At what point would my child benefit from a tonsillectomy and adenoidectomy?

Surgical removal of the tonsils and adenoids in children is performed for two primary reasons: recurrent tonsil/adenoid infections and snoring with associated sleep apnea.

Tonsil infections: As a general guideline, a tonsillectomy is recommended in patients with seven or more tonsil infections in one year, five infections a year for two years, or three infections for three or more years.

Sleep apnea: Enlargement of tonsil and adenoid tissue in children can obstruct airways during sleep. Children with sleep apnea typically are mouth breathers who snore loudly and can be heard to stop breathing or make gasping noises during sleep. Sleep apnea results in fragmented sleep that can lead to daytime fatigue or hyperactivity, failure to thrive, difficulties in concentrating, and occasional problems with bedwetting.

Surgical procedure: Tonsils and adenoids are removed through the mouth with no external scars. In most children, this is outpatient surgery.

CHRONIC ADENTONSILLITIS AND COBLATION ASSISTED (ADENO)TONSILLECTOMY (CAT)

Management of chronic adenotonsillitis or tonsillitis can involve both medical and surgical options. Medically, oral rinsing, water pick, and gargling with salt water or other cleansers can improve symptoms. Long term antibiotic use has shown in some patients to reduce the size and symptoms of tonsillitis. Unfortunately, length of treatment is not well established. Antibiotic resistance is also a serious problem with long term use. Stomach acid reflux and post nasal sinus drainage are other relatively common afflictions that can occasionally complicate a chronic sore throat or pharyngitis.

When patients are clinically disabled enough by recurrent sore throat and “strep tonsillitis,” surgery may be helpful. Typically, a patient will have several infections and may miss several days of school or work The patient may have difficulty with swallowing, may have choking or gagging, and at times, a peritonsillar abscess. Airway compromise, sleep disordered breathing, restless sleep, and obstructive sleep apnea are currently more common reasons to consider tonsillectomy and adenoidectomy than simple infections. Left untreated, obstructive sleep apnea can be a dangerous disease.

Tonsillectomy/adenoidectomy can be done with traditional sharp cutting for removal, and burning (cautery) to control bleeding. This is traditionally a very painful operation. I have been using a newer technique called COBLATION ASSISTED TONSILLECTOMY (CAT) for the last several years. In fact, I have used this technique longer than essentially all other surgeons in Minnesota. CAT employs radiofrequency to “coblate” or disintegrate the tonsil and adenoid tissue. This is a safer and cleaner operation. Blood loss tends to minimal (occasionally absent!) and pain in the recovery period is often greatly reduced compared to traditional tonsillectomy. Tonsillectomy/adenoidectomy is generally straightforward, often taking only 10 to 15 minutes.

There are some risks to the surgery. General intubation through the vocal cords to control the airway is necessary. A general anesthesia is used. Complications of anesthesia are very rare but can include death, airway obstruction, allergic reactions, and others. Bleeding after surgery is rare. Immediate postoperative bleeding may necessitate returning to the operating room. Bleeding can occur anytime within the first 2 weeks when the scabs come off. The risk is about 1 to 2 percent. Occasionally, very mild bleeding will resolve with inactivity and observation. Avoid aspirin, herbals, and other blood thinners for 10 days prior to and several days after surgery. Ear pain is very common after tonsillectomy. This is a referred pain, not an ear infection. It is treated with analgesics or narcotics. After one week, yawning may be the most traumatic part of the day. Voice change and increased resonance is possible. Rarely, liquids will come out of the nose and the voice will sound very “nasal” (especially after adenoidectomy in small children). This usually resolves on its own. Speech therapy and surgery are rarely needed to correct these problems. Infections after surgery are possible. A slight fever and fatigue are common for 1 to 2 weeks. Generally, antibiotics are not indicated.

Activity should be limited and a soft diet should be employed for 2 weeks after surgery. This includes ice cream, popsicles, pudding, and other soft food. Avoid very spicy or scratchy foods like toast, chips, or popcorn. Also avoid using a straw. After two weeks, most symptoms resolve and any diet or activity restrictions are lifted. Follow up is usually after 2 weeks.

In the case of emergency, the patient should go straight to his or her local emergency department. Call my office anytime during working hours at 320 231-3277 or Rice Hospital ER at 320 231-4560 to contact me.