Children’s tonsil and adenoid removal – the tonsils
Tonsil and adenoid removal is one of the most frequently needed children’s operations.
The tonsils are two clumps of tissue, on either side of the throat, embedded in a pocket at the side of the palate (roof of the mouth). The lower edge of each tonsil is beside the tongue – way in the back of the throat.
Each tonsil has pits on its surface (crypts) that go into the tonsil. During eating and drinking the tonsils are pushed together by the throat muscles and small particles of food may lodge in the tonsil crypts – potentially leading to infection.
Children’s tonsil and adenoid removal – the adenoid
The adenoids are a single clump of tissue in the back of the nose (nasopharynx).
They are located on the back wall of the throat (pharynx) about two centimetres above the uvula (the little teardrop shaped piece of tissue that hangs down in the middle of the soft palate).
Tonsil and adenoid anatomy
What function do the tonsils and adenoids serve – aren’t they important?
What are the tonsils and adenoid
The tonsils and the adenoids are mostly composed of lymphoid tissue, which is found thoughout the gastointestinal tract and on the base of the tongue.
Lymphoid tissue is composed of lymphocytes which are mostly involved in antibody production – since we generally consider antibody production to be a good thing, many studies have been performed to try to clarify the importance of the tonsils, and there seems to be no adverse effect on the immune status or health of patients who have had them removed.
Any noticable effect has generally been positive and it appears that the tonsils and adenoids do not effectively handle the huge number of viral infections that occur in children in an urban population – the immune system, including the tonsils and adenoids, developed during a era where the child was rarely exposed to a large number of other people and the germs they carried.
It may also be that the tonsils and adenoids are relatively more important in dealing with certain types of infections, such as worms or other parasites that are relatively uncommon in today’s society.
It is clear that the immune system may improve after diseased tonsils and adenoids are removed.
Why are the tonsils / adenoids removed?
Reasons why tonsil and adenoid removal are needed
Tonsillectomy – there are a number of well-established valid reasons for tonsil and adenoid removal – some patients will have more the one reason.
The most common reasons to remove the tonsils / adenoids include:
- Snoring in Children
- Blockage of the nose and throat – they are too big
- Chronic and recurrent tonsillitis – sore throats
- White debris in the tonsils – tonsil stones & bad breath
- Unusual enlargement or appearance – as a biopsy for suspected tumour
Snoring in children
Sleep disordered breathing in children is often caused by enlargement of the tonsils and adenoids. Children sleep with the mouth open and the head bent back and snores – often a child’s breathing has stops or pauses followed by snorting.
Other symptoms include bedwetting, slow growth, headache, irritability, poor concentration and misbehaviour.
Big tonsils can also cause difficulty with eating and drinking in children. Sleep disordered breathing caused by enlargement of the tonsils and adenoids is a common indication for surgery.
Tonsil infection – tonsillitis
Tonsillitis is an inflammation of the tonsils caused by infection and the adenoids are often infected at the same time.
Viruses are the commonest cause of tonsillitis but often bacteria are also involved – it is may not be possible to tell the difference between viral and bacterial tonsillitis.
Symptoms of tonsillitis include a sore throat, difficulty with eating and drinking and loss of appetite, bad breath, fever, swollen neck glands, and generally feeling irritable and unwell.
During episodes of tonsillitis the tonsils will become swollen and red often with debris on the surface.
Most people get tonsillitis at some time – it is common for children to get repeated episodes of tonsillitis with associated tonsil thickening and scarring.
Chronic tonsillitis
After repeated acute infections or low-grade infection, chronic tonsillitis can develop. The tonsils become scarred and trap bacteria and debris within the crypts. In this situation symptoms persist despite treatment with antibiotics.
Glandular fever
Tonsillitis due to glandular fever often occurs in teenagers and can be severe with huge tonsil and adenoid swelling. The neck glands are also swollen. Partial blockage of the throat can develop leading to problems breathing, eating and drinking.
Quinsy throat
Quinsy is a severe throat infection (abscess) between the tonsil and the tonsil socket which requires urgent attention by an ENT specialist. Progressively worsening unilateral sore throat and pain during swallowing usually are the earliest symptoms.
As the abscess develops, symptoms include persistent pain in the tonsil area, fever, headache and a “hot potato voice”. Neck pain associated with tender, swollen lymph nodes, referred ear pain and halitosis are also common.
A quinsy should be specifically considered if there is limited ability to open the mouth (trismus). For more information about quinsy throat infection click here.
Tonsil stones
Tonsil stones, also known as tonsilloliths, are clusters of calcified material that forms in the crevasses of the tonsils. Tonsil stones are a common cause of bad breath (halitosis).
Tonsil removal (tonsillectomy) may be needed to cure bad breath due to tonsil stones. For more information about tonsil stones click here.
Surgical removal of the tonsils and adenoids
Adenotonsillectomy
The tonsils and adenoids are usually removed together – called adenotonsillectomy or tonsil and adenoid removal. Tonsillectomy and adenoidectomy are performed through the mouth. The tonsils are removed from their sockets and in most cases can be removed with very little bleeding.
Adenoidectomy without tonsillectomy can be performed when the adenoids are enlarged and blocking the nose and tonsils are not causing symptoms. Adenoidectomy may also be needed in the treatment of children with persistent ear infections or sinus problems.
After tonsillectomy
The recovery period after a tonsillectomy / adenoidectomy is generally smooth and uncomplicated. The following advice will help you plan for a comfortable recovery period.
Normal findings
A white or yellow membrane will form on the throat where the tonsils were removed – this is normal healing tissue and will clear after 5 to 10 days.
Mouth care
- Brush your teeth at least 3 times per day
- Gargle with salt water and drink water as much as possible
- Chew gum as this creates saliva and helps with the healing process
Tonsillectomy recovery diet
Knowing what to eat after tonsil and adenoid surgery is a key part of recovery care. It is very important to re-establish eating and drinking as soon as possible – the longer the delay before eating and drinking – the more discomfort that will usually be experienced.
Tips for a fast recovery after tonsillectomy
- Drink plenty of fluid and chew gum to keep the throat moist.
- Fluids are essential – start with ice chips, sips of water or your favourite juice drink, and progress to at least a 250mL glass of drink
- Cold liquids, non-acidic juices, ice cream and ice blocks are tolerated better in the first 24-hours after tonsillectomy
- Progress to soft foods gradually
- Avoid acid foods and juices, salty and fried foods and very hot food and drinks for two weeks
- Click here for more information about what to eat after a tonsillectomy and adenoidectomy.
Bleeding
Bleeding after leaving hospital is uncommon and usually occurs in around 2% of all patients. If bleeding is going to occur it would usually be within the first 10-11 days after surgery. Persistent spitting or vomiting blood is abnormal – notify you doctor. If you experience bleeding go straight to your nearest Emergency Department. Gargling with cold water or with 1% hydrogen peroxide may help bring bleeding under control.
Pain
A sore throat after tonsillectomy is common and will limit chewing – you may also experience referred ear pain. It is not unusual for your throat to become more painful on the 4th or 5th day after the operation. A good pain relief is to eat or drink and chew more – cooler foods may be soothing, for example, cold drinks and ice cream – chewing gum is also soothing.
Take pain medication as prescribed every 4 to 6 hours as needed – Do not take aspirin, aspirin products or NSAIDs like Nurofen for pain relief as this may increase the risk of bleeding.
Eating and drinking will be easier around 30 minutes after taking pain medication.
Activity
- Rest with limited activity at home for 24 – 48 hours after tonsillectomy.
- Avoid lifting, straining or strenuous exercise for 2 weeks to prevent bleeding.
Follow-up
Generally your follow-up will consist of:
- A visit six weeks after surgery – you will need to ring the office to make an appointment.
- Review by your local doctor as needed.