Although adenotonsillectomy is a very safe procedure, surgery can be a frightening experienceespecially for children. It is important for parents and caregivers to answer the child's questions and address his or her concerns in a way that is appropriate for the age of the child. It may be helpful for the child's parents and/or physician to reassure the child that he or she will be healthier following the procedure and to explain exactly what the child can expect before and after surgery.
Prior to undergoing tonsillectomy and/or adenoidectomy, a blood test and urine test may be performed. General anesthesia is used during the procedure. The child will be unconscious during surgery and will not feel anything.
Parents should inform the physician if the child has a personal or family history of problems with anesthesia and should make sure the child follows all instructions regarding eating, drinking, and taking medications prior to surgery. In many cases, the child must not take anything by mouth (including gum, toothpaste, cough drops, or water) after midnight on the day of the procedure.
Adenotonsillectomy usually is performed as an outpatient procedure, which means the child will go home from the hospital the same day as his or her surgery. Children who have serious medical conditions (e.g., cerebral palsy, epilepsy), children with obstructive sleep apnea (OSA), and children younger than 3 years old may be admitted to the hospital overnight.
Adenotonsillectomy takes about 30 minutes to perform. Traditional surgery involves removal of the entire tonsil or adenoid and partial (intracapsular) surgery involves removing only the inflamed tonsillar tissue. Children who undergo partial tonsillectomy or adenoidectomy may experience less post-operative pain and may recover more quickly than children who undergo traditional surgery. In rare cases, remaining tonsillar tissue can enlarge or become infected following partial removal, requiring additional surgery.
Tonsillar tissue can be removed through the mouth, using a number of different devices, and surgery to remove the tonsils and/or adenoid does not require an incision in the skin. The method used depends on a number of factors, including the surgeon's preference, the extent of the surgery, and the age and overall health of the child.
Adenotonsillectomy techniques that may be used include the following:
- Coblation (involves using cool electrical current to remove tonsillar tissue; may produce less postoperative pain and a faster recovery)
- Dissection (most common method; involves removing the tonsils using a scalpel)
- Electrocauterization (involves using hot electrical current to remove the tonsils; may cause damage to surrounding tissue that increases postoperative pain)
- Harmonic scalpel (involves using a scalpel that vibrates; minimizes bleeding and damage to surrounding tissue)
- Laser ablation (involves using a hand-held laser to vaporize tonsillar tissue)
- Microdebridement (involves using a rotary "shaving" device to remove tissue from enlarged tonsils)
- Radiofrequency ablation (also called somnoplasty; involves using energy transferred through probes inserted into the tonsils)
Due to recent improvements in surgical methods, complications associated with adenotonsillectomy are rare. The primary risk is adverse reaction to anesthesia. Other risks include the following:
- Bleeding (hemorrhage; may be indicated by excessive swallowing after the procedure)
- Difficulty swallowing
- Injury to other structures in the mouth (e.g., soft palate [roof of the mouth], uvula [tissue that hangs down from the soft palate above the entrance of the throat])
- Throat and/or ear pain
Following tonsillectomy and/or adenoidectomy, children may experience mild sore throat, ear pain, and a stuffy or runny nose for a week or two. Soft foods (e.g., ice cream, pudding, gelatin) and cool liquids may help relieve discomfort. Your child's physician may suggest over-the-counter or prescription pain relievers, such as acetaminophen (e.g., Tylenol®), or prescription pain relievers to reduce pain.
Aspirin should not be used in children due to a risk for a serious condition called Reye's syndrome. In February 2013, the U.S. Food and Drug Administration (FDA) issued a strong recommendation against (contraindication) using codeine (e.g., Tylenol® with codeine) to relieve pain in children who have undergone tonsillectomy and/or adenoidectomy. Codeine, which is converted into morphine by the liver, may be metabolized too quickly in some children, resulting in a life-threatening or fatal overdose of the drug. According to the FDA, children with obstructive sleep apnea (OSA) are especially at risk.
Most children recover fully from tonsillectomy and adenoidectomy in about 2 weeks. Parents and caregivers should contact a qualified health care provider if they have questions or concerns following their child's adenotonsillectomy.
According to the National Institutes of Health (NIH) in a study published in the April 2014 issue of OtolaryngologyHead and Neck Surgery, about 20 percent of adults who undergo tonsillectomy experience complications. Within 14 days of the procedure, 10 percent with complications are seen in hospital ERs and 1.5 percent require hospitalization. The most common complications in adults include pain, bleeding, and dehydration.