Tonsillectomy / Adenoidectomy

Tonsils are lymph nodes found in the back of the mouth. Adenoids are also tonsils but they are higher up, in the back of the nose. Lymph nodes are structures that are part of the immune system and help fight infection.. However, in some people, particularly in children with larger tonsils, these glands can perform less efficiently and can actually cause frequent throat and ear infections or obstruct breathing. In these cases, surgery to remove the tonsils is of benefit Tonsillectomy is performed only if specific indications are seen.

Indications for Tonsillectomy / Adenoidectomy

Tonsillectomy is advisable when tonsillitis attacks are so frequent or severe that they affect a child's general health or interfere with school, hearing, or breathing.

Specifically, the guidelines for surgery are:

1. Five or more episodes of tonsillitis per year in a 1-2 year period
2. Three or more episodes per year over a 3-year period
3. Obstructive sleep apnea (gasping or stopping of breathing during sleep)
4. Suspicion of tonsil tumor
5. Recurrent ear infections (adenoid tonsils)
6. Severe tonsillitis failing antibiotic therapy or causing excessive time off of school or work
7. Halitosis (chronic bad breath not responsive to other therapy)
8. Tonsillar abscess
   

Tonsillectomy / Adenoidectomy Procedure

The classic method of removing tonsils is performed under general anesthesia. Tonsils are "shelled" out of their pockets. Several instruments can be used including cold knife, radiofrequency electrocautery (most common), KTP laser, powered microdebrider (for adenoids) and harmonic scalpel. In addition, tonsils can also be "shrunk" utlizing special radiofrequency instruments. Although experienced and proficient in all of these methods, Dr. Sinha usually prefers radiofrequency electrocautery (Bovie scalpel) or harmonic scalpel for the throat tonsils and cold knife for the adenoid tonsils.

In addition to the risks associated with surgery under general anesthesia, in rare instances, postsurgical bleeding can go unnoticed and cause serious consequences. Frequent swallowing may be a sign of bleeding from tonsils. Other risks include injury to the uvula (soft palate). Breathing may be more nasal or there may actually be reflux of liquid into the nose during drinking. This is usually temporary.

Recovery from Tonsillectomy / Adenoidectomy

Tonsillectomy is usually done on an outpatient basis, with the patient returning home the same day as the surgery. Only rarely are patients observed overnight in the hospital and return home the day after the surgery. The tissue of throat has many sensory nerves and is always moving because of swallowing. Therefore, there is pain associated with the healing period following tonsillectomy. This is usually worse in adults. There is approxiamtely one week of significant pain and difficulty swallowing and usually a second week of mild to moderate pain or swallowing. The use of ice-packs to relieve pain may be used, although sucking on an ice cube or ice cream may provide adequate comfort. In addition, pain-relief medication may be prescribed. During recovery, it is recommended to eat soft, easy-to-swallow food and to drink a lot of cold fluids. The use of humidifier at home can also bring some comfort. Your child may experience alternating "good and "bad days for 2 weeks after surgery. It is a good idea to keep your child away from crowds or ill people for 7 days, since the throat is highly susceptible to infections during this period.

Expected Results from Tonsillectomy / Adenoidectomy

The surgery clears problems immediately in most cases. After surgery, the number of throat infections is reduced but not completely eliminated.