T&A in Pediatric Patients
Tonsil and adenoid tissues are masses of immune cells commonly called lymphoid tissue. The tonsils are located along the wall of the upper throat just at the level of the soft palate. The adenoids are not easily seen, and in fact are located directly behind the nose above the soft palate.
The tonsil and adenoid lymphoid tissues are important in the first several months of life. However, what is initially a benefit in the production of antibodies can start to cause upper airway obstruction, as well as recurrent tonsillitis for some.
Parents are frequently concerned that removal of the tonsils and adenoids will decrease the child’s immunity. Studies have shown that children who have a chronic tonsillitis and airway obstruction have fewer problems after removal of the inflamed lymphoid tissue than those that do not undergo the procedure.
The primary care physician or pediatrician will usually refer the child for evaluation. In the past, the majority of tonsillectomies and adenoidectomies were performed because of recurrent strep throat, usually 4-5 episodes a year. Antibiotics have helped to decrease and control the recurrent “strep” tonsillitis. However, some children continue to experience recurrent tonsillitis, requiring tonsil and adenoid removal.
Frequently, the child will experience mouth breathing and snoring and occasional apnea (obstruction of breathing) as a result of the tonsil and adenoid tissue, partially obstructing the airway. The long-term problems with airway obstruction may not be readily apparent. Children with mouth breathing and snoring frequently experience what is known as the “sleep disorder breathing.” Sleep disorder breathing results in poor sleep quality and an increase incidence in daytime fatigue, with a lack of attention and focus. In addition, significant obstruction and mouth breathing leads to the development of an “open bite”, which becomes apparent when the child is 6 or 7 years of age.
The Tonsil Removal Procedure
Removal of the tonsils and adenoids (tonsillectomy and adenoidectomy) is a very commonly performed procedure that is typically an outpatient procedure in children over 3-4 years of age. Some children that are younger require an overnight stay in the hospital. The child is evaluated in office. A history of the child’s infections and airways problems are documented and an exam of the tonsils is easily performed.
The child is evaluated by a pediatric anesthesiologist and usually given an oral medication that is very pleasant tasting. These results in mild sedation and easily controls the anxiety the child experiences. Many times, the child won’t remember the procedure later.
The procedure requires less than 10 minutes of surgical time with minimal-to-no bleeding.
Immediately After Getting Tonsils Removed
Your child will be taken to the post anesthesia care unit after surgery. During recovery, you will be at the bedside. From the post anesthesia care unit, your child will be transported back to the pediatric preoperative area after full recovery from anesthesia. Once your child is fully awake and taking fluids, you will be discharged from the unit. A follow-up will occur within 3-4 weeks. Postoperative medications, including antibiotics and pain medicine, will be called in to your pharmacy.
Tonsillectomy in Adults
Adults experience chronic tonsil problems that differ from childhood tonsillitis. Childhood tonsillitis is associated with recurrent strep infections and mouth breathing and snoring. Adults with tonsil issues complain more of a chronic discomfort in the throat in large tonsils with the frequent complaint of debris that becomes a lodge in pits or crypts (a hidden place) in the tonsils. The food debris undergoes decay as a result of the common bacteria in the oral cavity. This results in the mild to moderate enlargement, intermittent throat discomfort, and a frequent foul taste and breath that the patient experiences.
Adult patients usually have had a history of tonsil problems when they were younger, but not to the extent that would indicate a tonsillectomy. Adults frequently are under the misconception that they are “too old to have a tonsillectomy,” or a physician has told them that “a tonsillectomy is dangerous in an adult”. Tonsillectomy is an entirely safe procedure in adults. The distinction is that adults are very aware of the postoperative pain; while children that have undergone tonsillectomies frequently do not remember the discomfort or period of recovery.
An adult tonsillectomy is performed under general anesthesia and requires less than 10 minutes to perform with minimal-to-no blood loss.