Tonsil and Adenoid Removal (Tonsillectomy and Adenoidectomy)

What is a tonsillectomy and adenoidectomy?

A tonsillectomy and adenoidectomy (T&A) is surgery that is done to remove the tonsils and adenoids. Each person has 2 tonsils, one on each side of the back of the throat. They look like reddish, oval-shaped masses and are easy to see. The adenoids are high in the throat behind the nose and the roof of the mouth and cannot be seen without special equipment. The tonsils and adenoids help the body fight respiratory infections, such as colds. However, they can be removed without changing the body's ability to fight infection.

There are different methods for removing the tonsils and adenoids:

• The tonsils can be cut out with a scalpel and the blood vessels sealed with electrical cautery or tied with stitches that will dissolve.
• Tonsil removal and the sealing of blood vessels can also be done with a laser or radio frequency generator.
• A third method uses a device that quickly bites away small pieces of the tonsils, letting the small blood vessels seal them selves.

Each method has its own benefits and risks. Ask your healthcare provider which method will give you the best combination of complete removal of the tonsils, minimal bleeding, and the least pain.

When is it used?

Reasons for removing the tonsils or adenoids are:

• trouble breathing at night because of enlarged tonsils or adenoids
• frequent infections of the tonsils (more than 7 serious infections of the tonsils in a year; or 4 infections each year for 2 years in a row)
• an abscess (a build-up of pus) around one or both tonsils
• the strep carrier state, which means that strep bacteria are living in the tonsils and adenoids and the bacteria are causing repeated infections or spreading infection to other people
• trouble swallowing because of enlarged tonsils
• possible cancer of the tonsils.

How do I prepare for a tonsillectomy and adenoidectomy?

Be sure you understand the reason for the surgery and ask any questions that you have. Plan for your care and recovery after the operation. Find someone to drive you home after the surgery. Allow for time to rest and try to find people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you are taking daily aspirin for a medical condition, ask your provider if you need to stop it before your surgery. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery.

Follow any other instructions your provider may give you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

Before the operation starts, you will be given a general anesthetic. This drug relaxes your muscles and puts you to sleep. It will keep you from feeling pain during the procedure.

Your healthcare provider will use a device to keep your mouth open. Then he or she will remove the tonsils and/or adenoids from the surrounding tissues. The surgeon may use stitches or a burning tool (cautery) to help stop any bleeding. The device that kept your mouth open will then be removed.

What happens after the procedure?

You may go home later that day or stay in the hospital overnight and go home the next day, depending on your condition. You will have a sore throat and be uncomfortable for about 7 to 10 days. It will hurt to swallow. Spend this time at home and avoid all strenuous activity for at least 2 weeks. There may be some change in your voice due to the removal of your tonsils and adenoids. This is normal.

Ask your healthcare provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

This procedure helps prevent repeated bouts of tonsillitis. Breathing or swallowing problems will get better. If you had cancer in the tonsils, removing them may remove the cancer, but you may need other treatment as well.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Talk about these risks with your healthcare provider.
• The most common risk is that as your throat heals and the scabs come off, your throat may bleed. If this happens, spit the blood out. Don’t swallow it.
• The device used to keep your mouth open during the operation may cause some numbness or soreness in your tongue.
• You may become dehydrated if you are unable to swallow.
• You may have infection or bleeding. You might need more treatment, possibly surgery, to stop bleeding.
• If there was cancer, not all of the cancer may be removed. The cancer may grow back.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever over 100°F (37.8°C).
• You have bleeding that lasts for more than 10 to 15 minutes.
• You become dehydrated.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.