Tonsils & Adenoids
What Are 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. Figures 1 & 2 show the anatomical sites of tonsils and adenoids.
What Are Tonsils And Adenoids For?
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.
When Should Surgery (Adenoidectomy/Tonsillectomy) Be Done?
Recurrent Tonsillitis
Frequent acute infections causing high fever and sore throat.
#Snoring/Obstructive Sleep Apnoea#
Enlarged adenoids/tonsils causing nose and throat obstruction to breathing while asleep. If untreated, it may lead to complications involving the heart and lungs.
Chronic #Otitis Media# with Effusion
Persistent fluid in the middle ear causing hearing impairment
Peritonsillar Abscess
Pus forming around the tonsillar bed
Tumors
Rare, but may occur in children e.g. lymphoma
Surgery
The operation is done under general anaesthesia 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 anaesthetist's assessment. The operation is done through the oral cavity. No incision will be made on the face or neck.
Preparation For Surgery
The doctor should be informed if the child has fever and cough just before the surgery. 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 anaesthesia, it should be brought to the doctor's attention.
Soon After Surgery
The child might still be sleepy and have vomiting from the effects of general anaesthesia. This will wear off with a little time. After a few hours, he will be allowed to drink water and hence 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 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 help in recovery. The 'pain killer' given should be taken to relief 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 recovering. This is the normal appearance of a recovering wound in the mouth.
After Discharge
There is no diet restriction 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.
Emergencies
If the child experiences:
- Significant throat or ear pain not relieved by medication
- Fresh bleeding from the mouth
Please seek treatment at Children's Emergency, Basement 1, KK Women's and Children's Hospital. They will then contact the #ENT doctors# as required.
Follow-Up Appointment
Usually, a single post-operative follow-up date is given. Do keep your appointment with the doctor as the follow-up care is important is preventing complications.