Tonsils and Adenoid

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

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)

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

There are a number of well-established valid reasons for removal – some patients will have more the one reason
The most common reasons to remove the tonsils / adenoids include:
- Snoring in children is a common reason for tonsillectomy and adenoidectomy
- Blockage of the nose and throat – they are too big
- Chronic and recurrent tonsillitis – sore throats
- Tonsil stones – white debris in the tonsils & bad breath
- Unusual enlargement or appearance – as a biopsy for suspected tumour

Sleep disordered breathing in children is often caused by enlargement of the tonsils and adenoids
The child sleeps with the mouth open and the head bent back and snores – often the 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 an indication for surgery in children

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, tonsil stones, 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

After repeated acute infections or low-grade infection, chronic tonsillitis can develop
The tonsils become scarred and trap bacteria, debris and tonsil stones within the crypts
Symptoms persist despite treatment with antibiotics

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

The tonsils and adenoids are usually removed together
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

The recovery period after a tonsillectomy / adenoidectomy is generally smooth and uncomplicated
The following advice will help you plan for a comfortable recovery period

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

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 there will be
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

Bleeding after leaving hospital is rare but may occur up to 10 days after tonsillectomy
Drink plenty of fluid and chew gum to keep the throat moist
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

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

Generally your follow-up will consist of:

A visit at 2 to 3 weeks – you will need to ring the office to make an appointment for that visit
Α final surgical check up at 3 months
You will also need to be reviewed by your local doctor at around 6 weeks

If you are unable to return to Sydney for follow-up, it may be for your follow-up to be undertaken by your local doctor – we would need to confirm these arrangements before you leave hospital