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Adenoid and tonsil removal in children (adenotonsillectomy)
Published by Bupa's health information team, November 2008.
This factsheet is for parents of children who are having their adenoids and tonsils removed. These are small lumps of tissue at the back of your child's throat. The operation for removing the adenoids and tonsils is called adenotonsillectomy.
Your child's care will be adapted to meet their individual needs and may differ from what is described here. So it's important that you follow the surgeon's advice.
About adenoids and tonsils
Adenoids and tonsils are small lumps of tissue that help fight ear, nose and throat infections in younger children. The adenoids lie where the throat meets the back of the nose. The tonsils lie at the back of the throat, one at each side.
Adenoids and tonsils usually reach their maximum size when your child is between three to five years old. They begin to shrink by age seven and can hardly be seen by the late teens.
The location of the adenoids and tonsils
When children have a cold or a throat infection the adenoids and tonsils can become infected and swell up, causing symptoms such as sore throat, headache and fever. They can also block the airways, making it difficult for your child to breathe, especially when asleep. This can cause sleep problems such as snoring. In severe cases they can stop your child from breathing for a short time (known as sleep apnoea).
Swollen adenoids can block the eustachian tube, which is a tube that connects the back of the throat to the middle part of the ear. Blockage of the eustachian tube can lead to ear infections and a build-up of sticky fluid in the ear - called glue ear. This can make it difficult for your child to hear properly and, as a result, can cause learning problems. Removing the adenoids may help with treatment of glue ear.
Your doctor will examine the adenoids and tonsils by looking in the back of your child's mouth using a light and mirror or a flexible telescope. X-ray images can also show enlarged adenoids and tonsils.
Your doctor may recommend adenotonsillectomy if your child suffers from sleep problems due to a blocked nose, or has recurrent or persistent sore throats and ear infections. Most adenotonsillectomies are done in children aged two to eight.
What are the alternatives?
The only effective treatment for recurrent and persistent sore throats and ear infections in young children is to have an adenotonsillectomy. However, the adenoids and tonsils shrink in size as your child grows older, so an operation may not be necessary.
Painkillers and antibiotics only provide temporary relief and are not used for long-term treatment. A viral infection won't respond to antibiotics.
Preparing for your child's operation
Adenotonsillectomy usually requires an overnight stay in hospital. If your child has a cold or infection in the week before the operation, please let the hospital know. The operation may need to be postponed until your child has fully recovered.
The operation is always done under general anaesthesia. This means your child will be asleep during the procedure. Typically, your child must not eat or drink for about six hours before a general anaesthetic. Often the operation will be planned for the morning, so that your child will only have to miss breakfast.
At the hospital a nurse will ask you questions about your child's general health, and check that your child has not had anything to eat or drink. He or she will also measure your child's heart rate and blood pressure.
The surgeon and anaesthetist will usually visit your child before the operation. Please tell them if your child has any allergies, loose teeth or any history of bleeding problems in the family.
If you have parental responsibility for the child, you may be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
About the operation
The operation usually takes about 30 minutes.
Removing the tonsils
There are several methods available for removing tonsils.
Traditional method - a special surgical blade is used to cut out the tonsils. Pressure is applied to stop the bleeding, and dissolvable stitches or heat is used to seal the wound.
Lasers or ultrasound waves - high-energy waves are used to cut out the tonsils and seal the blood vessels to stop bleeding.
Diathermy - heat from an electric current is used to cut out the tonsils and seal the blood vessels.
Removing the adenoids
The surgeon will use special instruments to remove the adenoids from the back of the throat via the mouth. The surgeon will apply pressure to the wound area to stem the bleeding. When the bleeding has stopped your child is woken up from the anaesthetic.
How an adenotonsillectomy is carried out
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What to expect afterwards
Your child will be monitored and will need to rest on their side until the effects of the anaesthetic have passed. Your child will be groggy, and may feel or be sick.
Your child will have a sore throat, earache and a stiff jaw for the first week or two. Pain relief and antibiotics are usually prescribed for a week to 10 days.
Encourage your child to drink and eat as soon as they feel ready, starting with clear fluids such as water or apple juice.
After about 12 hours, a white or yellowish membrane (new "skin") will appear where the adenoids and tonsils were.
Your child will usually be ready to go home the morning after the operation. Before you go home a nurse will give you a date for a follow-up appointment.
Recovering from adenotonsillectomy
Once home, follow the surgeon's advice about pain relief. You can give your child over-the-counter painkillers such as paracetamol or ibuprofen syrup (for example Calpol or Calprofen). Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. Do not give aspirin to children under 16.
If your child is prescribed antibiotics it's important to finish the course.
Get your child to drink plenty of fluids and eat. It's best to start with soft or liquid foods which are easier to swallow. Giving your child a dose of pain relief half an hour before meals may help make eating more comfortable. Encourage your child to brush their teeth thoroughly, at least twice a day.
Your child should rest for a few days and stay at home to avoid contact with possible infections at school. Also keep your child away from crowded and smoky places, and from people with coughs and colds.
A small nose bleed is common after surgery. However sniffing or sneezing shouldn't cause any bleeding. If your child develops any of the following symptoms, please contact your GP or the hospital immediately:
bleeding in the nose or throat
an inability to drink normally, as this can lead to dehydration
a high temperature
You can expect your child to make a full and quick recovery once the initial pain has resolved. Complete recovery can take two weeks.
What are the risks?
Adenotonsillectomy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
These are the unwanted, but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic. Common side-effects include:
sore throat, earache and a stiff jaw - these side-effects may last for up to two weeks
change in voice - your child may sound like they are talking through their nose, this can last two to four weeks
bad breath - this usually improves after two to three weeks
This is when problems occur during or after the operation. Most children are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection. Antibiotics are usually prescribed to help prevent infection.
Specific complications of adenotonsillectomy are rare but include:
bleeding within 24 hours - your child may need to go back into theatre to have it stopped
bleeding four to seven days after the operation (secondary haemorrhage) - this can be the result of an infection
damage to the teeth or jaw - this can be caused by the instruments used to keep the mouth open during surgery
chest infection and breathing problems - there's a risk blood and tissue from the operation may get into the throat and down into the lungs
damage to the muscle in the roof of the mouth - this can cause a long-term change in your child's voice
injury to eustachian tube - this can cause problems such as glue ear
The exact risks are specific to your child and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to your child.
020 7404 8373
Action for Sick Children
See our answers to common questions about adenotonsillectomy, including:
- Tonsil surgery. ENT UK.
accessed 16 August 2007
- Adenoid surgery. ENT UK.
15 August 2007
- McClay JE. Adenoidectomy. Emedicine.
accessed 15 August 2007
- Tonsillectomy for sore throats. Bandolier.
accessed 15 August 2007
- van Staaji BK, van den Akker EH, Rovers MM, Hordijk GJ, Hoes AW, Schilder AG. Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial. BMJ 2004;329:651-657
- Tonsillectomy using ultrasonic scalpel. NICE guidance 178. June 2006.
accessed 16 August 2007
- Tonsillectomy using laser. NICE guidance 186. July 2006.
accessed 16 August 2007
- Electrosurgery (diathermy and coblation) for tonsillectomy. NICE guidance 150. December 2005.
accessed 17 August 2007
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by ENT specialist Mr Paul Tierney, MA, FRCS, FRCS (ORL-HNS) of Bristol ENT Partnership and by Bupa doctors. It has been patient reviewed by The Charity for Sick Children. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: November 2008.