A tonsillectomy and adenoidectomy (T&A) is a surgical procedure for children and adults in which the tonsils and adenoids are removed, often at the same time.
Anatomy of the Tonsils and Adenoids
The tonsils are soft tissue masses located in the back of the mouth on both sides of the throat. The tonsils are part of the lymphatic system and help to fight infection. Varying in size, the tonsils are visible through the mouth and often swell with infection. Adenoids are similar to tonsils; however, they are positioned behind the soft palate and cannot be seen by looking through the mouth. Adenoids are made of lymph tissue and also play a role in fighting infections. The main function of the tonsils and the adenoids is to prevent bacteria from reaching further down the throat by producing antibodies that bind to the bacteria.
Indications for Tonsillectomy and Adenoidectomy
The adenoids and tonsils can progressively grow with ongoing infections and inflammation causing a number of problems. When other treatments such as antibiotics fail to treat episodes tonsillitis and adenoiditis the tonsils and/or the adenoids may need to be removed surgically. The following are indications that your child may need a T&A.
- Chronic Tonsillitis: When more than 5 episodes of streptococcal tonsillitis (Strep Throat) occur in a 12 month period or when 3 or more episodes of Strep Throat occur each year for 2 years, surgery should be considered. In severe cases, untreated tonsillitis can spread infection to other organs such as the heart or kidneys.
- Chronic Ear infections: Swelling of the adenoids can block the Eustachian tubes and cause the middle ear to fill with fluid or pus. Repeated ear infections can even lead to hearing loss and speech problems in young children.
- Obstructive sleep apnea, loud snoring and fatigue: These are caused by enlarged adenoids blocking the airways during sleep. Sleep apnea can be a serious condition marked by pauses in breathing.
- Peritonsillar abscess: When infection of the tonsils spreads to the soft tissues it can cause an abscess (puss filled sac) surrounding the tonsil. This is more common in adults than in children.
Coblation® Tonsillectomy and Adenoidectomy
Coblation is an innovative approach to tonsillectomies and adenoidectomies that has many benefits including less pain and faster recovery. Traditional methods for T&A surgery involve the use of cutting or burning to remove the tonsils and adenoids. This can potentially cause pain and extensive damage to the healthy tissue surrounding the tonsils and adenoids. Coblation is a gentle procedure that uses cool-temperature technology. It is now the preferred method for a T&A and results in a better overall experience for patients compared to traditional methods. Coblation technology combines radiofrequency energy with a natural salt solution allowing the surgeon to quickly and safely remove the tonsils and adenoids while leaving the surrounding healthy tissue unaffected. Additional benefits of Coblation T&A include:
- Significant reduction in recovery time
- Fewer post-surgery complications such as bleeding or dehydration
- Less pain and discomfort post surgery
- Shorter surgical procedure (Typically 20 – 30 minutes)
- Faster return to normal diet and regular activity for patients
Tonsillectomy and Adenoidectomy Procedures
Regardless of the surgical method, both a T&A is performed under general anesthesia in a hospital or surgery center. This is typically an outpatient procedure unless other medical conditions require a hospital stay for observation and monitoring. The surgeon can remove both the tonsils and the adenoids through the mouth without making any external incisions. After surgery, the patient is taken to a recovery area and allowed to wake up. Medication is given to reduce pain and swelling. Once the patient is fully awake and doing well, he or she will typically be released to go home. It is important that someone else is available to drive the patient home.
Post Surgery Instructions
Medications: It is extremely important to follow all instructions for medications carefully. The doctor will prescribe an antibiotic before the patient leaves the hospital. Start this the day after surgery and finish the entire prescription. Pain medication will also be prescribed, and this should be taken as directed. Over the counter decongestants can be used to relieve nasal stuffiness. Do not use aspirin or ibuprofen products because they can lead to bleeding. Also avoid herbals such as Ginseng, Gingko or garlic supplements.
Activity: Normal activity may be resumed as tolerated by the patient. Follow the recommendations of the surgeon regarding school, work, and physical activities. Rough play for children should be avoided during the first week. Most patients are able to return to school or work within a week.
Post Surgery Expectations
- A T&A is typically a well-tolerated surgery, but most patients can expect to experience some of the following common side effects.
- A sore throat that typically lasts about a week in children and up to two weeks in adults
- A stiff neck resulting from swelling. If the stiffness gets severe and prevents mobility of the neck, call the doctor immediately
- Difficulty swallowing due to swelling and discomfort
- White scabs that may appear in the back of the throat. These scabs are part of the normal healing process
- A low-grade fever. If the fever is high, however, or associated with rapid breathing while awake, contact the doctor.
- Snoring, mouth breathing and nasal congestion that may last a few weeks.
- A temporary change in voice strength or quality
- Foul smelling breath
- A mild cough
- Ear pain
- Nasal discharge
Post Surgery Diet
Typically, the patient does not need to eat or drink the day of surgery. In general, cold liquids and desserts are tolerated best. No heavy foods or milk should be eaten on the evening of surgery because they could cause vomiting. Starting the day after surgery, the patient can add foods as tolerated. Soups, Jell-O, juices and popsicles are good options. It is extremely important to drink plenty of liquids to prevent dehydration.
Risks and Complications
A T&A is a safe surgery and complications are rare. Possible complications include:
- Allergic reaction: Anesthesia can cause a mild or severe allergic reaction. The anesthesiologist will take precautions to lessen the chances of a reaction.
- Infection: As with all surgeries, infection is a risk. If an infection occurs, medications will be prescribed to treat the infection.
- Bleeding: About 5% of children experience bleeding from the surgery site and may need additional surgery or blood. It is important to check the mouth often in the first few days.
- Voice changes: Changes to the voice may occur, but are usually temporary. In very rare cases these changes may last and treatment may be needed.
- Dehydration: Some children may refuse to swallow liquids due to a sore throat, and this can lead to dehydration. Signs of dehydration are a low-grade fever, dark or very little urine, dry lips, sunken in eyes, and no tears. Call the doctor if you notice any of these symptoms.
- Difficulty breathing: In rare cases, patients may have difficulty breathing due to severe swelling. Seek immediately medical attention if this occurs.
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