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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.
Purpose
Tonsillectomy
Tonsils are removed (with or without the adenoids) when the child has any of the following
conditions:
•
obstruction
•
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.