What Parents Should Know About Tonsillectomy and Adenoidectomy
Tonsil and adenoid surgeries are the most common surgical procedures performed on children in the United States. That’s been true for about the last 20 years, says Vikash K Modi, MD, Chief of Pediatric Otolaryngology - Head and Neck Surgery at Weill Cornell Medicine. Dr. Modi, also Associate Professor of Otolaryngology in Pediatrics at Weill Cornell Medical College, reports that about 75 percent of his practice comprises pediatric tonsil and adenoid surgery.
Here Dr. Modi explains when tonsil and adenoid surgery are necessary, and what families need to know about the procedures.
Tonsil and adenoid response to infections
Tonsils are located on both sides of the back of the throat, and adenoids are located in the back of the nose.
“Often, in response to infection, or for other reasons, the tonsils will enlarge, and you can see them as two large balls of tissue on either side of the throat,” Dr. Modi explains.
Adenoid tissue may enlarge in response to respiratory tract infections, allergies, or sometimes for unknown reasons.
Common reasons for tonsil and adenoid surgeries
There are two common reasons for tonsil and adenoid surgery: infection and upper airway obstruction.
Frequent throat infection—most commonly, strep throat—is an indication for tonsillectomy when a child has had seven or more episodes in one year, five episodes in two successive years, or three episodes in three successive years.
Physicians may recommend a partial or total tonsillectomy when the tonsils and/or adenoids become enlarged and obstruct the airway.
“Parents should watch for disruptive sleep patterns, such as frequent waking at night that occurs with snoring, or apnea [a cessation of breathing],” Dr. Modi says. “Sometimes parents hear loud, irregular snoring at night, or notice their child is wetting the bed or mouth-breathing.”
Enlarged adenoids may cause chronic earaches and ear infections, with or without middle ear fluid.
“Adenoid tissue is near the opening of the eustachian tube, which ventilates the middle ear space,” Dr. Modi says. “Large adenoids can block the eustachian tube opening, leading to fluid build-up, ear infections, and hearing loss.”
A doctor may recommend an adenoidectomy for a child who experiences long-term or recurrent sinus or nasal infections despite adequate medical treatment he adds.
When parents notice that their child is more tired than usual or is taking daytime naps, it can be a sign of possible disrupted sleep and/or sleep apnea.
“Apnea can affect a child's growth and development,” Dr. Modi says. “Disrupted sleep and/or sleep apnea also has been closely correlated with learning disabilities, such as ADHD. Long-term sleep apnea can lead to cardiopulmonary issues.”
Surgical options can include tonsil reduction (shaving) or removal.
If a child suffers from sleep apnea or obstruction, surgeons would typically perform a partial tonsillectomy with an adenoidectomy. When the major challenge is chronic throat infections, they’d be more likely to perform a total tonsillectomy, Dr. Modi says.
It’s important to prepare a child for these procedures
Sometimes children may be given a sedative before surgery, and anesthesia is administered with a mask. Both may surprise children, so Dr. Modi advises parents to prepare their child for surgery.
Parents are allowed to be with children in the operating room until the child is asleep, and in the recovery room when the child wakes up.
“There are several books that you and your child can read together that would help to prepare for the experience,” Dr. Modi adds. “One example is Curious George Goes to the Hospital, by M & H Rey.”
Tonsillectomies and adenoidectomies are usually outpatient procedures
Sometimes, Dr. Modi explains, a child may stay in the hospital overnight.
Both procedures—which require general anesthesia—are brief. An adenoidectomy usually takes 30 to 40 minutes, and the surgeries performed together usually take between 45 and 60 minutes.
“After a tonsillectomy, children may experience some pain and bleeding,” Dr. Modi says. Bleeding is less frequent with a partial tonsillectomy, and usually occurs closer to the time of the procedure, or about a week later, when a scab falls off the surgical site.
With a partial tonsillectomy, a child may complain of a mild sore throat for two to three days after surgery. Dr. Modi says over-the-counter medications usually bring relief.
Recovering from surgery
Some children feel better in just a few days, and some take as many as 14 days to recover.
“During the recovery period, make sure your child stays well hydrated,” Dr. Modi says, and suggests avoiding carbonated drinks, and acidic drinks (like orange juice).
A soft diet where chewing is necessary also is important: chewing and swallowing relieve pain and promote healing.
Parents may notice a high-pitched or squeaky change in the child’s voice—it’s usually temporary, but may last for six to eight weeks.
Children who undergo a partial tonsillectomy usually return to school when they feel ready, usually in three to five days.
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