Does my child need a tonsillectomy and adenoidectomy?

Generally, there are two reasons why a child needs a tonsillectomy and adenoidectomy (T&A). The first reason to perform a T&A is due to recurrent tonsil infections that keep recurring after multiple treatments of antibiotics. The second reason to perform a T&A is for upper airway obstruction causing sleep apnea. If the adenoids are too enlarged they can cause trouble smelling and breathing through the nose. If the tonsils are too enlarged the child could have trouble eating and often have to mouth breath. Enlarged tonsils can also cause a child to struggle to breath, even stop breathing for many seconds, while asleep.

How are the tonsils and adenoids removed?

There are many techniques to remove the tonsils and adenoids such as: using a knife, harmonic scapel, electrocautery, laser and coblation. In our practice we use coblation to remove the tonsils and adenoids, which we believe is the most safe and effective. The procedure lasts anywhere form 30 minutes to an hour under general anesthesia. In the past children had to stay overnight, but with newer and safer techniques we perform T&A as and outpatient procedure.

What are the possible complications of having tonsillectomy and adenoidectomy?

1. Anesthesia - this is a chemical in the body not normally there, so a chance for problems is always present.  But, because of their experience and skill, the anesthesiologists and nurse anesthetists have very few problems.  Specific questions can be answered by them.


2. Bleeding - Approximately one in fifty children return to the operating room for bleeding.  The incidence may be higher in adults and may approach one in twenty patients depending upon the surgical technique used. There is usually not too much bleeding during the operation, but there is always a chance of bleeding after your child comes home after the operation. The most common time for a child to bleed after tonsillectomy or adenoidectomy is between 4 to 8 days after surgery. Most children do not have significant bleeding afterwards, but every year a few do. If this occurs, have the child swallow some ice water.  If the bleeding persists, you should bring your child to the Emergency Room for evaluation and inform our office.  Sometimes, the child may have to return to the operating room to control the bleeding. After surgery there will be white patchy scabs in the back of the throat where the tonsils were. This is normal. But, because these scabs are easily removed we stress sticking to a soft diet for two weeks. If the diet is advanced too quickly the scab can be torn off and cause bleeding.
   
   
3. Pain - Having adenoids removed requires 2-3 days of recovery with some pain or discomfort.  After tonsils are removed, it hurts!  It usually takes a week to 10 days for full recovery. Pain medicine and diet instructions are given on the day of surgery.
    
   
4.  Hyper-nasal speech may rarely occur after an adenoidectomy.  This type of speech results from the failure of the soft palate (back part of the roof of the mouth) to close off the nasopharynx (back part of the nose).  This may normally occur during the first four weeks after surgery but prolonged cases may require speech therapy.   If the speech is very poor, corrective surgery may be needed.  This complication usually happens in children who have abnormalities in their soft palate or uvula (piece of hanging tissue in the back of the throat) and occurs in about 1 in 3000 surgeries.  It is extremely rare to occur from a tonsillectomy alone.
   
   
5. Rarely, a small through and through hole may develop in one of the folds in the back of the throat.  This will not cause any problems and does not require treatment.
      
6. Other very rare complications include: Nasopharyngeal stenosis (the back part of the nose scars shut) from an adenoidectomy and tonsillectomy and damage and dislocation of the cervical spine. 
    
   
7. Death:  This is a very rare but devastating complication. The factors, which can cause death, are massive hemorrhage and anesthetic complications such as reaction to the anesthetic or inhaling stomach contents (which is why it is very important not to eat or drink anything after midnight the night before surgery and nothing the morning of). The incidence of death after tonsillectomy is one in every 15,000 patients.

Can my child eat a little something before surgery?

NO!!!!!!!!!!!!!!!!!! It is VERY IMPORTANT on the day of surgery, that your child has an empty stomach.  If anything has been put into the mouth or stomach, because of SAFETY for your child, the surgery must be cancelled. Even chewing gum will cause the cancellation of surgery. DO NOT let your child eat or drink ANYTHING on the day of surgery.  PLEASE tell someone if you think your child has eaten or has drank anything on the day of surgery.  If there is food or liquid in the stomach at the time of surgery, there is a chance your child could choke while asleep. We recommend nothing to eat or drink after midnight the night before surgery or the day of.