Do your child's tonsils or adenoids need to be removed?
Tonsils and adenoids are a type of tissue that helps filter bacteria and viruses. Tonsils are small, round pieces of tissue located in the back of the mouth on both sides of the throat, whereas adenoids are similar to tonsils but located in back of the nasal cavity.
Removal of a child's tonsils and/or adenoids may be recommended if they are experiencing repeated infections caused by inflammation - known as tonsillitis and adenoiditis - and have not responded to alternate treatments.
Lurie Children's otorhinolaryngology (head and neck) surgeons Drs. Doug Johnston and Taher Valika explain what might indicate to caregivers that removal is needed, and what these routine surgeries look like.
"Most commonly, tonsils and adenoids are removed because they are enlarged and causing an airflow blockage in the back of a child's throat (tonsils) or nose (adenoids) when they are sleeping," Johnston said. "This blockage causes snoring in the child. In some cases, the snoring is mild, but in others it can cause a significant impact on the child's sleep quality and even on their health and behavior."
The brief but continual breathing blockages during sleep is known as obstructive sleep apnea (OSA) and can greatly impact a child's developing heart and lungs, and overall development. Consistent and excessive snoring in a child, accompanied by OSA, is one of the most reported symptoms leading to a tonsillectomy or adenoidectomy.
Some children may also experience recurrent tonsil infections, which is another sign to otorhinolaryngologists that more significant intervention might be necessary. Based on the severity, these might look like any combination of fever, sore throat, bad breath, difficulty or painful swallowing, dehydration, tender lymph nodes in the neck, mouth breathing, snoring or sleep apnea, tiredness; and white patches, pus and/or redness of the tonsils.
The American Academy of Otolaryngology recommends the following guidelines in determining if tonsil infections are considered "recurrent."
• Seven or more sore throats in one year
• Five or more sore throats per year in the past two years
• Three of more sore throats per year in the past three years
"In these instances, tonsillectomies and adenoidectomies can greatly improve a child's quality of life and it offers them the opportunity to avoid recurrent antibiotic use," Valika said.
Tonsil and adenoid infections, also known as tonsillitis and adenoiditis, are caused by bacteria and viruses.
"Many infections are passed between people, just like the common cold. Some children, however, are more prone to these infections compared to others," Valika said. "The tonsils and adenoids are responsible for filtering bacteria and viruses before they make it to the rest of your body, which is why having a sore throat is such a common symptom of tonsillitis and adenoiditis."
Tonsil and/or adenoid removal is a quick outpatient procedure at Lurie Children's, lasting around 30 to 45 minutes. Children are fully asleep under general anesthesia, which has proved to be an overwhelmingly safe approach. The procedure is conducted entirely through the patient's mouth, and therefore no cuts are made to the skin.
Luckily, our bodies have plenty of other tissue that also play a role in filtering bacteria and viruses, so the immune system is not weakened by tonsil and/or adenoid removal.
"Post-op, our pediatric anesthesia team are experts in determining the best pain medication and supplemental medication to improve the way children feel during recovery," said Valika. "Once your child wakes up, we make sure they are eating, drinking and the pain is relatively controlled before you even go home."
The doctors said the majority of tonsillectomy and adenoidectomy patients go home the same day as their surgery, and just a few are kept overnight for observation for special circumstances.
When it comes to recovery, Johnston and Valika say it's comparable to a bad sore throat.
"Younger children have an easier time recovering from this procedure than older children," Johnston said. "In most cases, children can eat whatever they prefer after surgery, but a combination of soft and soothing things like Popsicles, milkshakes and ice cream, can go a long way. Drinking plenty of liquids afterward also tends to make discomfort better."
Regardless of age, Johnston and Valika recommend pursuing tonsil and/or adenoid removal if they're presenting consistent discomfort, pain or affecting one's quality of life. Learn more about Lurie Children's Division of Otorhinolaryngology at www.luriechildrens.org/en/specialties-conditions/pediatric-ent-otolaryngology.
• Children's health is a continuing series. This week's article is courtesy of Ann & Robert H. Lurie Children's Hospital of Chicago. For more information, visit www.LurieChildrens.org.