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Tonsil and Adenoid Surgery

WHAT ARE TONSILS AND ADENOIDS?

The tonsils are two clusters of tissue located on both sides of the back of the throat. Adenoids sit high in the throat behind the nose and the roof of the mouth. They are the body’s first line of defense as part of the immune system. They sample bacteria and viruses that enter the body through the mouth or nose, but they sometimes become infected. At times, they become more of a liability than an asset and may even cause airway obstruction or repeated bacterial infections. The two most common problems affecting the tonsils and adenoids are recurrent infections of the nose and throat, and significant enlargement that cause nasal obstruction and/or breathing, swallowing, and sleep problems.

Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling white deposits can also affect the tonsils and adenoids, making them sore and swollen. Your ear, nose, and throat (ENT) specialist can suggest the best treatment options.

Tonsils and adenoids are often removed when they become enlarged and block the upper airway, leading to breathing difficulty. They are also removed when recurrence of tonsil infections or sore throat cannot be successfully treated by antibiotics. The surgery is most often performed on children.

The procedure to remove the tonsils is called a tonsillectomy; excision of the adenoids is an adenoidectomy. Both procedures are often performed at the same time; hence the surgery is known as a tonsillectomy and adenoidectomy, or T&A.

T&A is an outpatient surgical procedure lasting between 30 and 45 minutes and performed under general anesthesia. Normally, the young patient will remain at the hospital or clinic for several hours after surgery for observation. Children with severe obstructive sleep apnea and very young children are usually admitted overnight to the hospital for close monitoring of respiratory status. An overnight stay may also be required if there are complications such as excessive bleeding, severe vomiting, or low oxygen saturation.

VARIOUS TECHNIQUES

    1. COLD DISSECTION METHOD
      ADVANTAGE: Cost affective
      DISADVANTAGE:Painful, Chances of bleeding
    2. CO2 LASER
      ADVANTAGE: Almost blood less surgery
      DISADVANTAGE: Costly, painful (may be severe)
    3. HARMONIC SCALPEL
      ADVANTAGE: Blood less surgery, Minimal pain (as tissue cutting at low temperature), Early recovery
      DISADVANTAGE: Costly
    4. COBLATION
      ADVANTAGE: Blood less surgery, Least painful (as tissue cutting is at further lower temperature), Early recovery
      DISADVANTAGE: Costly

    1. CURREATTAGE (CONVENTIONAL)
      ADVANTAGE: Cost effective
      DISADVANTAGE: Blind procedure, Bleeding, injury to Eustachian tube, cervical injury, chances of recurrence
    2. POWERED ADENOIDECTOMY (MICRODEBRIDDER)
      ADVANTAGE: Under vision removal, almost complete removal, no injury to Eustachian tube and cervical spine, low recurrence rates.
      DISADVANTAGES: Bleeding, Costly.
    3. COBLATION ADENOIDECTOMY
      ADVANTAGE: Blood less surgery, Under vision complete removal, no injury to Eustachian tube and cervical spine, No recurrences.
      DISADVANTAGES: Costly.

WHEN THE TONSILLECTOMY PATIENT COMES HOME

Most patients take seven to ten days to recover from the surgery. Some may recover more quickly; others can take up to two weeks for a full recovery. The following guidelines are recommended:
Drinking: The most important requirement for recovery is for the patient to drink plenty of fluids.Starting immediately after surgery, children may have fluids such as water or apple juice. Some patients experience nausea and vomiting after the surgery. This usually occurs within the first 24 hours and resolves on its own after the effects of anesthesia wear off. Contact your physician if there are signs of dehydration (urination less than 2-3 times a day or crying without tears).
Eating: Generally, there are no food restrictions after surgery, but some physicians will recommend a soft diet during the recovery period. The sooner the child eats and chews, the quicker the recovery. Tonsillectomy patients may be reluctant to eat because of throat pain; consequently, some weight loss may occur, which is gained back after a normal diet is resumed.
Fever: A low-grade fever may be observed the night of the surgery and for a day or two afterward. Contact your physician if the fever is greater than 102º.
Activity: Activity may be increased slowly, with a return to school after normal eating and drinking resumes, pain medication is no longer required, and the child sleeps through the night. Travel on airplanes or far away from a medical facility is not recommended for two weeks following surgery.
Breathing: The parent may notice snoring and mouth breathing due to swelling in the throat. Breathing should return to normal when swelling subsides, 10-14 days after surgery.
Scabs: A scab will form where the tonsils and adenoids were removed. These scabs are thick, white, and cause bad breath. This is normal. Most scabs fall off in small pieces five to ten days after surgery.
Bleeding: With the exception of small specks of blood from the nose or in the saliva, bright red blood should not be seen. If such bleeding occurs, contact your physician immediately or take your child to the emergency room.
Pain: Nearly all children undergoing a tonsillectomy/adenoidectomy will have mild to severe pain in the throat after surgery. Some may complain of an earache (so called referred pain) and a few may have pain in the jaw and neck.
Pain control: Your surgeon will prescribe pain medication for the young patient such as acetaminophen, ibuprofen acetaminophen with codeine, or acetaminophen with hydrocodone. The pain medication will be in a liquid form or sometimes a rectal suppository will be recommended. Pain medication should be given as prescribed. Contact your physician if side effects are suspected or if pain is not well-controlled. If you are troubled about any phase of your child’s recovery, contact your surgeon immediately.