Tonsillectomy and adenotonsillectomy

Tonsillectomy and adenotonsillectomy

A tonsillectomy is an operation to remove the tonsils. An adenotonsillectomy is an operation to remove both the adenoids and tonsils.

Key points to remember

  • your child may need one of these operations if they have snoring, obstructed breathing or, pauses between breathing at night
  • they may also need an operation if they have frequent and severe bouts of tonsillitis, or long-lasting tonsillitis
  • it takes 10 to 14 days for children to recover from the operation
  • don't give your child any aspirin or aspirin-containing medicines

What are tonsils and adenoids?

Tonsils and adenoids are lumps of tissue (similar to the 'glands' that are in the neck and other parts of the body).

The tonsils sit on either side of the back of the throat (pharynx).

Diagram of tonsils

Adenoids sit where the back of the nose meets the throat. You can't see them through the mouth without the use of special instruments.

Tonsils and adenoids are usually larger in children but tend to shrink to adult proportions by the age of 8 to 12 years.

Although tonsils and adenoids are part of the infection-fighting (immune) system, they are not essential and their removal will not cause harm to the infection-fighting system. Other parts of the infection-fighting system in the upper throat continue to function.

What is a tonsillectomy? 

A tonsillectomy is an operation to remove the tonsils.

What is an adenotonsillectomy?

An adenotonsillectomy is an operation to remove both the adenoids and tonsils.

How do I know if tonsils and adenoids are causing problems for my child?

photo showing enlarged tonsils

Big tonsils in child with obstructive sleep apnoea

If tonsils and/or adenoids get too big they can:

  • cause narrowing of the airway during sleep which makes it difficult for your child to breathe
  • cause blockage of the nose resulting in mouth breathing and a nasal sounding voice
  • cause snoring, which can be a sign of obstructive sleep apnoea
  • contribute to repeated throat infections or tonsillitis (swelling and inflammation of the tonsils)
  • cause difficulty eating
  • cause continuing nasal discharge
  • cause an infection of the sinuses (sinusitis) - the sinuses are air-filled hollow spaces in the bone of the cheeks and forehead
  • change the growth of the upper jaw and cause changes in the position of the teeth

Even if they are not too big, infected adenoids can still be a problem. They can contribute to glue ear and/or repeated ear infections. This is due to swelling and redness of the tube between the throat and middle ear (eustachian tube).

When might my child need a tonsillectomy or an adenotonsillectomy?

Your doctor will consider a number of factors when talking with you about whether an operation is necessary.

Obstructed breathing

Your doctor may recommend an operation if your child has obstructed breathing, snoring, restlessness, or short pauses in breathing (apnoeas). See snoring or noisy breathing.

Frequent and severe bouts of tonsillitis

Your doctor may recommend an operation if your child is getting tonsillitis frequently. As a general guideline:

Photo showing Tonsillitis

Tonsillitis - tonsils have yellow, cheesy material on them

  • 7 or more infections in 1 year (and each infection is severe enough to affect normal life such as needing time off school)
  • 5 each year over 2 consecutive years or
  • 3 to 4 each year over 3 or more years

Long-lasting tonsillitis

Your doctor may recommend this operation when there is so much damage to your child's tonsils that they remain infected and do not respond well to antibiotic treatment. They may have a sore throat much of the time, often with bad breath and sometimes yellow, cheesy, bad smelling and bad tasting material in the small cracks in the tonsils.

How successful is the operation?

For sleep-disordered breathing

Studies show that an adenotonsillectomy will cure or improve symptoms of sleep-disordered breathing in 80 to 97 percent of cases. The operation is more successful if there are no other conditions that may be contributing to sleep-disordered breathing (such as obesity). On rare occasions, the adenoids may grow again.

For repeated acute tonsillitis

After removal of the tonsils, tonsillitis should never happen again. Throat infections due to colds and the flu will still happen (see sore throat).

Who will do the operation?

Your family doctor will refer you to a specialist ENT (ear, nose, and throat) surgeon. After talking to you and examining your child, they may recommend removal of the tonsils and/or adenoids.

What happens to my child during the operation?

  • a tonsillectomy or adenotonsillectomy usually takes less than an hour
  • your child will have a general anaesthetic
  • the surgeon will do the operation through your child's mouth
  • there are usually no stitches
  • there will be a small raw patch, like a graze, on each side of your child's throat where the tonsils were - it will take 10 to 14 days to heal

How long will my child need to be in hospital after the operation?

In some centres, your child will be able to go home the same day as their operation. In other centres, your child will stay in hospital overnight. Usually, your child will need to stay in hospital at least 4 hours in hospital after the operation.

Some children with severe obstructive sleep apnoea before the operation may need closer monitoring of their breathing in hospital after the operation. These children may need to stay in hospital longer.

What can my child expect after the operation?

  • a tonsillectomy, with or without removing the adenoids, is a painful and uncomfortable procedure -your child's throat can be sore for 10 to 14 days after the operation
  • 5 to 6 days after the operation, the pain may get worse as the membrane over the grazed area gets smaller 
  • your child may have ear pain for 7 to 10 days following an adenotonsillectomy
  • you will notice white areas over the throat where the tonsils were - this does not mean infection and will go away within the first 2 to 3 weeks after the operation
  • bad breath is common during healing
  • some children's voices can be slightly different after the operation but soon return to normal after 3 or 4 weeks
  • some children experience a change in their sense of taste after the operation but this usually only lasts for a few weeks

After the operation, there can be some bloodstained saliva, discharge from the nose, or bleeding. Sucking ice can help this, but if there is a larger amount of fresh blood (more than 1 to 2 teaspoonfuls), or if the bleeding continues for more than 5 minutes, dial 111 within New Zealand and ask for emergency medical help (use the appropriate emergency number in other countries)

How can I care for my child at home?

Medication

Pain relief is important after the operation. Your doctor or nurse can advise you about what pain relief to use. Giving pain-relieving medication (such as paracetamol) regularly is important for as long as your child needs it.

Make sure you don't give your child any aspirin or aspirin-containing medicines (such as Aspro, AsproClear or Codis). If you are unsure, check the label and see if it mentions the words aspirin or salicylic acids. Aspirin may increase the risk of bleeding during or after the operation and may increase the risk of a serious and rare disease named Reye syndrome.

Please discuss the use of any other medicines or remedies with your doctor during this period.

Many doctors give antibiotics following a tonsillectomy as there is evidence that this speeds the healing process, reduces pain after the operation, and may lessen the chance of bleeding.

Eating and drinking

Encourage your child to eat and drink as normally as possible. They may feel more comfortable having softer foods at first.

Avoid giving your child hot liquids, acidic or highly spiced foods for several days.

Cool fluids and ice blocks are a good option. Fluids are especially important to help your child recover, to prevent dehydration and to prevent the build-up of debris and blood clots at the operation site.

Giving pain relief 30 minutes before eating can help - regular pain relief can help your child drink adequate amounts. Remember, it's important to follow your doctor's advice about pain relief.

Vomiting once or twice after leaving hospital is common. If your child feels sick, stop giving food and fluid for a few hours then try small amounts when they are feeling better. If your child continues to vomit, contact your doctor.

Rest

Children should rest for 5 to 7 days after their operation. They should avoid sports and swimming for 14 days. They can usually return to normal activity after 14 days. Children will usually need 2 weeks off school.

What are the complications?

Bleeding after the operation

  • bleeding from the area where the tonsils have been removed is the most frequent complication - it happens in 2 to 5 percent of children
  • dehydration and too much activity after the operation increase the chances of bleeding
  • usually, the bleeding is mild - only a small number of children have to return to hospital to stop the bleeding or for a blood transfusion
  • bleeding is more common 7 to 14 days after the operation but can happen up to 21 days after the operation
  • it is best to avoid going away in the 3 weeks following the operation in case of bleeding - you should not travel overseas or to a remote area during this period
  • if bleeding does happen, give your child some ice to suck on and cold water to drink - rest their head on a high pillow
  • if there is a large amount of blood (more than 1 to 2 teaspoonfuls), or if the bleeding continues for more than 5 minutes, dial 111 within New Zealand and ask for urgent medical help (use the appropriate emergency number in other countries)

Infection

Infection following an adenotonsillectomy is not common. Increasing pain or fever can be a sign of infection.

When should I seek help?

Dial 111 within New Zealand and ask for urgent medical help (use the appropriate emergency number in other countries) if:

  • bleeding does not stop after 5 minutes of rest, elevation and sucking on ice
  • there is a large amount of blood (more than 1 to 2 teaspoonfuls)

Return to the hospital where your child had the operation, or the nearest hospital emergency department if:

  • your child continues to vomit and cannot take any fluids
  • your child is experiencing pain that is not controlled by the pain relief that was prescribed
  • your child has a fever greater than 38 degrees for longer than 4 hours

Paediatrics and Child Health Division of The Royal Australasian College of Physicians and The Australian Society of Otolaryngology, Head and Neck Surgery. 2008. Indications for tonsillectomy and adenotonsillectomy in children: A joint position paper.
 

Diagram
The diagram of the tonsils has been reproduced with kind permission from Great Ormond Street Hospital for Children NHS Trust. © GOSH Trust 2001.

Photos
Thank you to Dr Murali Mahadevan for providing the photos of enlarged tonsils and tonsillitis from his personal collection.

This page last reviewed 11 June 2014.
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