Tonsillectomy and Adenoidectomy

Tonsillectomy and Adenoidectomy is surgery to remove the tonsils adenoids


Having your tonsils removed is a surgical procedure called a tonsillectomy. Reasons you may need to have your tonsils removed include: frequent infections, episodes of tonsillitis, usually 7 or more in 1 year, difficulty breathing or swallowing, sleep apnea, or any growths on the tonsils.

What is Tonsillectomy?

Tonsillectomy with or without adenoidectomy is one of the most commonly performed surgeries in America.  It is also one of the oldest described surgical procedures, with texts dating to 1000 BC detailing the operation.  As one may imagine, indications for surgery and techniques for removal have changed substantially over the last 3000 years.  The tonsils are located in the back of the throat, flanking the uvula, and are essentially lymph nodes.  The adenoids reside in the back of the nose (nasopharynx) and are visible only on endoscopy.  Enlargement of either the adenoids or tonsils can cause airway obstruction in a child, leading to nasal obstruction, recurrent sinusitis, frequent ear infections, and sleep apnea.  One common question concerns whether tonsillectomy has an effect on future immune system development.  Though the tonsils and adenoids are lymphatic structures, thousands of other lymph nodes are distributed throughout the head and neck, such that removal of tonsils and adenoids does not affect the immune system.  Studies have been performed on children who had tonsillectomy and adenoidectomy performed at an early age, comparing them to unoperated patients, and found no difference in immune function.  Indications for tonsillectomy and adenoidectomy include sleep apnea or sleep disordered breathing, recurrent tonsillitis, peritonsillar abscess, and difficulty with speech/swallowing.  Signs and symptoms of sleep apnea in a child include snoring, possible pauses in breathing, unusual movements during sleep, unusual head position/craning, excessive daytime fatigue, and hyperactivity.  Recent studies confirm the link between pediatric sleep apnea and attention deficit hyperactivity disorder (ADHD).  Unlike in adults, sleep apnea in children can cause a daytime activation and difficulty with focus and concentration.

So how are tonsils and adenoids removed?

Though a multitude of methods have been described, most otolaryngologists today use either electrocautery or coblation.   ENTNELA prefers electrocautery for its long track record of minimal bleeding during surgery, low risk of post-operative bleeding, and post-operative pain profile.  The major risk of tonsillectomy is post-operative bleeding.  Numerous studies have looked at the incidence of post-tonsillectomy hemorrhage, and have determined the average rate is 2% (2 out of 100).  Bleeding is most common on days 5-9 after surgery and usually resolves spontaneously.  Rarely, a patient will require a return trip to the operating room.  A soft diet is prescribed after surgery to help prevent bleeding, and any food “with an edge” should be avoided including chips, crackers, pizza, and fried foods for the first two weeks.  Most patients after tonsillectomy are discharged the day of surgery, and pain is managed with liquid oral narcotic therapy.  Children under three years of age are frequently observed overnight.  Pain can be expected for two weeks after surgery, and is most severe the first week.

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