Tonsillectomy & Adenoidectomy

What are Tonsils?

The tonsils are lymphoid tissue lying on either side of the throat. This tissue is similar to lymph nodes or ‘glands’ found in the neck, groin and other parts of the body. They have a role in immune defence (defence against infection), although like the appendix their role has become less important as humans have evolved. If they are recurrently or chronically infected they become a source of, rather than a defence against, infection.

Why Remove Tonsils?

Recurrent/persistent infection causing sore throat, fever, halitosis and time lost from employment, school or studies.

Quinsy infections where an abscess forms behind the tonsil and needs to be drained. Food debris can get trapped in crypts in the tonsils causing tonsilliths. These can result in halitosis (bad breath) and throat irritation.

Large size causing obstruction to the upper airway during sleep. This can result in snoring or sleep disordered breathing or obstructive sleep apnoea (a problem more common in children). Suspicion of tumour or malignancy (v.rare)

General Points

  • Tonsillectomy is performed under a General Anaesthetic
  • Removal is performed through the mouth
  • Tonsillectomy is usually a day stay procedure
  • Two weeks rest and recuperation is recommended after surgery

What are Adenoids?

The adenoids are tonsil-like tissue in the back of the nose, up behind the roof of the mouth (palate). The Eustachian tube opens into the back of the nose near the adenoids. If adenoids are enlarged or chronically infected they can block this opening and contribute to glue ear or be a source of infection travelling up the Eustachian tube into the middle ear. The result is recurrent ear infections. If enlarged or chronically infected, they can also block the back of the nose leading to nasal obstruction, mouth breathing, chronic nasal discharge, snoring and obstructive sleep apnoea.

They are often large in small children because of the frequency of viral coughs and colds and are commonly also removed with the tonsils (Adenotonsillectomy). As children grow the adenoids tend to shrink and the adenoids seldom require removal in older children and adults.

Why remove adenoids?

Recurrent/persistent infection causing nasal blockage, purulent nasal discharge, sinusitis and snoring.

In combination with tonsillectomy for sleep disordered breathing or obstructive sleep apnoea (more commonly in children).

In combination with grommet insertion to reduce the chance of recurrent glue ear, ear infections and improve eustachian tube function.

In combination with nasal surgery to improve the nasal airway such as in rhinitis/sinusitis.

General Points

  • Adenoidectomy is performed under a General Anaesthetic
  • Removal is performed through the mouth using a curette to scrape the adenoid away or more commonly suction diathermy which reduces bleeding (heat wand that sucks and vapourises the adenoidal tissue away).
  • Adenoidectomy is usually a day stay procedure
  • 5-7 days of rest and recuperation is recommended

Possible Complications after tonsillectomy

Bleeding may occur for up to 2 weeks after the operation (most commonly 5-10 days). Most are brief and settle with bed rest and sucking ice. Up to 5% of patients will experience bleeding severe enough to be readmitted to hospital. If bleeding is more than a cupful or lasts longer than 10 minutes contact your family doctor, specialist, local A&E clinic or Hospital Emergency Department. It is thought that post-operative bleeding is related to infection.

In 1% or less of cases a further operation will be required to control significant bleeding and rarely a blood transfusion may be advised. Occasionally patients may complain of an unpleasant or decreased taste when eating. This usually resolves but may take weeks or rarely months. Vomiting is quite common in the first few hours. If it fails to settle it may require further treatment. Jaw damage which can restrict jaw opening is rare, unless there are pre-existing problems. Please tell your surgeon and anaesthetist if you have problems with your jaw.

There may be a change in the pitch of the voice. This is rarely more than mild and temporary. It is more likely to occur when very bulky tonsils have been removed.

Damage to teeth may occur: please draw attention to caps on the front teeth, or wobbly teeth in children.

Possible Complications after adenoidectomy

Occasionally there can be re-growth of adenoidal tissue after removal (usually when removed at a young age).

Bleeding after adenoidectomy is very unusual now with the surgical techniques used.

Altered speech * mild, usually settles. Very rarely, a congenital weakness of the soft palate may become apparent after adenoidectomy causing ‘cleft palate’ like speech and nasal regurgitation of swallowed fluids.

Damage to teeth may occur (rarely). Please inform surgeon of caps on the front teeth or wobbly teeth in children.

If Suction Diathermy is used, there may be a strong smell coming from your child’s nose. This may last 5 days but is quite normal.

What to expect after Surgery

Unfortunately tonsillectomy is a painful operation. Adequate pain relief is important. A combination of paracetamol, anti-inflammatories, and possibly other medications will be prescribed. Pain usually “peaks” 5-7 days post operatively and it is important to keep taking pain relief regularly for 10 days. Pain is often referred to the ears, which share the same nerves as those which supply the throat.

There are no food restrictions. Adequate fluid intake (2-3 litres/day in adults) is essential (avoid citrus juices as they sting). Encourage chewing to lessen jaw muscle stiffness: chewing gum is helpful.

A yellow layer called slough is normal over the surgical site. It usually seperates around 5-7 days, sometimes with a small amount of blood.

It is normal to feel tired and lethargic after the operation although children seem to bounce back more quickly. Resting and time off work or school are essential to make a good recovery. (1 week for adenoidectomy alone, 2 weeks for tonsillectomy.

Smoking after surgery is strongly discouraged.

Adult supervision is required for 24-48hrs after discharge from the hospital.

Updated January 2015

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