Tonsillectomy and Adenoidectomy

Definition

Tonsillectomy and adenoidectomy (T & A) are surgical procedures to remove the tonsils from the back of the mouth or adenoids from the back of the nasal cavity—both are are part of the lymphatic system, which is responsible for fighting infection. These operations are often performed together and are usually done on children. T & As are the most common childhood operations.

Tonsillectomy

Tonsils are removed (with or without the adenoids) when the child has any of the following conditions:

• obstruction of the upper airway.
• sleep apnea. This is a condition in which the child snores loudly and stops breathing temporarily at intervals during sleep.
• inability to swallow properly because of enlarged tonsils.
• "hot potato" voice (breathy voice) and other speech abnormalities due to enlarged tonsils
• recurrent or persistent abscesses or throat infections

Doctors do not agree completely on the number of sore throats that make a tonsillectomy necessary. Most would agree that four cases of strep throat in any one year; six or more episodes of tonsillitis in one year; or five or more episodes of tonsillitis per year for two years indicate that the tonsils should be removed.

Adenoidectomy

Adenoids are removed (with or without the tonsils) when the child has any of the following conditions:

• alteration of facial growth because of enlarged adenoids
• upper airway obstruction
• development of an irregular bite (dental malocclusion)
• difficult speech or swallowing

Precautions

T & As are not performed as frequently today as they were in the past. One reason for a more conservative approach is that there is always some risk involved when a patient is put under general anesthesia.

In some cases, a T & A may need to be modified or postponed:

• children with cleft palates should not have the adenoids removed
• bleeding disorders; these must be brought under control before surgery
• acute tonsillitis; surgery should be postponed—usually for three to four weeks—until the infection is gone

Description

Tonsillectomies are hospital procedures. In adults, they may be performed under local anesthesia. Children are usually placed under general anesthesia. The doctor depresses the tongue in order to see the throat and removes the tonsils with a scooplike instrument. The adenoids are usually removed through the nose.

Aftercare

Patients are turned on the side after the operation to prevent the possibility of blood being drawn into the lungs. The patient's vital signs are checked. After the patient is fully awake, he or she can drink water and other nonirritating liquids.

Adult patients are usually warned to expect some bleeding after the operation and a very sore throat.

Antibiotics are given to prevent infection. Medications to relieve pain may also be given. For at least the first 24 hours, the patient is fed soft or pureed foods and fluids. If the adenoids alone were removed, the patient may be allowed solid food the day after surgery.

Patients are usually sent home the next day, with instructions to call the doctor if there is bleeding, an earache, or a fever that lasts longer than three days. They are told to expect a white scab to form in the throat between five and 10 days after surgery.

Risks

About one in every fifteen thousand tonsillectomies ends in death, either from the anesthesia or from bleeding to death five to seven days after the operation. There is also a chance that children with previously normal speech will develop a nasal-sounding voice. In addition, children younger than five years may be badly emotionally upset by the hospital experience.

Normal results

Normal results include the correction of the condition for which the surgery was performed.

BOOKS

Berman, Stephen, and Ken Chan. "Ear, Nose, & Throat." In Current Pediatric Diagnosis & Treatment, ed. William W. Hay Jr., et al. Stamford: Appleton & Lange, 1997.

Markel, Howard, and Frank A. Oski. The Practical Pediatrician: The A to Z Guide to Your Child's Health, Behavior, and Safety. New York: W. H. Freeman and Co., 1995.

"Tonsillitis." In Professional Guide to Diseases, ed. Stanley Loeb, et al. Springhouse, PA: Springhouse Corporation, 1991.

Rebecca J. Frey, PhD

KEY TERMS

Abscess—A localized area of tissue destruction and pus formation.

Adenoids—Masses of lymphoid tissue that are found in the upper throat.

Sleep apnea—A condition marked by loud snoring during sleep and periodic episodes of suspended breathing.

Tonsils—Oval masses of lymphoid tissue on each side of the throat.