Patient education: Tonsillectomy and adenoidectomy in children (The Basics)

What is a tonsillectomy and an adenoidectomy? — A tonsillectomy is surgery to remove the tonsils. These are areas of soft tissue in the back of the throat (figure 1). An adenoidectomy is surgery to remove the adenoids. Adenoids are also areas of soft tissue in the throat. They are located higher up than the tonsils.

Doctors can do just a tonsillectomy, just an adenoidectomy, or both. When the tonsils and adenoids are both removed, it is called an "adenotonsillectomy," or "T and A" for short. The type of surgery depends on the child's symptoms and other factors.

Why might a child need a tonsillectomy or adenoidectomy? — There are a few reasons. The 2 most common are:

●Sleep apnea – Large tonsils and adenoids can keep a child from breathing normally when they sleep. If someone stops breathing for short periods during sleep, doctors call it "sleep apnea." Children with severe sleep apnea can have problems growing and learning. They can also have heart and lung problems if the sleep apnea is not treated.

●Many throat or ear infections – If other treatments do not help, surgery might be an option.

What happens before tonsillectomy or adenoidectomy? — The surgical team will do an exam and tell you how to prepare for the day of surgery.

The team will also ask questions about your child's "health history." This includes any health problems your child has or had in the past, past surgeries, and any medicines they take. Tell them about:

●Any medicines your child takes – This includes any prescription or "over-the-counter" medicines your child uses. It helps to write down and bring a list of any medicines your child takes, or bring a bag with all of the medicines with you.

●Any allergies your child has

●Whether your child has any bleeding problems – For example, tell the team if your child gets frequent or severe nosebleeds or if they had bleeding problems during past surgeries or dental procedures. Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about how to prepare for the day of surgery. This includes:

●Eating and drinking before the procedure – Your child will need to "fast" before surgery. This means not eating or drinking anything for a period of time. The doctor or nurse will tell you when your child should stop eating and drinking.

●Taking medicines – If your child takes any medicines regularly, the doctor or nurse will tell you if they should take their medicines on the day of surgery.

●Reducing anxiety – It's common for children to feel worried or anxious before surgery. When people are very worried or stressed before surgery, it can sometimes make their pain worse after surgery. So, it's helpful to try to reduce your child’s anxiety, if possible. You can do this by staying calm yourself, reassuring your child, and answering any questions they have.

If your child needs to do anything else to prepare, the surgical team will tell you. Ask them if you have questions or if there is anything you do not understand.

What happens during tonsillectomy or adenoidectomy? — When it is time for the procedure:

●Your child might get an "IV," which is a thin tube that goes into a vein. This can be used to give fluids and medicines.

●Your child will get anesthesia medicines. This is to make sure that they do not feel pain during the procedure. Tonsillectomy and adenoidectomy are done under "general anesthesia." This makes the child unconscious so they can't feel, see, or hear anything during the procedure.

●During the procedure, your child might get medicines to help reduce nausea, vomiting, and pain after surgery.

●The staff will monitor your child's breathing, blood pressure, and heart rate during the procedure.

●The surgeon will use special tools to hold your child's mouth open. Then, they will use other tools to remove the tonsils through the mouth. This can be done by cutting or using heat or lasers. They will remove the adenoids, too, if needed. The surgeon will make sure that any bleeding is controlled.

●The surgery usually takes about 30 to 60 minutes.

What happens after tonsillectomy or adenoidectomy? — After the procedure, your child will be taken to a recovery room. The staff will watch them closely as the anesthesia wears off. Many children can go home the same day after a tonsillectomy. But some children need to stay in the hospital overnight.

As your child recovers:

●They might feel groggy or confused for a short time. They might also feel nauseous or vomit. The staff can give medicine to help with this.

●The staff will help your child get out of bed and start moving around when they are ready.

●Your child might have throat pain. If needed, the staff will give medicine to help relieve pain. Sometimes, the pain does not get bad until 1 or 2 days after surgery.

●When your child is ready to eat, they will start with clear liquids. Then, they can start eating as they are able. Offer soft foods that are easy to swallow.

What are the risks of tonsillectomy and adenoidectomy? — Your doctor will talk to you about all of the possible risks and will answer your questions. Possible risks include:

●Bleeding

●Breathing problems

●Infection

●Injury to the mouth or teeth

●Changes in the voice (only if the adenoids are removed)

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand the doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Tonsillectomy and adenoidectomy in children – Discharge instructions (The Basics)
Patient education: Anesthesia (The Basics)
Patient education: Ear tubes (The Basics)
Patient education: Eustachian tube problems (The Basics)
Patient education: Strep throat in children (The Basics)
Patient education: Sleep apnea in children (The Basics)

Patient education: Ear infections (otitis media) in children (Beyond the Basics)
Patient education: Sore throat in children (Beyond the Basics)