Date issued: August 2016
For review: August 2018
Ref: A-310/ENT/MC/Adenotonsillectomy for Pharyngeal Obstruction
About this leaflet
Your surgeon has recommended that having your child’s adenoids and tonsils removed may help with their problem, but the decision whether to go ahead is yours entirely. This leaflet gives you some information about the risks and benefits, to help you make an informed decision.
The tonsils are bumps of tissue at the back of the throat. There is one on each side. Tonsils are usually removed because they are a focus of repeated infections, but they may also be removed if they are causing a blockage at the back of the throat that is interfering with eating or breathing. In this situation the adenoids are often removed at the same time. The adenoids are very similar to the tonsils and are found at the back of the nose.
It is not known what our tonsils or adenoids actually do, and people who have had their tonsils and adenoids removed do not seem to suffer any ill effects as a result.
What problems do children have when their tonsils and adenoids are causing a blockage?
When the tonsils and adenoids cause a blockage at the back of the throat, it is usually because they are very large. Children often have large adenoids and tonsils, but they usually shrink as they get older. They only need removal if they are causing problems with breathing and eating.
Children with this problem will often snore quite loudly. In addition, they may stop breathing for short periods throughout the night. Because they don’t sleep well, they may be irritable and badly behaved during the day. They will often be poor eaters, eating little food and taking a long time to do it. They will often be thin and pale as a result.
Why may an operation help?
Removing the adenoids and tonsils will remove the source of the blockage in a child’s throat. They will then sleep and eat better, and this usually means they put on weight and are not so tired and irritable during the day. It is effective in around 9 out of 10 children with these symptoms.
What will happen if I decide that I don’t want my child to have an operation?
As a child grows older it is normal for the tonsils and adenoids to shrink. The blockage at the back of the throat will then subside. This means that children with this problem will usually get better without any treatment.
Are there any alternatives to surgery?
There are no other known effective treatments for throat blockage due to large adenoids and tonsils.
What does the operation involve?
Tonsils and adenoids are always removed under general anaesthetic. This means your child will be asleep throughout the procedure and will not feel anything.
The tonsils and adenoids are removed through the mouth, so there are no external scars
- Traditional adenotonsillectomy
The tonsils sit in the side of the throat like boiled eggs in egg cups. In traditional tonsillectomy the whole egg is removed from the cup. The holes where the tonsils were are not stitched shut, so if you look into your child’s mouth after the operation you will see a grey/white area where the tonsils used to be.
- Coablation intracapsular tonsillectomy
In some cases your surgeon may recommend partially removing the tonsils to reduce the size, rather than complete removal. To use the example above, instead of removing the whole egg from the egg cup, a bit of egg shell and a thin rim of egg white are left behind.
The adenoids are stripped from the back of the nose with a special instrument.
No dressings or bandages are required.
Your child will normally be able to go home late on the day of surgery, or the following morning. You will be given painkillers to take home after the surgery, and it is very important that you give these to your child on a regular basis for the first week.
You must also make sure your child keeps eating and drinking properly after you go home, even though it can be painful to swallow at first.
Children who have had this surgery are not usually followed up. If symptoms persist please contact your GP and they will decide if your child requires further assessment by ENT.
Do I need to keep my child home from school?
We normally recommend that children be kept home from school for 2 weeks to recover fully from the effects of the surgery.
Are there any things my child must not do afterwards?
We recommend that patients avoid other people with coughs and colds during the 2 week recovery period.
Are there any complications?
Most operations are successful, and there are generally very few problems.
However, every operation has risks and these need to be understood before you agree to go ahead with treatment. These risks fall into 3 categories:
Complications of the anaesthetic
Your child’s anaesthetist will discuss the anaesthetic with you before the operation.
Complications that can affect any operation
- Pain: which occurs with every operation. Having your tonsils removed is always painful; the level of pain is similar to that experienced during an attack of tonsillitis. It is usually well-controlled with painkillers. Adenoidectomy is not, by itself, very painful.
- Bleeding: this can occur during or after any operation, and about 1 in 10 patients having their tonsils out will bleed after the operation. Most bleeding tends to occur 5 or 6 days after the operation, and if your child gets any bleeding at all you need to consult a doctor. Usually any bleeding settles quickly by itself, but occasionally a second operation is necessary to stop it. The risk of bleeding from the adenoids is very small.
The risk of bleeding is lower after coablation adenotonsillectomy.
Complications that are specific to adenoidectomy and tonsillectomy
There are no common or serious complications of adenoidectomy and tonsillectomy over and above than those described above.
The risk of symptoms coming back after coablation is 1 in 300 children; this is due to the adenoids and tonsils growing back.
What will happen before my operation?
Two to three weeks before your child’s operation, they will be invited to attend a pre-operative assessment clinic (PAC). This is a clinic run by one of the nurses at the Plym Day Surgery Unit in Derriford Hospital. The purpose of this clinic is to assess your child’s fitness for surgery, to request any necessary tests (e.g. X ray, ECG “heart tracing”, blood tests).
What happens on the day of my child’s operation?
On the day of your surgery, your child will be required to attend Plym Day Case Unit. You will be asked to wait in the admissions area until a bed is ready, when one of the nursing staff will admit your child. Your child’s anaesthetist and a member of the surgical team will also see you to answer any questions and to confirm you still wish to go ahead.
How soon will my child have their operation?
Your child should have their operation within 6 months from going on the waiting list.