Tonsillectomy / Adenoidectomy

The tonsils are a pair of small masses of lymphatic tissue located at the back of the throat (pharynx). The adenoids are masses of lymph tissue located behind the nasal cavity. Together, the tonsils and adenoids form part of the body’s immune system which helps to fight infection by producing antibodies. A number of different bacteria and viruses can cause infection of the tonsils and adenoids. Inflammation of the tonsils is known as tonsillitis and that of the adenoids is known as adenoiditis.

Tonsillitis is one of the commonest infections of childhood. If yellow spots can be seen on the tonsils during an episode of sore throat, it is likely that the child is suffering from an acute tonsillitis. The treatment is pain relief, with an antibiotic if the pain is severe or the child is unwell. Tonsillectomy is indicated if the child has more that 7 attacks of tonsillitis in a single year, 5 attacks of tonsillitis per year for 2 or more consecutive years or 3 attacks or more per year for 3 or more years. It is not recommended for a child to have surgery under the age of 3 for tonsillitis. Tonsils and adenoids are also taken out if they are large and they cause paediatric sleep apnoea (heavy snoring and disturbed sleep patern). This can lead to sleepiness, behavioural and cognitive problems (http://www.gosh.nhs.uk/medical-information-0/search-medical-conditions/sleep-apnoea).

Technique

Tonsillectomy with or without adenoidectomy is performed under general anaesthesia, which means your child will be put to sleep for the procedure. There are 2 techniques for tonsillectomy; a standard technique and a less painful, gentler technique (subcapsular tonsillectomy). The standard technique (performed in about 80% of kids and almost all adults) involves incisions made inside the mouth, and the infected tonsils and/or adenoids are then removed through the mouth. The tonsil is removed in its entirety, extending down to the muscle of the pharynx. This muscle contains a lot of the sensory nerve endings and blood vessels. The subcapsular technique is a newer technique that leaves approximately 10% of the tonsil tissue behing using a specialised instrument called an powered debrider. This reduces the pain and risk of bleeding post-operatively though increases the risk of regrowth of tonsil tissue. Suitability for each procedure can be discussed with Mr Harney in his rooms. The procedure requires no additional incisions other than where the infected tissues are excised and therefore leaves no visible scars. On completion of the procedure, the child is kept overnight for observation in the hospital for any complications.

Recovery

Recovery from surgery is somewhat variable, but pain settles after 5-14 days post-operatively. Your child will be off school for 2 weeks. If there is any bleeding (typically advised as more than a thumbnail of blood), the child should return to hospital. The GP does not have to be called. The child is to be brought directly to the hospital, letting the ward know on your way in that you are arriving. Any child under 5 is advised to sleep with the parents for the 2 weeks post-operatively in case there is bleeding during the night.

Adenoidectomy

Adenoids are removed in children with sleep apnoea, and symptoms of chronic sinusitis (nasal blockage and coloured nasal discharge), as well as in kids who need a second set of grommets to improve eustachian tube function. They are taken out through the mouth. It is a less painful procedure than tonsillectomy, though the procedures are often done concurrently.