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Tonsils and Adenoids

The tonsils are located in the back of the throat. Although the tonsils have a role in helping treat infection, the tonsils can contribute to infections as well. When this happens, removal of the tonsils can improve your child’s health. Removal of the tonsils has not led to an increase in infections or a loss of immune (disease-fighting) function due to hundreds of other lymph nodes in the head and neck that perform the same function.

Tonsillitis is an infection of the tonsils and usually involves the back of the throat as well (pharyngitis). This infection is uncommon in children less than one-year-old. It is seen most frequently in children four to seven years of age, and continues less frequently throughout late childhood and adult life.

In most cases, viruses are the most common cause of tonsillitis. The second most common cause is a bacteria known as Streptococcus, otherwise known as “strep throat”. Other bacteria can cause tonsillitis, but much less frequently. Occasionally an abscess or collection of pus may develop around the tonsils and needs to be drained.

Tonsillitis can become difficult to treat and become chronic, or recur frequently. This can result in fatigue, poor weight gain and poor school attendance among other things.

The tonsils can become so enlarged (tonsillar hypertrophy) that your child may have difficulty breathing (especially at night) or difficulty swallowing. Enlarged tonsils and adenoids combined with snoring and possible sleep apnea, where breathing repeatedly stops and starts, have become the most common reason to undergo removal. You should call your physician if your child is experiencing any of these symptoms.

Adenoids and Adenoiditis

Adenoid tissue is a lump of tissue at the back of the nose above the tonsils. In order to see them, your physician can look at the adenoid tissue by placing a fiber optic camera in the nose.

The adenoid is basically a lymph node. A lymph node contains lymphocytes, which are cells that help to fight infection. The adenoid is a part of a group of lymph nodes that include the tonsils, found around the back of the throat. Together, they act to help process infections in the nose and throat.

In most children, the adenoid enlarges normally during early childhood, when infections of the nose and throat are most common. They usually shrink as the child gets older and disappear by puberty. However, in some children, the adenoid continues to become larger and block the passage behind the nose. This can result in snoring, breathing through the mouth, and/or a hyponasal sound to the speech. Additionally, this can result in middle ear infections (otitis media) because of blockage of the tube that connects the ear to the throat, called the eustachian tube.

How to Prepare for Tonsil and or Adenoid Surgery

Children:

• Encourage the idea that the procedure will make him/her healthier.
• Be with your child as much as possible before and after the surgery.
• Tell him/her to expect a sore throat after surgery, and that medicines will be used to help with some of the soreness.
• Reassure your child that the operation does not remove any important parts of the body, and that he/she will not look any different afterward.
• It may be helpful to talk about the surgery with a friend who has had a tonsillectomy or adenoidectomy.
• Your otolaryngologist can answer questions about the surgical procedure.

Adults and children:

• For at least two weeks before any surgery, refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye’s syndrome). Your doctor may ask to you to stop taking other medications that may interfere with clotting.
• Tell your surgeon if the patient or patient’s family has had any problems with anesthesia, clotting of blood, or any other pertinent medical conditions.
• A blood test may be required prior to surgery.
• A visit to the primary care doctor may be needed to make sure the patient is in good health for surgery.
• You will be given specific instructions on when to stop eating food and drinking liquids before surgery. These instructions are extremely important, as anything in the stomach may be vomited when anesthesia is induced.
•  When the patient arrives at the hospital or surgery center, the anesthesiologist and nursing staff may meet with the patient and family to review the patient’s history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.
•  After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient closely until discharge. Every patient is unique, and recovery time may vary.
• Your surgeon and the team at Michigan ENT & Allergy Specialists will provide you with the details of preoperative and postoperative care and answer your questions.