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Adenoid and tonsil removal
This factsheet is for people who are having their adenoids and/or tonsils removed, or who would like information about it.
This factsheet is relevant for adults who are having their adenoids and/or tonsils removed and for parents of children who are having the operation. However, for simplicity, we refer to 'you' throughout.
Adenoids and tonsils are small lumps of tissue at the back of the nose and throat. An operation to remove the tonsils is called a tonsillectomy and an operation to remove the adenoids is called an adenoidectomy. An operation to remove both is called an adenotonsillectomy.
You will meet the surgeon carrying out your operation to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.
The adenoids and tonsils
About adenoid and tonsil removal
What are the alternatives to having your adenoids and tonsils removed?
Preparing for your operation
About the operation
Animation – How an adenotonsillectomy is carried out
What to expect afterwards
Recovering from adenoid and tonsil removal
What are the risks?
The adenoids and tonsils
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 apnoea.
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.
About adenoid and tonsil removal
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.
What are the alternatives to having your adenoids and tonsils removed?
Painkillers and antibiotics provide temporary relief, but 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 GP for more advice.
Preparing for your operation
If you have a cold or infection in the week before your operation, it’s important to let the hospital know. The operation may need to be postponed until you have fully recovered.
Your surgeon will discuss with you what will happen before, during and after your operation, and any pain you might have. You can ask 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 to go ahead, which you may be asked to do by signing a consent form.
The operation is done under general anaesthesia. 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. However, it’s important to follow your surgeon’s advice.
At the hospital, a nurse may check your heart rate and blood pressure, and test your urine.
About the operation
The operation usually takes about 30 minutes but this will depend on whether you’re having your tonsils or adenoids removed, or both.
There are several methods available for removing your tonsils and adenoids including the following.
- Traditional method – your surgeon carefully cuts your tonsils and/or adenoids out using specialised instruments. He or she applies pressure to stop the bleeding, and dissolvable stitches or heat are used to seal the wound.
- Lasers or ultrasound waves – your surgeon uses high-energy waves to cut out your adenoids and/or tonsils and seal the blood vessels to stop bleeding.
- Diathermy – your surgeon uses heat from an electric current to cut out your adenoids and/or tonsils and seal the blood vessels.
- Power-assisted adenoidectomy – your surgeon uses a microdebrider (a powered instrument with a very small rotating tip) to remove your adenoids.
How an adenotonsillectomy is carried out
What to expect afterwards
You will need to rest on your side until the effects of the anaesthetic have passed. Try to drink and eat as soon as you feel ready.
You will usually be able to go home when you feel ready, unless your surgeon feels you should stay overnight. Before you go home, a nurse will give you a date for a follow-up appointment.
You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.
Recovering 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. Your surgeon may prescribe pain killers and antibiotics. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Try to drink enough fluids and eat normally. If it’s 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 GP or hospital immediately.
A complete recovery can take two weeks.
What are the risks?
Operations to remove your adenoids and tonsils are commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.
Side-effects
Side-effects are the unwanted but mostly temporary effects you may get after having the operation. Common side-effects 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
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, 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
The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.
Tags:
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
How soon can I give my child something to eat and drink after an operation to remove the adenoids and tonsils?
Will an adenotonsillectomy affect my child's voice?
Will an adenotonsillectomy stop my child from snoring?
Will an adenotonsillectomy stop my hay fever?
What's the difference between a tonsillectomy, adenotonsillectomy and an adenoidectomy?
How soon can I give my child something to eat and drink after an operation to remove his or her adenoids and tonsils?
Your child will usually be allowed to drink fluids as soon as he or she has recovered from the general anaesthetic. You should try to get your child back to his or her usual diet as soon as possible.
Explanation
After an operation to remove his or her adenoids and/or tonsils, your child will have a sore throat and will find it painful to swallow during the first few days. Giving your child painkillers such as paracetamol half an hour before meal times will make it easier for him or her to swallow. Start with bland rather than spicy food for a few days because spicy foods can irritate your child’s healing wound.
Make sure your child eats a healthy balanced diet. A healthy diet will help your child to recover quickly because his or her body needs a good source of nutrients to maintain a healthy immune system and to repair tissue. A poor diet can increase your child's risk of developing an infection and delay healing.
Encourage your child to eat by keeping his or her meals varied and simple, and try to limit snacks between meals. It's also important to get your child to drink regularly. Encourage your child to drink fruit juice, milk or water.
Further information
- Food Standards Agency
- British Nutrition Foundation
020 7404 6504
www.nutrition.org.uk
Sources
- Adenoid surgery. ENT UK. www.entuk.org, accessed 29 October 2009
- Tonsil surgery. ENT UK. www.entuk.org, accessed 29 October 2009
- Starchy foods. Food standards Agency. www.eatwell.gov.uk, accessed 10 November 2009
- What are nutrients? British Nutrition Foundation. www.nutrition.org.uk, accessed 10 November 2009
Will an adenotonsillectomy affect my child's voice?
Your child's voice may sound different for a short while after the operation. However, it’s unlikely that the operation will have any long-term effects on his or her voice.
Explanation
Your larynx, or voice box, sits at the entrance to your trachea (windpipe). It functions as an airway to your lungs, and stops food and drink going into your windpipe when you swallow.
Your voice consists of a tone produced by your larynx, which is modified by the resonating chamber including the tongue, teeth, lips and nose. Some temporary changes may occur because the adenoids and tonsils lie close to the larynx and nasal passage. Swelling in the area may affect your child’s voice after their operation. Your child may temporarily sound as if he or she is talking through his or her nose. This usually settles within a few weeks. However, if voice changes persist for more than three weeks, contact your ENT surgeon.
Further information
The British Voice Association
020 7713 0064
www.british-voice-association.com
Sources
- Adenoid surgery. ENT UK. www.entuk.org, accessed 29 October 2009
- Adenoidectomy. eMedicine. www.emedicine.medscape.com, accessed 10 November 2009
- Mora R, Crippa B, Dellepiane M et al. Effects of adenotonsillectomy on speech spectrum in children. Int J Pediatr Otorhinolaryngol 2007; 71(8) 1299-304. doi:10.1016/j.ijporl.2007.05.005
Will an adenotonsillectomy stop me snoring?
Removing your adenoids can help reduce snoring but may not completely cure it.
Explanation
Snoring is noisy breathing through your mouth and nose during sleep. Snoring happens when air doesn't flow smoothly through your air passages, or when the soft tissues or muscles in your air passages vibrate. Infected tonsils or adenoids can narrow your airway and make you snore during sleep. There are, however, several other reasons that may be causing you to snore.
- Sinus congestion. You’re likely to have a blocked, itchy and runny nose if you suffer from frequent coughs and colds or have allergies. The lining of your nose and throat may also be swollen. This interferes with sleep and makes you more likely to snore.
- Smoking or passive smoking. Cigarette smoke can irritate your nose and throat, making snoring more likely.
- Sleeping position. If you sleep flat on your back, your tongue is more likely to fall back into your throat and block your airway, making snoring more likely.
- Obesity. If you’re overweight, you’re more likely to snore.
- Medical conditions. Asthma can cause snoring.
If your snoring is being caused by any other reason than enlarged tonsils or adenoids, removing these won't cure the problem. Ask your GP for advice.
Further information
- ENT UK
Sources
- Lim J, McKean MC. Adenotonsillectomy for obstructive sleep apnoea in children. Cochrane Database of Systematic Reviews 2009 Issue 2. doi: 10.1002/14651858.CD003136.pub2.
- The effectiveness of tonsillectomy and adenoidectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: a meta-analysis. Centre for Reviews and Dissemination, 2008. www.crd.york.ac.uk
- Guidelines for GPs and other doctors The Sleep Apnoea Trust. www.sleep-apnoea-trust.org, accessed 10 November 2009
- Who gets sleep apnoea? The Sleep Apnoea Trust. www.sleep-apnoea-trust.org, accessed 10 November 2009
- Service framework for respiratory health and wellbeing. Department of Health Social Services and Public Safety for Northern Ireland, November 2009. www.dhsspsni.gov.uk
- Marshall NS, Almqvist C, Grunstein RR et al. Predictors for snoring in children with rhinitis at age five. Pediatr Pulmonol 2007; 42:584-91. doi: 10.1002/ppul.20606
- Adenoid hypertrophy. GP Notebook. www.gpnotebook.co.uk, accessed 29 October 2009
Will an adenoidectomy stop my hay fever?
There is no evidence to suggest that an adenoidnectomy will stop hay fever.
Explanation
Hay fever (also known as seasonal allergic rhinitis) means you’re allergic to pollen and/or fungal spores. Some of the symptoms of hay fever include sneezing, a runny nose and itchy eyes.
Enlarged adenoids may cause symptoms that are similar to hay fever such as a blocked or runny nose, sore throat and feeling unwell, but they are unlikely to cause sneezing or itchy eyes. There is no evidence to suggest that removing your adenoids will help improve hay fever.
If you have hay fever, there is a range of treatments available and you can buy some of these medicines over-the-counter. Always read the patient information leaflet that comes with your medicine, and if you have any questions ask your GP or pharmacist for advice.
Further information
- Allergy UK
01322 619898
www.allergyuk.org
Sources
- Hay fever. GP Notebook. www.gpnotebook.co.uk, accessed 10 November 2009
What's the difference between a tonsillectomy, adenotonsillectomy and an adenoidectomy?
If only your tonsils are removed, the operation is called a tonsillectomy. If both your tonsils and adenoids are removed, the operation is called an adenotonsillectomy. If only your adenoids are removed, the operation is called an adenoidectomy.
Explanation
Your adenoids and tonsils are small lumps of tissue that help fight ear, nose and throat infections. Your adenoids lie where your throat meets the back of your nose. Your tonsils lie at the back of your throat, one at each side.
When you have a cold or a throat infection your adenoids and tonsils can become infected and swell up, causing symptoms such as a sore throat, headache and fever. They can also 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 and tonsils can stop you breathing for a short time during sleep – this is known as sleep apnoea.
Swollen adenoids can also block your eustachian tube, which is 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 delays in learning.
If you suffer from sleep problems due to a blocked nose, or if you have recurrent or persistent sore throats and ear infections, your doctor may recommend that you have both your adenoids and tonsils removed in an adenotonsillectomy. Alternatively, your doctor may recommend that you have just your tonsils removed (tonsillectomy) or just your adenoids (adenoidectomy).
Most operations to remove the tonsils and adenoids are done in children but adults can have these operations too.
Further information
ENT UK
020 7404 8373
www.entuk.org
Related topics
Adenoiditis
Antibiotics
General anaesthesia
Glue ear
Middle ear infection in children
Sleep apnoea
Tonsillitis
X-ray
Sources
- Adenoid surgery. ENT UK. www.entuk.org, accessed 29 October 2009
- Tonsil surgery. ENT UK. www.entuk.org, accessed 29 October 2009
- Adenoid hypertrophy. GP Notebook. www.gpnotebook.co.uk, accessed 29 October 2009
- Enlarged adenoids. MedlinePlus. www.nlm.nih.gov, accessed 29 October 2009
- About tonsillectomy and adenoidectomy. American College of Surgeons. www.facs.org, accessed 29 October 2009
- Suction diathermy adeniodectomy. National Institute for Health and Clinical Excellence (NICE), 2009. www.nice.org.uk
- Otitis media with effusion in children. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, accessed 29 October 2009
- Recurrent throat infections (tonsillitis). BMJ Clinical Evidence. www.clinicalevidence.bmj.com, accessed 29 October 2009
- Burton MJ Glasziou PP. Tonsillectomy or adeno-tonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database of Systematic Reviews 2009, Issue 1. doi: 10.1002/14651858.CD001802.pub2.
- Zhang L, Mendoza-Sassi RA, César JA et al. Intranasal corticosteroids for nasal airway obstruction in children with moderate to severe adenoidal hypertrophy. Cochrane Database of Systematic Reviews 2008, Issue 3. doi: 0.1002/14651858.CD006286.pub2
- Adenoidectomy. Canadian Society of Otolaryngology. www.entcanada.org, accessed 10 November 2009
- Tonsillectomy using ultrasonic scalpel. National Institute for Health and Clinical Excellence (NICE), 2006. www.nice.org.uk
- Adenoidectomy. eMedicine. www.emedicine.medscape.com, accessed 10 November 2009
This information was published by Bupa’s Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: April 2010.
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