What are the tonsils?

The tonsils are small, round pieces of tissue that are located in the back of the mouth on the side of the throat. Tonsils are thought to help fight infections by producing antibodies. The tonsils can usually be seen in the throat of your child by using a light.

Tonsillitis occurs when the tonsils become inflamed from infection.

Infections can be bacterial in origin, or viral.

What are adenoids?

Adenoids are similar to the tonsils. The adenoids are made up of lymph tissue and are located in the space above the soft roof of the mouth (nasopharynx) and cannot be seen by looking in your child's nose or throat. They can not be seen by looking in your child's nose or throat with just a light. Adenoids also help to fight infections. Adenoids may cause problems if they become enlarged or infected.

Adenoiditis is when the adenoids become inflamed from infection.

What are the symptoms of tonsillitis?

The symptoms of tonsillitis vary greatly depending on the cause of the infection, and can occur either suddenly or gradually. The following are the most common symptoms of tonsillitis. However, each child may experience symptoms differently. Symptoms may include:

• Sore throat

• Fever (either low-grade or high-grade)

• Headache

• Decrease in appetite

• Not feeling well

• Nausea and vomiting

• Stomach aches

• Painful swallowing

• Visual redness or drainage in the throat

The symptoms of tonsillitis may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

What are the symptoms of adenoiditis, or enlarged adenoids?

The symptoms of adenoiditis vary greatly depending on the cause of the infection, and can occur either suddenly or gradually. The following are the most common symptoms of adenoiditis. However, each child may experience symptoms differently. Symptoms may include:

• Breathing through the mouth

• Noisy breathing

• Snoring

• Nasal speech

• Periods at night when breathing stops for a few seconds

The symptoms of adenoiditis may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

Treatment for tonsillitis and adenoiditis

Specific treatment for tonsillitis and adenoiditis will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history

• Extent of the infection

• Type of infection

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the infection

• Your opinion or preference

Your child's doctor will decide the best treatment for your child. Treatment depends on the cause of the infection, the severity of the infection, and the number of times the child has developed infections. Your child's doctor may order antibiotics to help with the infection.

Some children may be referred to an ear, nose, and throat surgeon to have the tonsils and adenoids removed. This surgery is called a tonsillectomy and adenoidectomy (T&A). Often, the tonsils and adenoids are removed at the same time, but, sometimes, only one is removed. Your child's doctor will discuss this with you.

What are the reasons to have a tonsillectomy and adenoidectomy (T&A)?

The reasons for this surgery are not well-defined, and many surgeons differ in their views. The following are some of the more widely accepted reasons for having a T&A:

• Sleep apnea, or periods at night when your child stops breathing

• Trouble swallowing

• Tumor in the throat or nasal passage

• Bleeding from the tonsils that cannot be stopped

• Significant blockage of the nasal passage and uncomfortable breathing

The following are T&A Guidelines from the American Academy of Otolaryngology:

• Seven throat infections in one year

• Five throat infections in each of two years

• Three throat infections in each of three years

The guideline defines throat infections as having at least one of the following:

• Fever above 101 degrees 

• Discharge on the tonsils

• Swollen lymph nodes in the neck 

• Positive strep throat culture

The following are additional reasons that are more controversial regarding the removal of the adenoids and tonsils:

• Bad snoring

• Recurrent infections or abscesses in the throat

• Recurrent ear infections

• Hearing loss

• Chronic sinusitis, or infection in the sinuses

• Constant mouth breathing

• Frequent colds

• Cough

• Bad breath

The following are some situations that DO NOT require removal of the tonsils, although each child will be evaluated on an individual basis:

• Large tonsils. Some children have large tonsils. The tonsils will decrease in size after the ages of eight  to 12 years. This, in itself, is not a reason to remove the tonsils, in most cases.

• School absence. If your child seems to miss a lot of school due to different symptoms, such as a sore throat, removing the tonsils will not increase school attendance.

• Poor appetite, allergies, or seizures. A T&A will not likely help any of these problems.

What happens during tonsillectomy and adenoidectomy?

The need for tonsillectomy and adenoidectomy (T&A) surgery will be determined by your child's ear, nose, and throat surgeon and discussed with you. Most T & A surgeries are done on an outpatient basis. This means that your child will have surgery and then go home the same day. Some children may be required to stay overnight, such as, but not limited to, children who:

• Are not drinking well after surgery.

• Have other chronic diseases or problems with seizures.

• Have complications after surgery, such as bleeding.

• Are younger than three years of age.

Before the surgery, you will meet with different members of the healthcare team who are going to be involved with your child's care. These may include:

• Day surgery nurses. Nurses who prepare your child for surgery. Operating room nurses assist the doctors during surgery. Recovery room (also called the Post Anesthesia Care Unit) nurses care for your child as he or she emerges from general anesthesia.

• Surgeon. A doctor who specializes in surgery of the ear, nose, and throat.

• Anesthesiologist. A doctor with specialized training in anesthesia. He or she will complete a medical history and physical examination and formulate a plan of anesthesia for your child. The plan will be discussed with you and your questions will be answered. This surgery requires a general anesthesia.

During the surgery, your child will be anesthetized in the operating room. Although the parents/guardians are not allowed to join the child for the surgery, they are allowed to be with the child in the preoperative area. The surgeon will remove your child's tonsils and adenoids through the mouth. There will be no cuts visible on the skin.

In most cases, after the surgery, your child will go to a recovery room where he or she can be monitored closely. After your child is fully awake and doing well, the recovery room nurse will bring the child back to the day surgery area.

At this point, if everything is going well, you and your child will be able to go home. If your child is going to stay the night in the hospital, the child will be brought from the recovery room to his or her room. Usually, the parents are in the room to meet the child. It is worth noting that only one caregiver may stay in the room with the patient overnight.

Bleeding is a complication of this surgery and should be addressed immediately by the surgeon. If the bleeding is severe, the child may return to the operating room.

At home after a T&A

The following are some of the instructions that may be given to you to help care for your child:

• Increased fluid intake- a recommendation for fluid intake will be made based on the child’s weight
• Pain medication, as prescribed - note: it is no longer recommended to use narcotics for post operative pain in children less than 12 years old for tonsillectomy recovery
• No heavy or rough play for a duration of time recommended by the surgeon
• No travel for the first two weeks after surgery in case any complications arise

What are the risks of having a T&A?

Any type of surgery poses a risk to a child. A small percentage of children begin bleeding from the surgery site about five to eight days after the surgery, and may require additional blood and/or surgery. Some children may have a change in the sound of their speech due to the surgery. The following are some of the other complications that may occur:

• Bleeding (may happen during surgery, immediately after surgery, or at home)

• Dehydration (due to decreased fluid intake; if severe, fluids through an intravenous, or IV, catheter in the hospital may be necessary)

• Fever

• Difficulty breathing (swelling of the area around the surgery; may be life-threatening if not treated immediately)

Note: You should contact the surgeon’s office immediately if any of the above occur

Follow up after tonsillectomy/adenoidectomy

Although there is no specified follow up recommended in the office after surgery, your provider is available for follow up should concerns persist after surgery.

Other helpful information

If your primary care provider suggests an evaluation with an ear, nose, and throat specialist for recurrent tonsillitis or adenoiditis, you can have your child evaluated on telemedicine with one of our providers. It eliminates the need to come into the office, and still provides a way for you to have your child evaluated by one of our specialists. The office may ask that you take a picture of the tonsils before the visit to upload into the chart. If interested in this option, you can inquire about it at the time you schedule your visit. Much information can be gathered during a telemedicine visit, and a clinical plan can be made all while you stay in the comfort of your own home.