Feature: Tonsils & Adenoids

Tonsils and adenoids are part of a “ring” of glandular/lymphoid tissue encircling the back of the throat. Tonsils are visible at the back of the mouth, one on each side. The adenoid is found high in the throat, right behind the nose and needs special instruments in order to see it. Figure 1 & 2 show the anatomical sites of tonsils and adenoids.

They act as “policemen” and help to form antibodies to “germs” that invade the nose, mouth and throat. This function may be important in young children up to 3 years old but there is no evidence that it is important after that.

Studies have shown that children that have tonsils/adenoids removed suffer no loss in their immunity to diseases. Surgery is recommended when there are frequent acute infections causing high fever and sore throat. It can create snoring or obstructive sleep apnea with enlarged adenoids causing nose and throat obstruction to breathing while asleep. If untreated it may lead to complications involving the heart and lungs.

The operation is done under general anesthesia and requires admission to the hospital. Generally, a total of 48 hours’ stay is required. Shortly after admission, blood tests will be carried out. The child will be required to fast overnight i.e. no food or drink after 12 midnight before the operation. For a younger child, a shorter period of fasting might be sufficient, depending on the anesthetist’s assessment. The operation is done through the oral cavity. No incision will be made on the face or neck.

In preparation towards the surgery the doctor should be informed if the child has had fever and cough within the previous few days. The surgery might be postponed if the child is found to be unfit for surgery. If the child has any history/family history of bleeding disorder or any previous problems with anesthesia, it should be brought to the doctor’s attention.

After surgery, the child might still be sleepy, and may vomit due to the effects of general anesthesia. This will wear off with a little time. After a few hours, he will be allowed to drink water and eat ice cream. A soft diet is usually given the next morning. There might be slight blood stained sputum produced but this is expected.

Days after the surgery the child will have a sore throat and dryness of the mouth. But this will improve as the throat muscles return to normal. Eating and drinking should be resumed and encouraged as this will prevent debris from collecting and will also help in recovery. The pain killer prescribed should be taken to relieve throat discomfort and the entire course of antibiotics must be completed. The tonsillar beds at the back of the throat will have a whitish coating during the first few days of recovery. This is the normal appearance of a recovering wound in the mouth.

There is no diet restriction after discharge and normal diet and oral hygiene should resume. During the first week, the child should stay at home and avoid contact with people suffering from cough, colds and other infections. Contact with smoking adults and crowded places should be avoided. These precautions are to prevent a very small risk of bleeding from the tonsillar beds. Usually, a single post-operative follow-up date is given. Do keep your appointment with the doctor as the follow-up care is important in preventing complications.