Indications for Tonsillectomy & Adenoidectomy
Physicians have learned more about the role of the tonsils and adenoid in recent years and health care providers do not recommend removal of the tonsils and adenoid as often today as in the past. Although adenotonsillectomy is not performed as often as it once was, it is one of the most common surgical procedures performed in children in the United States. According to some medical professionals, tonsillectomy and adenoidectomy may still be performed more often than is necessary.
In most cases, tonsillectomy or adenoidectomy is performed when enlarged tonsillar tissue blocks (or obstructs) the child's airway and causes complications, such as obstructive sleep apnea (OSA), difficulty breathing, and difficulty swallowing. OSA is a serious condition in which the child stops breathing for a short period of time while he or she is sleeping.
Adenotonsillectomy may be recommended if the child experiences the following signs of upper airway obstruction:
- Changes in the voice (e.g., nose sounds blocked, hoarseness)
- Choking or gasping during sleep
- Difficulty breathing through the nose (breathing through the mouth most of the time)
- Difficult or painful swallowing
- Heavy snoring
- Noisy breathing
Enlarged tonsils may not cause symptoms. In some cases, they may shrink in size as the child gets older, even without treatment. Although swollen or enlarged tonsils and adenoids can increase the risk for chronic (long-lasting) throat, ear, and sinus infections, there is some controversy about whether tonsillectomy and/or adenoidectomy should be performed to treat recurrent infections.
Because children are exposed to a number of viruses and bacteria, the tonsils and/or adenoid often become inflamed or infected (called tonsillitis). Symptoms of tonsillitis include sore throat, painful swallowing, fever, and swollen lymph nodes in the neck or jaw. In many cases, the tonsils become swollen, red, and covered with white patches or a yellow coating. If tonsillitis occurs frequently, the tonsils may no longer be able to produce effective levels of antibodies, and surgery may be necessary.
Current recommendations for adenotonsillectomy in children include the following:
- Enlarged tonsils or adenoid that block the upper airway and cause problems swallowing or breathing, alter speech, or affect normal growth of the face or alignment of the teeth
- Peritonsillar abscess (serious infection that involves a collection of pus surrounding the tonsil)
- FAPA syndrome (FAPA stands for fever, aphthous stomatitis [oral ulcer or canker sore], pharyngitis [sore throat], and cervical adenopathy [swollen lymph nodes in the neck]; this condition often recurs every 4–6 weeks with no known cause and is more common in children under the age of 5 years)
- Recurrent throat, ear, or sinus infections (e.g., strep throat, otitis media, sinusitis) that cause the child to miss school frequently, require persistent antibiotic treatment, occur more than five times in 1 year, or occur more than three times per year for 2 years
- Swollen lymph nodes in the lower jaw for at least 6 months, in spite of antibiotic treatment
- Tonsillitis (inflammation of the tonsils) that occurs more than seven times in 1 year or more than five times per year for 2 years
- Tonsils that differ substantially in size (i.e., are asymmetrical)
Adenotonsillectomy usually is not recommended and may be contraindicated in children who have a cleft palate, a bleeding disorder, or acute tonsillitis. In most cases, a course of antibiotics is prescribed to resolve tonsillitis before surgery. However, if the infection does not respond to antibiotics, an emergency tonsillectomy may be necessary.
Parents and caregivers who have questions or concerns about frequent infections in their child, or about whether the child's tonsils or adenoid are enlarged or infected should speak with a qualified health care provider.