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28 Jan 2012

Adenoid and Tonsil Removal

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style="font-family: arial; font-size: 10pt"Adenoids and tonsils are small lumps of tissue that help fight ear, nose and throat infections in younger children. Your adenoids lie where your throat meets the back of your nose. Your tonsils lie at the back of your throat, one on each side. Adenoids and tonsils usually reach their maximum size in children aged three to five. They begin to shrink by age seven and can hardly be seen by your late teens. 

When you have a cold or a throat infection, your adenoids and tonsils can become infected and swell up, causing symptoms such as a blocked nose and a sore throat. They can block your airways, making it difficult for you to breathe, especially when you're asleep. This can cause problems such as snoring. In severe cases, swollen adenoids or tonsils can stop you breathing for a short time while you're asleep - this is called sleep apnea.    

Swollen adenoids can also block your Eustachian tube (the tube that connects the back of your throat to the middle part of your ear). This can lead to ear infections and a build-up of sticky fluid in your ear - called glue ear. This can make it difficult to hear properly and, as a result, can cause learning delays in children.    
 
An operation to remove your tonsils is called a tonsillectomy and an operation to remove your adenoids is called an adenoidectomy. An operation to remove both is called an adenotonsillectomy. Most operations to remove the tonsils and adenoids are done in children but adults can have these operations too.     

Having your tonsils removed can be a very effective treatment for recurrent and persistent sore throats. Likewise, having your adenoids removed is an effective treatment for recurrent ear infections and nasal blockage caused by enlarged adenoids. However, surgery isn't always needed for children as they often 'grow out of' these problems.    
 
Although painkillers and antibiotics provide temporary relief, they aren't normally used for long-term treatment. In children, the adenoids and tonsils shrink as they get older, so an operation isn't always necessary. If children have enlarged adenoids and these block the airways in their nose, treatment with medicines called steroids may relieve the problem. Ask your doctor for more advice.    
 
If an operation is unavoidable, ask your surgeon questions about the risks, benefits and if there are any alternatives to the procedure. This will enable you to give your informed consent for the procedure.
 
The operation is done under general anesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. The operation usually takes about 30 minutes but this will depend on whether you're having your tonsils or adenoids removed, or both. 

The traditional method for removing your tonsils and adenoids is  when the tonsils and/or adenoids are cut out using specialized instruments, and dissolvable stitches or heat are used to seal the wound. Newer methods use lasers or ultrasound waves, diathermy where heat from an electric current is used or power-assisted adenoidectomy which uses a microdebrider (a powered instrument with a very small rotating tip).
    
Recovery from Adenoid and Tonsil Removal
- You should rest for around a week and stay at home. Keep away from crowded and smoky places and from people with coughs and colds.    
- You may have a sore throat, earache and a stiff jaw for the first week or two. You may be prescribed pain killers and antibiotics.     
- Try to drink enough fluids and eat normally. If it is uncomfortable to eat, it may help to take a painkiller (such as paracetamol) half an hour before meals. Don't take aspirin as it may make you bleed.    
- A white or yellowish membrane will appear as your skin heals where your tonsils were.    
- If you notice any bleeding from your throat or nose, contact your doctor immediately.    
- A complete recovery can take two weeks.    

Risks
Operations to remove adenoids and tonsils are commonly performed and generally safe. However, you need to be aware of the possible side-effects and the risk of complications which may include:     
- a sore throat, earache and stiff jaw
- a blocked nose - this usually clears within a week or so
- a change in your voice - you may sound like you're talking through your nose, this can last a few weeks

Complications
The possible complications of any operation include an unexpected reaction to the anesthesia, excessive bleeding or infection. Specific complications of operations to remove the adenoids and/or tonsils are rare but include:    
- bleeding after the operation.
- damage to your teeth or jaw - this can be caused by the instruments used to keep your mouth open during surgery.
- chest infection and breathing problems - there's a risk that blood and tissue from the operation may get into your throat and down into your lungs.  
- damage to the muscle in the roof of the mouth - this can cause a long-term change in your voice.
- injury to your Eustachian tube.

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