Our Health Topics

Tonsillectomy and Adenoidectomy

  • The tonsils are small, round pieces of tissue that are located in the back of the mouth on the side of the throat. Tonsils are thought to help fight infections by producing antibodies. You can see your child's tonsils with a flashlight. Tonsillitis occurs when the tonsils become inflamed.

    Adenoids are similar to tonsils. They're made up of lymph tissue and are located in the space above the soft roof of the mouth (nasopharynx) and cannot be seen by looking in your child's nose or throat. Adenoids also help to fight infections. Adenoids may cause problems if they become enlarged or infected.

    How Boston Children's Hospital approaches tonsillectomy and adenoidectomy

    Once the need for surgery has been determined, you will meet with different members of your health care team who are going to be involved with your child's care at Children's. These include:

    • Nurses. Day surgery nurses prepare your child for surgery. Operating room nurses assist the physicians during surgery. Recovery room (also called the Post Anesthesia Care Unit) nurses care for your child as she emerges from general anesthesia.
       
    • Surgeon. The pediatric physician who specializes in surgery of the ear, nose, and throat will perform your child's surgery.
       
    • Anesthesiologist. A pediatric physician with specialized training in anesthesia will complete a medical history and physical examination and formulate a plan of anesthesia for your child. The plan will be discussed with you; all your questions will be answered. Your child will have to undergo general anesthesia for this procedure.

    Contact Us 

    Otolarnygology and Communication Enhancement
    Boston Children's Hospital

    300 Longwood Avenue
    Boston MA 02115 

    617-355-6460

  • What are tonsillitis and adenoiditis?

    Adenoiditis happens when adenoids become inflamed from infection.

    The symptoms of tonsillitis vary greatly depending on the cause of the infection, and can occur either suddenly or gradually. The following are the most common symptoms of tonsillitis. However, each child may experience symptoms differently. Symptoms may include:

    • sore throat
    • fever (either low-grade or high-grade)
    • headache
    • decrease in appetite
    • not feeling well
    • nausea and vomiting
    • stomach aches
    • painful swallowing
    • visual redness or drainage in the throat

    The symptoms of tonsillitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

    The symptoms of adenoiditis vary greatly depending on the cause of the infection, and can occur either suddenly or gradually. The following are the most common symptoms of adenoiditis. However, each child may experience symptoms differently. Symptoms may include:

    • breathing through the mouth
    • noisy breathing
    • snoring
    • nasal speech
    • periods at night when breathing stops for a few seconds

    The symptoms of adenoiditis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

    Some children may be referred to an ear, nose, and throat surgeon to have the tonsils and adenoids removed. This surgery is called a tonsillectomy and adenoidectomy (T&A). Often, the tonsils and adenoids are removed at the same time, but, sometimes, only one is removed. Your child's physician will discuss this with you.

  • What are the reasons to have a tonsillectomy and adenoidectomy?

    The reasons for this surgery are not well defined, and physicians may differ in their views. The following are some of the more widely accepted reasons for having a T&A:

    • sleep apnea, or periods at night when your child stops breathing
    • trouble swallowing
    • tumor in the throat or nasal passage
    • bleeding from the tonsils that cannot be stopped
    • significant blockage of the nasal passage and uncomfortable breathing

    The following are T&A Guidelines from the American Academy of Otolaryngology:

    • seven sore throats in one year
    • five sore throats in each of two years
    • three sore throats in each of three years

    The sore throats may be associated with the following:

    • fever above 101°F (Fahrenheit)
    • discharge on the tonsils
    • positive strep throat culture

    Here are some additional reasons for removing the adenoids and tonsils that are more controversial:

    • bad snoring
    • recurrent infections or abscesses in the throat
    • recurrent ear infections
    • hearing loss
    • chronic sinusitis, or infection in the sinuses
    • constant mouth breathing
    • frequent colds
    • cough
    • bad breath

    What happens during tonsillectomy and adenoidectomy?

    Tonsillectomy and adenoidectomy (T&A) surgery is a common major surgery performed on children in the United States. About 400,000 surgeries are performed each year. The need for a T&A will be determined by your child's ear, nose, and throat surgeon and discussed with you. Most T&A surgeries are done on an outpatient basis. This means that your child will have surgery and then go home the same day.

    During the surgery, your child will be anesthetized in the operating room. The surgeon will remove your child's tonsils and adenoids through the mouth. There will be no cut on the skin.

    In most cases, after the surgery your child will go to a recovery room where he/she can be monitored closely. After your child is fully awake and doing well, the recovery room nurse will bring your child back to the day surgery area.

    At this point, if everything is going well, you and your child will be able to go home. If your child is going to stay the night in the hospital, your child will be brought from the recovery room to his/her room. Typically you would already be in the room to meet your child.

    Bleeding is a complication of this surgery and should be addressed immediately by the surgeon. If the bleeding is severe, your child may return to the operating room.

  • How do I care for my child after a tonsillectomy and adenoidectomy?

    We recommend the following:

    • increased fluid intake
    • pain medication, as prescribed
    • no heavy or rough play for a duration of time recommended by the surgeon

    What are the risks of having a tonsillectomy and adenoidectomy?

    Any type of surgery poses a risk to a child. About 5 percent of children begin bleeding from the surgery site about five to eight days after the surgeryand may require additional blood and/or surgery. Some children may have a change in the sound of their speech due to the surgery. The following are some of the other complications that may occur:

    • bleeding (may happen during surgery, immediately after surgery, or at home)
    • dehydration (due to decreased fluid intake; if severe, fluids through an intravenous, or IV, catheter in the hospital may be necessary)
    • fever
    • difficulty breathing (swelling of the area around the surgery; may be life threatening if not treated immediately)
  • Wracked by seizures and a 105-degree fever, 19-month-old Claire is rushed to the emergency room. The hospital runs test after test and specialists are brought in, but no explanation is found. This isn't the first time: The fevers have struck like clockwork every three weeks for the past nine months. Antibiotics and fever reducers have offered no relief.

    Claire's father, Greg Licameli, MD, of Boston Children's Hospital's Otolaryngology Department, decided to search the medical literature for answers. He found two reports of European children with unexplained cyclical fevers, some of whom got better after tonsillectomy. Seeing nothing to lose, he decided to try it. Colleague Dwight Jones, MD, removed Claire's tonsils and adenoids and the fevers immediately stopped.

    Other doctors began referring patients to Licameli, who's now operated on 60 patients with this mysterious condition, first reported in 1987 and known as PFAPA (periodic fever, aphthous ulcers, pharyngitis and adenitis). In the March Archives of Otolaryngology and Head and Neck Surgery, he describes 27 of these children, the largest published experience to date; 26 had complete fever resolution.

    The reason remains a mystery, since the removed tonsils and adenoids show no evidence of infection or any other abnormality. Licameli suspects the tonsils harbor a chronic, low-level infection to which the immune system overreacts. He and colleagues in Immunology plan to investigate further.

    Meanwhile, the referrals keep coming, and desperate families are finding surgery to be life-changing. "I tell parents, 'I don't know why this works, but it has a good chance of ridding your child of fevers,'" Licameli says. "It works in almost every single kid."

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