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 adenoids are found high in the throat, behind the nose and need special instruments or an X-ray to view it.

Tonsils and adenoids act as ‘policemen’ and help to form antibodies to ‘germs’ that invade the nose, mouth and throat. This function may be important for young children up to 3 years of age, but there is no evidence that it is important after that. Studies have shown that children who have had their tonsils/adenoids removed suffer no loss in their immunity to diseases.

Conditions affecting the tonsils and adenoids

Several conditions may affect the tonsils and adenoids in a child:

• Enlarged tonsils and adenoids contributing to snoring or obstructive sleep apnoea (OSA)
• Recurrent tonsil or adenoid infections
• Rarely, tumours or growths in the tonsils or adenoids

Medical

Antibiotics may be prescribed to treat recurrent tonsil and adenoid infections or otitis media with effusion (middle ear infections). If treated successfully, surgery may be avoided.

For children who snore or face breathing difficulties due to enlarged adenoids/tonsils, CPAP (Continuous Positive Airway Pressure) may be considered to keep the upper airway open.

Surgical

Surgical removal of tonsils or adenoids is done under general anaesthesia and requires admission to the hospital. Generally, about a 48-hour hospital stay is required. Shortly after admission, blood tests may be carried out as appropriate. 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 anaesthetist’s assessment. The operation is done through the oral cavity. No incision will be made on the face or neck.

If your child has a fever or cough just before the surgery, you must inform your doctor about it. The surgery may need to be postponed if your child is found unfit for surgery.

If the child has any history, or family history of bleeding disorders, or any previous problems with anaesthesia, it must be brought to the doctor’s attention.

Soon after the surgery, your child might still be sleepy, and may vomit from the effects of general anaesthesia. This will wear off over a little time. After a few hours, your child will be allowed to drink water and eat ice cream.

Encourage sips of a cool, clear liquid when the child is fully conscious. A soft diet is usually given the next morning. Slightly blood-stained sputum may be produced, but this is expected.

Care after the surgery

Your child will have a sore throat and dryness of the mouth but this will improve. Eating and drinking should resume and be encouraged as this will prevent debris from collecting, and help in recovery. The ‘pain killer’ given should be taken to relieve throat discomfort and the entire course of antibiotics to be completed.

The tonsillar beds at the back of the throat will have a whitish coating in the ensuing days of recovery. This is the normal appearance of a recovering wound in the mouth.

After the surgery, the child should avoid:

• Acidic/citrus fruit juices such as orange or lime juice to prevent irritation of the throat
•  Use of hard objects in the mouth
• Frequent coughing or clearing of the throat, as this may aggravate bleeding from the operative site
• Physical exercise for a period of 2 weeks
• Overcrowded places and smokers
• Contact with people suffering from cough, colds and other infections

These precautions are advised to prevent a very small risk of bleeding from the tonsillar beds.

After discharge

Oral hygiene should resume. Keeping your child on a soft diet for 2 to 3 days will help the wound to heal. Your child can revert to a normal diet after that.

The child should stay at home for a week after the operation and may return to school after that. During this first week, encourage small sips of plain water frequently to keep the throat moist and clean.

Children aged 12 and above should be encouraged to gargle their mouth after each meal to keep the throat clean.

Consult your doctor when:

• Fever is higher than 38°C
• There is large amount of bleeding from the throat:
• Excessive swallowing reflex
• Vomitus
• There is severe pain of the throat or ear not relieved by medication
• Any prolonged/abnormal symptom(s) which may cause concern.

Follow-up appointment

Usually a single post-operative follow-up date is given. Do keep the appointment with the doctor, as the follow-up care is important in preventing complications.