What is an adeno-tonsillectomy?

An adeno-tonsillectomy is a procedure to remove your child's adenoids and tonsils.

The adenoids and tonsils are part of a group of tissues that help to fight off infection.

What are the benefits?

Your child should get relief from a blocked or runny nose, and may get a better quality of sleep.

If your child’s adenoids are large, removing them will allow air to pass through your child’s nose while they are talking and eating. This may improve the quality of your child’s voice.

Tonsillitis happens if the tonsils become infected. This causes pain, fever and difficulty swallowing and can make your child feel unwell.

Are there any alternatives?

Your doctor may be able to give you steroid nasal sprays to improve your child’s symptoms of a blocked nose and reduce the size of the adenoids.

There are no other treatments for enlarged adenoids other than to leave them alone and wait for the problem to get better.

Surgery is the only dependable way to stop tonsillitis that keeps on coming back.

What will happen if I decide that my child will not have the procedure?

The adenoids will shrink away naturally with time so the blocked nose and snoring will improve without surgery.

Your child will continue to have disturbed sleep. This can affect behaviour and learning at school.

Enlarged tonsils may also cause your child to have disturbed sleep and to stop breathing for a short time while they are asleep. Over many years the tonsils are likely to shrink away.

Your child will probably keep on getting tonsillitis but attacks may become less frequent over time. Untreated tonsillitis can sometimes form an abscess behind the tonsil. Rarely, the infection may spread further into the tissues of the neck, causing a ‘parapharyngeal’ or ‘retropharyngeal’ abscess. This is a serious complication and needs a procedure.

What does the procedure involve?

The procedure is performed under a general anaesthetic (where your child is sent to sleep). The procedure usually takes about 30 minutes.

Your surgeon will remove the adenoids through your child’s mouth.

Your surgeon will perform the procedure using one of the following techniques:

• Cold dissection technique – Your surgeon will use a steel instrument to peel or cut the tonsil away from the layer of muscle underneath it.
• Diathermy technique – Your surgeon will use a special instrument that uses heat to stop the bleeding.
• Coblation technique – Your surgeon will use an instrument that uses radiofrequency energy to dissolve the tonsil.

What can I do to prepare my child for the procedure?

Your child should try to maintain a healthy weight. They will have a higher risk of developing complications if they are overweight and your child is having surgery to improve their breathing during sleep, it is less likely to be successful.

What complications can happen?

The healthcare team are trained to reduce the risk of complications.

Any risk rates given are taken from studies of people who have had this procedure. Your doctor may be able to tell you if the risk of a complication is higher or lower for your child.

Possible complications of this procedure are shown below. Some may be serious.

General complications of any procedure

• Bleeding on the day of surgery or in the next 2 weeks. Your child may need another procedure to stop the bleeding. If the bleeding is heavy, your child may need a blood transfusion. Bleeding can happen more than once.
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.

Specific complications of this procedure

• Adenoid tissue regrowing. Your child may need another procedure.
• Small pieces of the tonsil may be left behind. These remnants can cause tonsillitis.
• Lingual tonsillitis.
• Earache. This is rare and usually lasts up to a week.
• Stiff jaw. This is rare and normally lasts up to a week.

Consequences of this procedure

• Pain. Your child may experience pain when swallowing. This normally only lasts up to a week.

What happens after the procedure?

They should be able to go home the same day or the day after.

It is important your child eats normal food that needs to be chewed and swallowed. This keeps the muscles at the back of the throat moving.

Your child will need to stay off school and away from groups of people for 2 weeks. This is to help prevent throat infections while your child’s throat is still healing.

Most children make a full recovery and return to normal activities.

Summary

For those children who have a very blocked nose or disturbed sleep, a procedure should give them a better quality of life. Surgery is the only dependable way to stop tonsillitis that keeps on coming back and the resulting pain, fever and difficulty swallowing.

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