adenoid surgeries are most common in young children. If a person’s adenoids are found to be frequently enlarged, a doctor may try to prescribe anti-inflammatory medications or a medicated nasal spray to try and reduce swelling before recommending surgery. It may also be necessary to run certain blood tests to track down the nature and severity of an adenoid infection.
Complications of Enlarged Tonsils and Adenoids
When tonsils and adenoids are chronically enlarged other physiological problems can result, each with their own list of related complications. Some of these complications might be:
- Sleep disorders/sleep apnea
- Eating problems
- Nasal obstruction/congestion/trouble swallowing
- Problems with teeth or facial development
- Chronic ear infections or sinus infections
Enlarged tonsils and adenoids may cause no symptoms and infections can often be treated with medications. However, if the enlarged tonsils and adenoids cause breathing problems, recurring infections, or extreme discomfort, your doctor may recommend a tonsillectomy and/or adenoidectomy.
Tonsillectomy and Adenoidectomy (T&A) Surgery
A tonsillectomy (surgical removal of the tonsils) and adenoidectomy (excision of the adenoids) are often performed at the same time (adenotonsillectomy), especially if the patient has been experiencing recurrent infections in these glands. It is not unlikely for an infection to spread from one of these areas to the other so removing them both helps ensure that no further complications will arise. It is also the case that both the tonsils and adenoids lose most of their function as a child transition into adolescence, so removing them both is not putting the child’s immune system at any risk. Children tend to recover much quicker from these surgeries than adults do, so getting them out of the way in childhood can help prevent unnecessary suffering later.
Common reasons for having an adenotonsillectomy include:
- Obstructed night breathing/severe snoring: T&A has been highly successful in treating sleep apnea in children
- Frequent throat or sinus infections/recurring or chronic tonsillitis
- If a child is frequently found in unnatural sleeping positions due to difficulty breathing
- Difficulty swallowing and/or a limit to what a child can eat
- Constant mouth breathing
- Frequent bad breath
Adenotonsillectomy is one of the most common surgical procedures performed on children each year. The operation is performed under general anesthesia, usually as an outpatient procedure, and takes approximately 30 minutes to complete. The tonsils and adenoids are almost always removed through the mouth and no stitches are required.
Postoperative Care
Patients can typically go home within a few hours after having an adenotonsillectomy unless they are admitted to the hospital to address other existing medical issues. This short window is to make sure that there are no abnormalities or unusual complications after the procedure. There shouldn’t be too much pain immediately after the surgery since the local anesthesia should still be in effect, this will wear off at around the 10-hour mark. You should try and get your child to drink as much fluid as possible- or as much as they can comfortably handle as the risk of dehydration is high after a procedure such as this one. You should also try to encourage them to eat some food within this first 10-hour window as it is when the discomfort will be at its lowest. Certain foods might cause pain, like crunchy, spicy, or citrusy foods and therefore should be avoided. Other foods like ice cream and popsicles can provide minor relief (as well as a short-term distraction) and should be encouraged.
Besides dehydration, the most common risk to be looked for post-op is excessive bleeding. If food is eaten too aggressively or isn’t chewed properly trauma can be done to the area where the surgery was performed, and bleeding can result. If you notice your child bleeding excessively for more than a couple minutes, return them to the hospital or emergency room immediately. This is an uncommon occurrence but not one that should be overlooked.
Your child will have a sore throat for 1-2 weeks after the procedure as the tissue heals. Ear pain, nasal discharge, and some bleeding are common side effects. A temporary change in voice or taste may occur as well but will typically resolve within a few weeks. Pain medication and antibiotics to prevent infection are usually given for a week after the T&A, and healing is usually completed within 10-14 days.
Please carefully read and follow Tonsillectomy and Adenoidectomy Postoperative Instructions from Dr. John McClay.
If you have further questions about the nature of these procedures or would like to consult a doctor regarding your child’s personal symptoms, please contact us.