Tonsillectomy and Adenoidectomy

The tonsils and adenoids are organs made of a type of tissue called lymphoid tissue.  These organs in your throat and in the back of the nose in areas called the pharynx, or more specifically, the oropharynx and nasopharynx.  These tissues sample the environment and help the body gain immunity when the nose and throat become infected.  At some point, they can become more of a liability than serving a helpful purpose.  When they become recurrently and chronically infected they can grow crypts, which are grooves and crevices that sometimes make their job less effective.

When recurrently infected, painful or obstructive they may require removal.  This is called a tonsillectomy and adenoidectomy.  But no worries, they are part of a ring of tissue called Waldeyer’s ring.  When they are removed, the ring is still present it is just made smaller and that lymphoid tissue and capability to build immunity is still present.  In fact, there are no major long-term deficits to missing your tonsils and adenoids that we know of.

There are several reasons to remove the tonsils and adenoids including:

  1. Chronic tonsillitis and chronic throat infections.
  2. Chronic ear infections require removal of the adenoids.
  3. Recurrent abscess infections of the tonsils.
  4. Asymmetric tonsils may indicate a growth or neoplasm.
  5. Tonsil calculi or stones can lead to bad breath (halitosis).
  6. PFAPA is a condition of recurrent fever, aphthous ulcers or sores and chronic pharyngitis.
  7. PANDAS is a condition of streptococcal infection that is thought may cause certain children to develop tics or repetitive involuntary physical manifestations.
  8. Obstructive symptoms such as snoring, nasal obstruction or apneas.

When would I need to consider surgery?

When a child or adults has suffered prolonged symptoms as described above, they should consider consultations for surgery.  More specifically, if tonsillitis has occurred more than 7 times in one year or more than 4-5 times per year for several years they should consider tonsillectomy.  With that said, each individual situation will be considered based upon the severity. Certainly if a child is only sick with tonsillitis 4 times in a year but each time resulted in very high fevers leading to seizures or if an adult had to miss several weeks of work, then tonsillectomy may be considered.  To put it another way, when the infections and risks of infections outweigh the risk of tonsillectomy and adenoidectomy, then we will consider removing them.  This is also true of the other indications for surgery listed above.

What happens during surgery?

On the day of surgery, you’ll arrive with an empty stomach.  In fact, there is no eating or drinking after midnight the night before surgery.  In the holding area, nurses and physicians will meet with you or your child to discuss your health and prepare an IV catheter for access to give medicine prior to falling asleep. With the children, we often perform that step in the operating room with them already asleep with laughing gas.  Surgery is typically 30 minutes and is performed under general anesthesia.  Therefore, you cannot wake up during surgery, you are completely asleep.  In fact, a tube is placed in your throat to breath for you and is removed to wake you up.  Using a fine focused cautery under a small amount of water, the tonsils and adenoids are removed.  The area that the tonsils occupied is the injected to make it numb and less painful.  The patient is then woken up and brought to the recovery room.  You’ll likely stay there for 1-2 hours.

What is the recovery like?

To put it gently, it is a bit tough!  Imagine a sore spot on your bottom lip that occurred because you accidentally bit it.  Then imagine the prolonged period of soreness and tenderness that can occur when you have a small sore spot in your mouth or bottom lip.  It can take that little sore spot up to ten days to heal.  With tonsillectomy, the sores are the size of half dollar coins and they last for 30 days.  Fortunately, the pain typically only occurs for the first 10 days.  The patient will be given pain medication to help during the recovery.  Despite this, there is a risk of dehydration or even bleeding in the first 10 days, and you will need to rest at home and miss work or school during the initial recovery.

Often patients will complain of loss of taste or even some areas of numbness in the mouth that make food less exciting.  This can last for several weeks while the nerves regenerate around the tonsils.  As well, to avoid bleeding from a crack in the sores while they are healing, you will need to eat a soft mush-like consistency diet and avoid aspirin products which can cause bleeding.  Most important of all is hydration.  Without excellent hydration, the patient can quickly become dehydrated.  If this occurs you will need to be seen at the emergency room for IV hydration.  All of these details are discussed at length with the surgeon preoperatively.