What are the tonsils and adenoids?
The tonsils are lymphoid structures in the throat, and the adenoid is the same type of tissue but sits at the very back of the nose. Their function is as part of the immune system, but there are other areas of lymphoid tissue in the throat including the lingual tonsil and many small patches in the lining of the throat which take over their function after surgery – removal of the tonsils and adenoid doesn’t cause any long term immune problems.
In children, if tonsillectomy is performed we routinely remove the adenoid as part of the procedure – it is then called adenotonsillectomy.
What are the indications for Tonsillectomy and Adenotonsillectomy?
- Snoring and sleep disturbance – this is the most common reason for adenotonsillectomy in kids, even if they haven’t had any tonsillitis.
- Infections - recurrent tonsillitis or quinsy (abscess above the tonsil).
- Chronic tonsillitis with or without tonsilliths (tonsil stones) - mainly adults.
- Occasionally the tonsils are removed if there is suspicion of cancer.
How is surgery performed?
Surgery is performed through the mouth under general anaesthetic. In many cases this will be a day procedure, but with very small children, if you live more than about 30 minutes away from the hospital, have no-one to pick you up, or there are other reasons for concern we would plan an overnight stay.
What to expect after surgery
Pain is the main issue after surgery and regular pain relief will be required. Regular paracetamol and ibuprofen are used in children and adults. However, adults will often require a stronger medication such as endone or tramadol as well for breakthrough pain – this will be discussed on the day of surgery.
Risks of surgery
Bleeding is the main risk which may occur any time after surgery up until 2-3 weeks postop. The most common time for bleeding is between 5-10 days postop and about 90% of bleeds will occur within the first 10 days with the risk dropping after this – bleeds after 2 weeks are rare, but can occur. Significant bleeding is usually managed in the hospital and occasionally will need another surgical procedure or blood transfusions.
Leakage of fluid with swallowing or air with speaking is very rare, and if it does occur will usually resolve spontaneously over 1-2 months.
There is a small risk of injury to lips, teeth, tongue or jaw joint from the device that holds the mouth open, but the risk of significant injury is extremely low unless there are already problems with the teeth.
Disturbance to the sense of taste is common in the first 2 weeks but usually resolves, very rarely this can persist for 2-3 months or even permanently.