The tonsils are two clumps of tissue, on either side of the throat, embedded in a pocket at the side of the palate (roof of the mouth). The lower edge of each tonsil is beside the tongue, way in the back of the throat. The adenoids are a single clump of tissue in the back of the nose (nasopharynx).
The tonsils and the adenoids are mostly composed of lymphoid tissue, which is found throughout the gastrointestinal tract and on the base of the tongue. Lymphoid tissue is composed of lymphocytes, which are mostly involved in antibody production. Since we generally consider antibody production to be a good thing, many studies have been performed to try to clarify the importance of the tonsils. There seems to be no adverse effect on the immune status or health of patients who have had them removed. Any noticeable effect has generally been positive. It appears that the tonsils and adenoids were not "designed" to effectively handle the multitude of viral infections that occur in children in an urban population. Rather, the immune system, including the tonsils and adenoids, developed during a era where the child was rarely exposed to a large number of other people and the germs they carried. It may also be that these organs are relatively more important in dealing with certain types of infections, such as worms or other parasites, that are relatively uncommon in today's society. It is clear that in many cases, the tonsils and/or the adenoids become "dysfunctional" and are more of a liability than an asset.
There are a number of well-established valid reasons for removal. Some patients will have more the one reason. The most common are listed below.
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Blockage of the throat (tonsils are too big) |
This is now the most common reason for removal. The tonsils can be large enough to impede breathing, swallowing, or clear speech production. The blockage of breathing can range from simple "mouth breathing" to severe snoring, or sleep apnea (blockage of breathing at night). The health risks of this can be slight to life-threatening. Not all tonsils that appear to be large are actually causing obstruction. A history and an examination by a skilled practitioner is usually sufficient for the diagnosis. |
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Chronic and recurrent tonsillitis (sore throats) |
This used to be the most common reason for removal and remains so in some parts of the world. Some patients will have frequent severe bouts of tonsillitis. Other patients have a pattern of low-grade constant or very frequent sore throats. Unrelenting strep (Group A streptococcus) infection or colonization is still encountered despite antibiotics. |
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White debris in the tonsils, known as chronic cryptic tonsillitis |
The tonsils contain many pits and pockets called crypts. These, in some patients tend to become impacted with white foul-smelling (especially to the owner) debris that is composed of bacteria and dead cells. It may cause a low grade intermittent sore throat. Antibiotics are only transiently helpful. Some patients will use various mechanical picks and swabs to attempt removal. The only consistent cure is a tonsillectomy. |
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Unusual enlargement or appearance |
Like any other tissue, the tonsils can be the site of benign or malignant tumors. An unusual or markedly enlarged tonsil is sometimes seen in this situation. Lymphoma is the most common tumor of the tonsil in children. In adults, lymphoma or carcinoma can be seen. |
There are many techniques used for tonsillectomy. The surgeon may cut out the tonsils using a blade (scalpel) or a specialized surgical tool that uses heat or high-energy heat or sound waves to remove or destroy tissues and stop bleeding. General anesthesia is usually employed. Most patients are able to go home the same day as surgery.
At least in young children, enlargement or infection frequently affects the adenoids as well as the tonsils, so they are often removed together. Compared to a tonsillectomy, an adenoidectomy is less traumatic and painful.
After removal of the tonsils and adenoids, your child may lack energy and tire easily for several days, and be restless at night and not sleep well. These problems gradually get better in three to 14 days. Your child may be constipated for several days because of the codeine in the pain medication and he or she will not feel like eating much.
The most important thing for your child to have in the first three days after surgery is liquids. This will help lessen problems with fever and constipation and promote healing. Make an effort to give your child a drink (2 or 3 ounces) every hour during waking hours for the first two days after surgery. Frequent small feedings of soft foods and cool liquids are usually the most comfortable. As your child’s appetite gets better, encourage him or her to eat solid foods. Your child should not drink through a straw after surgery until the throat is completely healed because it may increase the risk of bleeding.
Your child may feel sick to the stomach, throw up or feel tired and cranky after surgery. This should get better within a few hours. Occasionally, nausea and vomiting can be caused by the codeine in pain medication. A very sore throat or ear pain is normal after the tonsils are removed. Expect pain in the ears between the third and seventh days because the same nerve that goes to the tonsils also goes to the ears. You can use cool compresses or ice packs on your child’s neck to help your child feel more comfortable. Prescriptions and instructions for taking the pain medication will be given to you in the recovery room prior to discharge as applicable.
Bad breath is normal and is caused by a white to yellowish scab that forms over the tonsil surgery site. The scab breaks off during healing within five to 10 days and the bad breath will go away.
There should be no bleeding from the nose or mouth after your child returns home. Get up to check on your child once or twice during the first night after surgery. If there is any bleeding, take the child to the emergency room immediately.
Between the fifth and 10th days after surgery, the scab breaks off the surgery site and your child may spit up some bloody mucus. If the bleeding does not stop in 20 to 30 minutes, bring your child to the emergency room.
It is best for your child to rest at home for the first 48 hours after surgery. Activity may be slowly increased as your child’s strength increases. There is no rule for the right time to go back to school, but a guideline is seven to 10 days after the tonsils are taken out. Rough play and contact sports should not be allowed until 14 days after tonsil or adenoid surgery.
Pediatric Ear, Nose and Throat Clinic
6400 Fannin St. Suite, 2700
Houston, Texas 77030
Phone: (713) 486-5000
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