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Adenoidectomy

Back­ground

Ton­sils and ade­noids are part of the lym­phat­ic sys­tem and found in the back of the throat and nose. Their func­tion is to help pro­duce anti­bod­ies ear­ly in life. Beyond late child­hood and adult­hood, there are no par­tic­u­lar func­tions unique to the ton­sils and adenoids.

Removal of the ton­sils and ade­noids is indi­cat­ed in two com­mon situations:

Recur­rent or chron­ic infections

Enlarge­ment also known as hypertrophy

Chron­ic infections

When recur­rent infec­tions occur in the ton­sils or ade­noids (ton­sil­li­tis and ade­noidi­tis) numer­ous times or if an infec­tion is nev­er cleared up, removal should elim­i­nate any fur­ther infec­tion and pain in the ton­sils and ade­noids. Ton­sil­lec­to­my and ade­noidec­to­my do not reduce the num­ber of colds or oth­er ill­ness­es. Ade­noidec­to­my can also be indi­cat­ed in recur­rent or chron­ic sinusi­tis in chil­dren. The loca­tion of ade­noid tis­sue can har­bor bac­te­ria and can also con­tribute to chron­ic ear infec­tions or oti­tis media. The only alter­na­tive to sur­gi­cal­ly remov­ing the ton­sils for infec­tion is fur­ther antibi­ot­ic treat­ment. Depend­ing on the num­ber and type of past treat­ments, more antibi­otics may not be helpful.

Enlarge­ment or hypertrophy

Abnor­mal enlarge­ment or hyper­tro­phy of the ton­sils and ade­noids usu­al­ly results in air­way obstruc­tion or prob­lems with swal­low­ing. When the enlarge­ment is severe, patients can have block­age in breath­ing, known as obstruc­tive sleep apnea, which occurs at night while sleep­ing. This severe med­ical con­di­tion requires treat­ment because of the pos­si­ble long-term prob­lems that can occur with the heart and lungs. If you sus­pect that your child or some­one you know suf­fers from sleep apnea, please dis­cuss this with your physician.

Surgery

Surgery is usu­al­ly done as out­pa­tient or same-day surgery. Surgery is done through the mouth, with­out the need for any exter­nal inci­sions. Depend­ing on your physi­cian and your prob­lem, surgery may require an overnight stay in the hos­pi­tal, which is usu­al­ly more com­mon with patients with obstruc­tive sleep apnea. Pain med­i­cine is pre­scribed and antibi­otics may also be pre­scribed. Most patients require a week of absence from school or work.

What to expect

Hav­ing ton­sils and/​or ade­noids removed is often per­formed at one of our hos­pi­tals or at The Sur­gi­cal Cen­ter of the DuPage Med­ical Group. Most of the time, the pro­ce­dure is done as an out­pa­tient, how­ev­er, chil­dren under 3 years old will often require overnight obser­va­tion in the hos­pi­tal. The pro­ce­dure is per­formed under gen­er­al anes­the­sia and does require the place­ment of an endo­tra­cheal tube (breath­ing tube.) An IV is required. Pro­ce­dure length is vari­able, but often lasts 30 min­utes. Imme­di­ate post oper­a­tive recov­ery can take 1 – 3 hours. Once a patient is awake and can drink flu­ids, they are able to go home.

Post oper­a­tive care instructions

After surgery

Pain may be very severe, last­ing up to 2 – 3 weeks. The worst pain occurs with­in the first week and is often asso­ci­at­ed with ear pain. Tylenol™ with codeine or oth­er nar­cot­ic med­i­cines will con­trol the severe pain, but there may still be severe dis­com­fort. No aspirin, ibupro­fen (Motrin™, Advil™) or any oth­er pain reliev­ers should be used, since these may cause bleeding.

Strong­ly encour­age drink­ing plen­ty of clear flu­ids, such as water and fruit juices. Avoid drink­ing straws for the first week after surgery.

No phys­i­cal activ­i­ty such as run­ning, lift­ing or climb­ing should be allowed for 14 days after surgery. While this is dif­fi­cult to enforce for most chil­dren, this will help reduce the pos­si­bil­i­ty of bleed­ing after surgery.

What may happen

Nau­sea or vom­it­ing dur­ing the first few days after surgery usu­al­ly is due to anes­the­sia. A small amount of old, swal­lowed blood or pink and slight­ly red-col­ored nasal mucous or sali­va may be seen and should not be concerning.

A change in voice or pas­sage of flu­id into the nose when swal­low­ing may occur. This is tem­po­rary and may last for a few weeks.

A low grade fever up to 100°F usu­al­ly occurs dur­ing the first week after surgery. The fever is due to the surgery and should be relieved with Tylenol. If a high fever occurs (over 101°F), please call our office.

When to call for emergencies

If con­stant, bright red blood con­tin­ues for more than 15 – 20 min­utes, please call our office IMME­DI­ATE­LY. Dur­ing office hours, please call our depart­ment direct­ly, or if after hours, ask the oper­a­tor to page the oto­laryn­gol­o­gy physi­cian on call. If bleed­ing becomes severe, go direct­ly to the near­est hos­pi­tal Emer­gency Depart­ment. The hos­pi­tal Emer­gency Depart­ment will then con­tact the physi­cian on call.