Tonsils and adenoids are masses of tissue that are similar to the lymph nodes or glands found throughout the body. Tonsils are located on each side of 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. The function of tonsils and adenoids is to catch incoming germs while we breathe. Children who have their tonsils and adenoids removed do not have a greater incidence of infection following surgery.

Obstructive Sleep Apnea
For some children, the tonsils and adenoids become so enlarged that they cause obstructive problems during sleep. Common symptoms include snoring, very restless sleep (tossing and turning), frequent arousals, fatigue or hyperactivity during the day. A common cycle occurs: as the child slips into a deep sleep, the tonsils relax and obstruct the airway. The child’s oxygen saturation decreases, and as a result, his or her brain responds by creating arousal and movement. The child then goes into a light sleep. This cycle continues all night, denying the child the deep sleep (also known as REM sleep) that he or she requires. Some parents will hear pausing or gasping during this cycle. Lack of sleep has been shown to impact negatively on school performance, concentration and behavior.

Recurring infections
Some children are prone to recurrent streptococcal (strep) throat infections, which must be treated with antibiotics. Removing the tonsils will greatly decrease the incidence of strep throat. Children who have recurring sore throats and tonsillitis may also benefit from the surgery for quality-of-life reasons.

Tonsils may also be removed for less common conditions such as enlargement of one of the tonsils, even without obstructive or infectious symptoms; or difficulties with swallowing (known as dysphasia) due to tonsil tissue.

The surgery is performed in the Pediatric Operating Room at Yale-New Haven Children’s Hospital and takes approximately 30-40 minutes. The child will receive an intravenous line (IV) in order to receive medication and fluids during the surgery. Following the operation, the child will go to the pediatric recovery room (PACU or Post-Anesthesia Care Unit). Parents or guardians may be with the child at this time. It is normal for children to be disoriented and upset as they come out of the anesthesia. The child will be ready to go home once he or she is drinking and acting normally, which often takes an hour or two. The will be given two prescriptions: an antibiotic and a pain medicine. Parents or guardians should make sure that the child takes them as directed.

Children under the age of two will be required to stay in the hospital overnight. Children between the ages of two and three may be required to stay in the hospital overnight, however if the child is recovering well, he or she will be able to go home.

As with any surgery, there are some associated risks.

The child will receive general anesthesia for the procedure. There is a very small risk of a complication occurring as the result of anesthesia. However, every precaution is taken to ensure the safety of the child.

There is a very low risk of postoperative bleeding which would require a trip back to the hospital for evaluation. There are two times when the risk for bleeding is greatest: during the first day following the operation and 5-7 days following the surgery as healing scabs on the tonsils fall off. Children who are eating and drinking well will have less of a chance of this happening.

All children experience postoperative pain and discomfort following the surgery. Some of the common complaints following the surgery may include a very sore throat, neck pain, ear pain, fever, night terrors, nausea and extremely bad breath. To lessen discomfort, pain medication will be prescribed. The child may also receive ibupropin, such as Motrin, starting 24 hours after the surgery. An antibiotic will also be prescribed to help lessen the bad breath.

There are no limitations to diet following the surgery. In fact, children who eat and drink well have a quicker, easier recovery. They may eat or drink anything that they want … just as long as they eat and drink. If a child is having postoperative pain, the parent or guardian should ensure that the child is taking pain medicine. This will make it easier for the child to eat.

Narcotics (such as Tylenol and codeine or hydrocodone) are very effective in reducing the pain. However, they do make some children feel nauseous. Once 24 hours have passed after surgery, the child may receive ibupropin such as Motrin. This is very effective in controlling the pain.

There are no limitations to activity. Children will limit themselves. Most children will return to school and other extracurricular activities about one week after surgery. However, they may return sooner if they are feeling up to it.

Physician referral

For a physician referral, click here or call (203) 688-2000 or toll free (888) 700-6543. Visit Connecticut Pediatric Otolaryngology for more information.

Situations that need medical attention

• If a child has any bleeding (from the mouth or nose or vomiting blood), take him or her to the emergency room.
• If a child has not urinated in 24 hours, call your doctor or take the child to the emergency room.
• If a child has a fever greater that 101.5 for more than 48 hours, call your doctor.

Last revised: Jan. 12, 2007 (dh)

Home page URL: http://www.ynhh.org

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.