Tonsil & Adenoid Removal: What Parents Need to Know

When parents are told that their child needs their tonsils or adenoids removed, they understandably have many questions and concerns.

Jay Shah, MD, pediatric ear, nose and throat specialist at University Hospitals Rainbow Babies & Children's, explains the benefits and risks of tonsillectomy and adenoidectomy and why one or both might be recommended for your child.

What Are the Tonsils and Adenoids?

“Tonsils and adenoids are part of the body’s immune system. Made of lymphatic tissue, these small structures help to fight infection by acting as filters, capturing and killing bacteria that enter through the nose and mouth,” says Dr. Shah.

The tonsils are located high in the back of the throat and can be seen during an oral exam. The adenoids are even higher up, in the membrane-lined cavity behind the nose. Adenoids can only be seen by using a special instrument called an endoscope that is inserted through the nose. Sometimes, an X-ray may also be done to check the size of the adenoids.

When the tonsils or adenoids become enlarged or infected, your child may experience any combination of the following symptoms:

• Sore throat
• Fever
• Swollen lymph nodes
• Mouth breathing/bad breath
• Nasal congestion
• Snoring and/or sleep apnea
• Ear aches

When Is Tonsillectomy Recommended?

Before the advent of modern antibiotics, tonsils were routinely removed if children were getting frequent infections like tonsillitis or strep throat. Today, bacterial infections can be treated with antibiotics, so tonsillectomy is not the first line of defense.

“However, the overuse of antibiotics is not a good thing. It can even be dangerous,” says Dr. Shah. “So now we closely track how many infections a child is getting before we consider surgery. Typically, if they get seven infections in a year or have had 10 within the last three years, tonsillectomy might be recommended.”

Many parents may wonder, if tonsils are there to catch and kill bacteria, will removing them leave their child more vulnerable to infections?

“Not necessarily,” says Dr. Shah. “Frequent, recurring infections can erode and weaken the outer wall of the tonsils. Over time, they become much less effective in fighting bacteria and may actually become somewhat of a breeding ground for them. For these patients, no tonsils are better than flawed tonsils,” he adds.

When Is Adenoidectomy Recommended?

Adenoids can become enlarged and swollen due to recurring infections or allergies. In some children, even after the infection is gone or the allergies are managed, the adenoids remain enlarged and may partially block the nasal passages. In other cases, the adenoid tissue may hold bacteria and cause recurring adenoiditis, which is often misdiagnosed as a sinus infection.

If chronic adenoiditis becomes a problem or if adenoid-related sleep apnea is diagnosed, your doctor may recommend removing or shrinking the adenoids with a variety of different techniques.

Adenoids typically shrink and disappear completely after puberty. Therefore, the decision to surgically remove them in childhood is highly personalized to each patient based on the severity of symptoms and the extent to which side effects like sleep apnea are affecting their quality of life.

The Procedures: What to Expect

Tonsillectomy and adenoidectomy are both done under general anesthesia. “Typically, they are outpatient procedures and the child goes home the same day; however, if sleep apnea or other medical conditions are present or the child is under three, I may keep them overnight to monitor their recovery,” says Dr. Shah.

“After tonsillectomy, I’m always upfront with parents and the child, telling them that their throat will be very sore for up to two weeks after the operation,” says Dr. Shah. “Swallowing will be painful so children may be reluctant to eat or drink anything, putting them at risk for dehydration. Stock up on popsicles, Jell-O, ice cream and smoothies,” he advises. “When they’re ready for solid food, keep it soft and bland for two weeks – mashed potatoes, soft fruit, yogurt, soup and well-cooked vegetables are good choices.”

If just the adenoids are removed, most children will only have mild post-operative pain for a few days. There are no specific dietary restrictions and your child can begin to eat a normal diet whenever they feel ready.

Making the Decision

The decision to remove the tonsils or adenoids – or both – is based on each child’s unique situation. “It’s not like peanut butter and jelly – if one comes out, it doesn’t always mean the other must,” says Dr Shah. “If sleep apnea and snoring are the main concern, they’re often both removed but if recurring tonsil infections are the only issue, I leave the adenoids alone,” he adds.

“I will always have an in-depth conversation with the parents before moving ahead with either surgery. It really is a shared-decision-making process based on the individual child, their symptoms and the comfort level of the parents. If the child has other medical conditions, I may recommend a sleep study be done before proceeding.”

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University Hospitals Rainbow Babies & Children’s has a team of pediatric otolaryngologists with the expertise to diagnose and treat enlarged and/or infected tonsils and adenoids in children and adolescents. They can also manage associated conditions like sleep apnea.