Tonsillectomy & Adenoidectomy

 

What are the tonsils and adenoids?

The tonsils are glands that sit at the back of the mouth. The adenoids can not be seen directly as they are tucked up at the back of the nose. They are part of a number of glands in the body that are involved in fighting infection. As we grow older they get progressively smaller.

The tonsils (highlighted by an asterix) when seen looking into the mouth

The tonsils (highlighted by an asterix) when seen looking into the mouth

 

When is Tonsillectomy helpful?

Recurrent tonsillitis or quinsy

Sometimes the tonsils may get infected and result in tonsillitis. This is mostly due to a viral infection and settles by itself over a few days. Occasionally, it is due to a bacterial infection and in these cases, antibiotics may be needed.

If episodes of tonsillitis are happening frequently, having a significant impact on daily living such as missing time from work or school, or you have had abscesses affecting the tonsils (quinsy), a tonsillectomy may be helpful.

Breathing obstruction

The tonsils can also be enlarged and cause problems with breathing. Breathing difficulties may be especially troublesome while sleeping and affecting the amount of oxygen getting to the lungs. This can be due to the tonsils blocking the passage of air to the lungs. A condition termed sleep apnoea.

Adults who have sleep apnoea may wake up tired, feel tired through the day, have difficulty concentrating. In particular, sleep apnoea is known to have significant negative effects on the heart and lungs.

Children do not necessarily exhibit breath holding but may simple be noisy sleepers or restless at night. Sometimes this can also be associated with bedwetting (nocturnal enuresis). In the daytime, while some may be tired, others may be hyperactive, irritable or have trouble at school.

In children, tonsillectomy for sleeping issues is often combined with adenoidectomy and can result in dramatic improvements. If indicated, Dr Michael may also combine the procedure with grommet insertion.

In adults, other surgical and non-surgical procedures may also be required to help control symptoms related to sleep apnoea or snoring

Swallowing difficulty

Occasionally, the tonsils can be so large that they cause difficulties in swallowing food. In young children this can affect their growth. Tonsillectomy in these cases can be extremely helpful.

Bad breath (halitosis) / Tonsil stones(tonsilloliths)

The tonsils can have furrows or crypts which collect food debris and build up to cause stones within the furrows of the tonsil. These can also cause irritation and when infected and can contribute to bad breath. Conservative measures for management include keeping well hydrated and addressing dental hygiene as well as salt water gargling.

If these measures fail, a tonsillectomy operation may benefit and certainly will cure problems occurring due to tonsil stones.

When is adenoidectomy helpful

Breathing difficulty

Adenoidectomy is undertaken when the adenoid glands are enlarged and causing difficulty in breathing through the nose.

Research has suggested that nasal obstruction and associated mouth breathing in early childhood can potentially affect growth of the middle portion of the face. In children where medical treatment has not been successful in improving the nasal airway, a surgical procedure such as an adenoidectomy or surgery to reduce the size of the turbinates may be helpful. Dr Michael works closely with one of his dental colleagues, Dr Donny Mandrawa (http://thedentalsuites.com.au), who has shares a special interest in this field.

Adenoidectomy is also often performed together with a tonsillectomy if there is a suspicion of sleep disordered breathing or breath holding at night (sleep apnoea).

Recurrent ear infections

Adenoidectomy may be considered in some cases where recurrent middle ear infections and occurring

Will a tonsillectomy stop me getting sore throats?

You will no longer get tonsillitis but sore throats can still occur due to inflammation affecting the throat termed pharyngitis.

What does a tonsillectomy operation involve?

Tonsillectomy is performed through the mouth under general anaesthesia. Dr Michael uses a number of method to remove the tonsils but favours using a technology termed Coblation which has been shown in some studies to reduce the amount of pain after having a tonsillectomy. The video below shows the principles behind this technology.

 

After the operation, you will return to the ward and the nursing staff will monitor you regularly and provide you with drinks and then food as soon as you can tolerate them. Some people who are healthy and live near the hospital may leave the same day of the operation. Others, and especially those who have had sleep issues, would need to stay over night.

What does an adenoidectomy operation involve?

The adenoids are usually removed through the mouth under general anaesthesia either as a procedure on its own or together with a tonsillectomy. Occasionally specialised instruments and cameras are used to remove them through the nose

What are the risks from the operation?

As the operation is carried out through the mouth, there is a potential risk of damage to the lips, teeth or tongue. However, this occurs very rarely and is usually more of an issue in children who already have ‘wobbly’ teeth.

With tonsillectomy, most people experience pain after the operation. However, this tends to be less in younger children. You will be given a prescription for painkillers which you or your child should take regularly for the first few days and then as needs be. Having cold liquids and foods and can also help. However, it is also important to keep well hydrated and eat regularly with rougher foods such as celery, carrots or toast helping to clear any slough that builds up at the area from which the tonsils have been removed.

With adenoidectomy, there is also a small risk of a condition called velopharyngeal incompetence. Normally the back portion of the mouth of the roof (soft palate) helps to close off the mouth from the nose when swallowing to prevent food going upwards into the nasal cavity. In a small proportion of individuals, removal of the adenoids can cause this to happen temporarily and even more rarely as a permanent issues. There are some variations in people's anatomy that can contribute to this. Dr Michael will make an assessment regarding this and may recommend against an adenoidectomy to minimise the risk of this complication.

Rarely, the adenoids or tonsils may regrow after an operation and a repeat procedure may be warranted.

Some people may experience bleeding. This can be limited to a few streaks of blood. However, if the bleeding does not settle after a few minutes, it is important to contact Dr Michael or contact an ambulance to attend an Emergency Department.

The risk from general anaesthesia is extremely small. You will see the anaesthetist before your operation who will be able to provide you with more details about the anaesthetic.