What is a tonsillectomy and adenoidectomy?

Tonsillectomy is surgery to remove the tonsils. Tonsils are 2 Macademia nut-sized masses at the back of the throat.

Adenoidectomy is surgery to remove the adenoids. Adenoids are soft tissue at the back of the throat. They are higher than the tonsils.

Removal of the adenoids and tonsils is the 3^rd most common surgery in children (after circumcision and grommet insertion).

Adeno-tonsillectomy is often thought of, and most often carried out, as a single, combined operation. However, depending on your child’s symptoms and other factors, one or both will be performed.

Why does my child need a tonsillectomy or adenoidectomy?

There are several reasons why your child might need this operation:

1. Trouble breathing
   1. Consistently blocked nose, snoring, breathing through the mouth, waking up frequently at night, daytime sleepiness, bed wetting, perception of choking or inability to inhale and pausing of breathing at night (up to 10 seconds) are common symptoms.
2. Recurrent throat infections.
3. Recurrent tonsillitis unresponsive to antibiotics.
4. Recurrent ear infections despite grommet tube insertion.
5. Recurrent sinus infections unresponsive to medications.
6. Trouble swallowing normally.
7. Bad breath despite treatment with other methods.
8. Growth in the tonsils.

What are the expected benefits of adenoidectomy and tonsillectomy?

When performed in properly selected children, adeno-tonsillectomy can reduce:

1. Throat infections
2. Doctor’s visits
3. Antibiotic use

The aim is to improve:

1. Your child’s quality of life
2. Daytime functioning
3. Ability to sleep well during the night.

What are my options?

We do not suggest surgery for children who are mildly affected.

Most tonsil-related problems in children tend to decline naturally with increasing age, although not predictably. The decision to regarding tonsillectomy in your child is individualized according to the potential benefits and risks of tonsillectomy in comparison with appropriate alternative strategies (e.g, watchful waiting, and continued antibiotic treatment) and the values and preferences of the family and child.

What does the surgery involve?

Before surgery, your child should not eat or drink several hours prior to the operation.

During surgery, the anaesthetist will put your child to sleep; your ENT surgeon will remove the tonsils and/or the adenoids through the mouth. There is no incision or scar on the face or neck.

After surgery, you might go home after a few hours if there’s no complication or stay overnight for any compelling reason.

What are the complications of tonsillectomy or adenoidectomy?

Your child might experience an upset stomach for 1-2 days, throat pain for some days or occasional specks of blood in their saliva.

How can I help my child heal after the surgery?

• Plenty of fluids-provide water; please avoid citrus drinks like orange, pineapple and passion fruit juice.
• Medicine-paracetamol, ibuprofen and diclofenac are the common pain killers your ENT surgeon will prescribe; please give your child regularly.
• Food that is easy to swallow-mashed potatoes, matoke, and yoghurt.
• Avoid scratchy, hard and spicy foods.

Remember, your child is them self the best judge of what they can tolerate, and their wish should be respected.

Disclaimer

The content on the Nairobi ENT website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.

References

1. Baugh, Reginald F., et al. “Clinical practice guideline: tonsillectomy in children.” Otolaryngology–Head and Neck Surgery1_suppl (2011): S1-S30.
2. Kukwa, Wojciech, et al. “Long-term parental satisfaction with adenotonsillectomy: a population study.” Sleep and Breathing4 (2015): 1425-1429.
3. Morad, Anna, et al. “Tonsillectomy versus watchful waiting for recurrent throat infection: a systematic review.” Pediatrics(2017): e20163490.