TONSILLECTOMY AND ADENOIDECTOMY
Tonsils and adenoids are masses of tissue that are similar to the lymph nodes or “glands” found in the neck, groin, and armpits. Tonsils are the two masses on the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth without special instruments. These two are near the entrance to the breathing passages where they can trap incoming germs, which cause infections. They “sample” bacteria and viruses and can become infected themselves. Scientists believe they work as part of the body’s immune system by filtering germs that attempt to invade the body, and help to develop antibodies to germs.
This happens primarily during the first few years of life, becoming less important after 12 years of age. Children who must have their tonsils and adenoids removed suffer no loss in their resistance. This is due to the fact that surgery removes only the main faucial tonsils and the others like pharyngial, lingual, tubal tonsils are still in place.
What affects tonsils and adenoids?
The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and significant enlargement or obstruction that causes breathing and swallowing problems.
Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen. Tumors are rare, but can grow on the tonsils.
When should one see a doctor?
One should see a doctor when the child suffers the common symptoms of infected or enlarged tonsils or adenoids.
The primary methods used to check tonsils and adenoids are:
- Medical history
- Physical examination
- Throat cultures/Strep tests
- Blood tests
What should I expect at the exam?
The physician will ask about problems of the ear, nose, and throat and examine the head and neck. He or she will use a small mirror or a flexible lighted instrument to see these areas.
Cultures/strep tests are important in diagnosing certain infections in the throat, especially “strep” throat. This test is not available in all centres.
X-rays are sometimes helpful in determining the size and shape of the adenoids. Before assessing adenoids a course of medication is a must and direct examination with a paediatric endoscope is possible in the OPD. Blood tests can determine problems such as mononucleosis.
How are tonsil and adenoid diseases treated?
Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Sometimes, removal of the tonsils and/or adenoids may be recommended. The two primary reasons for tonsil and/or adenoid removal are
- Recurrent infection despite antibiotic therapy. Especially when more than 4 attacks of sore throat with fever per year or 6 attacks of sore throat without fever per year happens and
- Difficulty in breathing or eating due to enlarged tonsils and/or adenoids.
Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness in adults and behavioral problems in children. Some orthodontists believe chronic mouth breathing due to large tonsils and adenoids causes malformations of the face and improper alignment of the teeth.
Chronic infection affects other areas such as the Eustachian tube – the passage between the back of the nose and the inside of the ear. This lead to frequent ear infections and potential hearing loss.
Recent studies indicate adenoidectomy may be a beneficial treatment for some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).
In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids.
In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For them treatment with steroids (e.g., cortisone) is sometimes helpful.
Tonsillitis and its symptoms
Tonsillitis is an infection in one or both tonsils. One sign is enlargement of the tonsils. Other signs or symptoms are:
- Redder than normal tonsils
- A white or yellow coating on the tonsils
- A slight voice change due to swelling
- Sore throat
- Uncomfortable or painful swallowing
- Swollen lymph nodes (glands) in the neck
- Bad breath
Enlarged adenoids and their symptoms
If the child’s adenoids are enlarged, it may be hard to breathe through the nose.Other signs of constant enlargement are:
- Breathing through the mouth instead of the nose most of the time
- Nose sounds “blocked” when the person speaks
- Noisy breathing during the day
- Recurrent ear infections
- Snoring at night
- Breathing stops for a few seconds at night during snoring or loud breathing (sleep apnea)
Support your child
- Talk to the child about his/her feelings and provide strong reassurance and support throughout the process.
- Encourage the idea that the procedure will make him/her healthier. Be with the child as much as possible before and after the surgery.
- Tell him/her to expect a sore throat after surgery.
- Reassure the child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward.
- If the child has a friend who has had this surgery, it may be helpful to talk about it with that friend.
Adults and children
For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye’s syndrome).
- If the patient or patient’s family has had any problems with anesthesia, the surgeon should be informed. If the patient is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the surgeon should be informed.
- A blood test and possibly a urine test may be required prior to surgery.
- Generally, after midnight prior to the operation, nothing (chewing gum, mouthwashes, throat lozenges, toothpaste, and water) may be taken by mouth. Anything in the stomach may be vomited when anesthesia is induced, and this is dangerous.
When the patient arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet the patient and family to review the patient’s history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.
After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient until discharged. Every patient is special, and recovery time vary for each individual. Many patients are kept overnight in the hospital. Adults generally have more discomfort – pain compared with children.
The ENT specialist will provide with the details of pre-operative and postoperative care and answer any questions one has.
There are several postoperative symptoms that may arise. These include (but are not limited to) swallowing problems, vomiting, fever, throat pain, and ear pain. Occasionally, bleeding may occur after surgery. If the patient has any bleeding, The surgeon should be notified immediately.
Any questions or concerns should be discussed openly with surgeons, who are there to assist you.