Tonsillectomy, either alone or in combination with adenoidectomy, is one of the most commonly performed surgical procedures in the United States. Children suffering from throat infections or sleep disturbance often benefit from tonsil and adenoid surgery. With more than half a million patients undergoing tonsil and adenoid surgery annually in the United States, the procedure has proven to be safe and effective.
Sleep disorders that can be treated with tonsillectomy and / or adenoidectomy include sleep disturbed breathing and obstructive sleep apnea. Patients with sleep disturbed breathing experience recurrent episodes of partial or complete airway obstruction associated with restless sleep and in some cases frequent awakenings. In obstructive sleep apnea, patients experience complete airway obstruction and stop breathing for several seconds at a time. Children with these types of sleep disorders will often fail to progress through the stages of sleep, including REM sleep, normally. This disruption of normal sleep can affect neurologic development in children and may have an adverse effect on school performance and behavior. In some cases, children with a significant sleep disturbance may be incorrectly diagnosed with and treated for attention deficit disorder. Lack of adequate or normal sleep
may also lead to problems with growth delay or enuresis (bed wetting).
Sleep disturbed breathing and obstructive sleep apnea are both associated with an obstruction or blockage of the airway, especially the upper airway. In children, enlarged tonsils and adenoids are by far the most common cause of upper airway obstruction. Removing these structures will often eliminate the obstruction and allow the patient to achieve normal sleep. In some patients, the restoration of normal sleep patterns can help improve behavior, school performance and energy level.
Tonsillectomy and adenoidectomy may also be indicated for children who suffer from chronic tonsillitis or recurring episodes of acute tonsillitis. Patients experiencing recurring episodes of strep throat may ultimately require tonsillectomy to prevent the infection from returning. In some instances, patients who are strep carriers will undergo tonsil and adenoid surgery. Children developing unusual or severe symptoms with strep infections, including those who develop symptoms of obsessive compulsive disorder with strep infections (PANDAS), often benefit from tonsillectomy.
Patients who suffer from non-strep infections of the tonsils may also be appropriate candidates for tonsillectomy. Some children require frequent courses of antibiotics for tonsillitis but never have a positive strep culture. Others may develop unusually severe symptoms with episodes of tonsillitis, including high fevers or painfully enlarged lymph nodes. Others may have difficulty tolerating antibiotics or may have multiple antibiotic allergies. Some patients develop peritonsillar abscesses which usually require incision and drainage in addition to antibiotics for successful treatment. Periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA), while not a true infection of the tonsils, also seems to respond to tonsillectomy.
Chronic tonsillitis patients are candidates for tonsillectomy. These patients often experience persistent or frequent sore throat, bad breath, a foul taste in the mouth, and tonsil stones. Children with this problem may miss significant time from school, frequently visit the nurse’s office or find themselves using over the counter analgesics including acetaminophen and ibuprofen.
Patients and families often worry that there may be an increased risk of upper respiratory infection after removing the tonsils and adenoids. After all, they are lymphoid organs and as such are involved in fighting infection. Despite their role as part of the immune system, removal of the tonsils and adenoids does not seem to decrease a patient’s ability to fight off future infections. Multiple studies have shown no higher incidence of infection in children undergoing tonsillectomy as compared with children who still have their tonsils.
There are probably a couple of reasons that we do not see increased rates of infection after tonsil and adenoid surgery. First, there are actually four tonsils in the throat (or pharynx). There are the two palatine tonsils that the doctor can see when we open up and say, “Ahh.” These are what most people think of when we talk about tonsils. The adenoid is also a tonsil, the pharyngeal tonsil. The adenoid cannot be visualized through the mouth and is typically evaluated with an x-ray. In addition to the tonsils and adenoid, there is a fourth tonsil at the tongue base called the lingual tonsil. This tonsil is rarely removed in children, so even after tonsillectomy and adenoidectomy, there is still tonsil function present. Second, tonsils seem to be most important during the first three years of life, particularly the first twelve months. Tonsillectomy is less common under age
three and almost never performed before the first birthday, so most of the patients undergoing these procedures are old enough to have no ill effects from the loss of tonsil tissue.
In most patients tonsillectomy and adenoidectomy are performed in an outpatient setting. Patients with other medical problems, including heart disease, respiratory problems such as asthma, or bleeding disorders may require preoperative labs or x-rays and may spend a night in the hospital postoperatively. In younger children the recovery period is typically about a week during which most patients experience a sore throat and stay on a soft diet. Adolescents and adults tend to have a longer recovery, often closer to two weeks. Like every surgery, it is reserved for cases in which the benefits outweigh the risks, but for many patients it can provide a significant improvement in their quality of life.