Tonsillectomy
A tonsillectomy is commonly performed to improve breathing and decrease sings of upper airway obstruction. Common signs include restless sleep, neck arching during sleep, snoring and difficulty swallowing chunky foods. It is also helpful for children who suffer from recurrent episodes of pharyngitis. The potential benefits of a tonsillectomy, usually in combination with an adenoidectomy, must be weighed against potential risks and the overall discomfort associated with having the procedure performed.
Children between the age of 3 and 6 years are at highest risk for tonsil and/or adenoid enlargement that is commonly called hypertrophy. Tonsil size generally decreases after age 8 years. This is why many children who snore prior to age 8 stop snoring by their teen years. If your child has upper airway symptoms with associated sleep apnea then the benefits of surgery clearly outweigh any risks. Snoring alone is not enough of an indication for the surgery. If the complaints listed above are present as well as other complaints including daytime sleepiness, academic difficulties, attention difficulty, enuresis or behavioral problems then surgery should be strongly considered. Children whose BMI is above the 95th% are considered severely overweight (obese). Their symptoms of nighttime upper airway obstruction are less often cured by adenotonsillectomy. Pre-operative sleep studies can often assist decision making on whether to perform surgery on these children.
In addition to the above upper airway obstruction indications children who have 7 episodes of severe recurrent sore throats in 1 year, 5 episodes in 2 consecutive years or 3 episodes in 3 consecutive years are candidates for surgery.
The greatest risk with surgery is the postoperative pain. Bleeding occurs in up to 5% of cases and the general anesthesia can cause transient post-operative disorientation, nausea and vomiting. A single dose of intraoperative dexamethasone has been shown to decrease postoperative nausea and vomiting.
The best way to prevent and manage any post-tonsillectomy problems is through good perioperative care. Make the doctor aware of any obstructive sleep issues or any accompanying medical problems including obesity, sickle cell disease, blood problems, heart problems, heart arrhythmias, craniofacial abnormalities or a family history of anesthesia problems.
After surgery a clot composed of fibrin, inflammatory cells and bacteria will coat the area where the tonsils were removed. This clot will come off after about 1 week and can be associated with delayed bleeding. The area will heal over 2-3 weeks.
Pain is usually intense on day 1 and decreases over the next week. There may be a period of increased pain on day 3 after surgery. This increase is associated with the intense healing and inflammation. The pain is usually gone by 2 weeks. Pain is worse if associated with anxiety. Age and prior experience with pain also affect the perception and severity of the pain. Ibuprofen is the present recommendation for pain management. Caution should be used with acetaminophen with codeine since some children over respond to the codeine and become over sedated. Rough foods and vigorous activity should be avoided after surgery. Your surgeon will give you instructions on returning to a regular diet and an active lifestyle.
