TONSILLECTOMY AND ADENOIDECTOMY
WHAT ARE TONSILS AND ADENOIDS
Tonsils
and adenoids are masses of tissue that are similar to the lymph nodes or
"glands" found throughout our body. Tonsils are located on each side
of the back of the throat. Adenoids are high in the throat behind the nose and
the roof of the mouth (soft palate) and are not visible through the mouth
without special instruments. The function of tonsils
and adenoids are to catch incoming germs while we breath. Children who must have their tonsils and
adenoids removed do not have a greater incidence of infection following surgery.
INDICATIONS
FOR SURGERY
·
Obstructive
Sleep Apnea
For some children, the tonsils and
adenoids become so enlarged that they are causing obstructive problems during
your child’s sleep. Common symptoms
include snoring, very restless sleep (tossing and turning), frequent arousals,
fatigue or hyperactivity during the day.
A common cycle occurs…as your child slips into a deep sleep, the tonsils
relax and obstruct the airway, your child’s oxygen saturation decreases, as a
result your child’s brain responds by arousing your child. Your child then moves and self arouses, and
goes into a light sleep. This cycle
continues all night, not allowing your child the deep sleep (REM sleep) they
require. Some parents will hear pausing
or gasping during this cycle. Lack of
sleep has been shown to impact negatively on school performance, concentration
and behavior.
·
Recurring
infections
There are some children who are
prone to recurrent streptococcal throat infections. Streptococcal infections are something that
must be treated with antibiotics due to the potential risks of the
infection. Removing the tonsils will
greatly decrease the incidence of strep throat.
Other children who have recurring sore throats and tonsillitis may
benefit from the surgery for quality of life reasons.
·
Less commonly tonsils are
removed for other reasons:
Enlargement of one of the tonsils,
even without obstructive of infectious symptoms.
Dysphasia or difficulties with
swallowing due to tonsil tissue.
RISKS
As with any surgery, there are some associated risks.
·
Your child will receive general anesthesia for the procedure.
There is a very small risk of a complication occurring as the result of
anesthesia. However, every precaution to
taken to ensure the safety of your child.
·
There is a 1% chance of postoperative bleeding which would require
a trip back to the hospital for evaluation and possible return to the operating
room. There are two times when the risk
for bleeding is greatest. The first occurs
during the first day following the operation.
The second occurs 5-7 days following the surgery as healing scabs on the
tonsils fall off. Children who are well
hydrated and are eating well will have less of a chance of this happening.
·
All children will have postoperative pain and
discomfort following the surgery. Some of the common complaints
following the surgery may include a very sore throat, neck pain, ear pain,
fever, night terrors, nausea, very bad breath.
We will give you a prescription for Tylenol and Codeine that should be
taken every 4 hours as needed, to help relieve the discomfort. 24 hours following the surgery, you may give
your child Motrin to help with the discomfort.
We will also prescribe an antibiotic to help lessen the bad breath.
SO MY CHILD NEEDS SURGERY, WHAT IS THE
NEXT STEP…
·
Choose the date. You
can pick the date you would like during your appointment with us, or just give
us a call.
·
A preoperative tour is available for you and your child if you are
interested. We strongly recommend taking advantage of this tour. During the tour, your child will meet with a Child
Life Specialist (if age appropriate) who will help prepare your child for
surgery using age appropriate play and descriptions. You will also meet
with a pediatric anesthesiologist and pediatric nurse. To schedule an appointment, please call
688-7996.
·
All the appropriate paper work will be completed during your visit
with us, and in most cases, there is no need for further preoperative physicals
or paperwork prior to the surgery.
THE DAY OF SURGERY….
·
The
surgery is preformed in the Pediatric Operating Room at Yale. The procedure will take approximately 30-40
minutes. Your child will receive an (IV)
intravenous in order to receive medication and fluids during the surgery. Following the operation, your child will go
to the pediatric recovery room (PACU or Post-Anesthesia Care Unit). You can be with your child at this time. Some children are disoriented and upset as
they come out of the anesthesia. This is
normal. Your child will be ready to go
home once they are drinking and acting like themselves again. This normally takes an hour or two. You will be given 2 prescriptions, an
antibiotic and one for pain medicine.
Please take as directed.
·
Children
under the age of two will be required to stay in the hospital overnight. If your child is between the ages of 2 and 3,
come prepared to spend the night in the hospital, however if your child is
recovering well, we will be able to send your child home.
WHAT TO
EXPECT FOLLOWING SURGERY…
·
There are no limitations in diet following the surgery. If fact, children who eat and drink well have a quicker, easier
recovery. They may eat or drink anything that they
want… just as long as they eat and drink. Ensure that they are taking their pain
medicine. This will make it easier for
them to eat.
·
Narcotics are very effective in reducing the pain. However, it does make some children feel
nauseous or ‘funny’. You may give your
child Ibuprofen (Motrin) 24 hours following surgery. This is very effective in controlling the pain.
·
There
are no limitations in activity. Children
will self limit themselves. Most
children will return to school and other extracurricular activities about one
week after surgery. However, they may
return sooner if they are feeling up to it.
·
It generally takes children about 7-10 days to feel better
following the surgery. They can feel quite miserable and it is not
uncommon to have many of the following complaints…
o
Fever,
even up to 102. Ensure your child is
receiving Tylenol. Please call us if
your child has a persistent fever over 101.5 for more than 48 hours.
o
Horribly
bad breath. This is very common
following the surgery. It can last up to
a couple of weeks. The antibiotic that
your child will be taking will help to reduce the odor. You can also use breath mints or gum and
ensure proper mouth care.
o
Snoring. Some children may snore initially following
surgery. This occurs due to swelling and
usually resolves in the first week.
o
Voice
changes. It is common for children to
have a temporary change in their voice.
It will return to normal with time.
o
Stiff/sore
neck. This may occur as a result of
positioning during surgery. Warm soaks,
Tylenol or Motrin and range of motion exercises of the head will help to reduce
the discomfort.
o
Pain
or popping in the ears.
o
Night
terrors.
SITUATIONS THAT NEED
MEDICAL ATTENTION
·
If your child has any
bleeding (from the mouth or nose or vomiting blood), go to the emergency room.
·
If your child has not
voided in 24 hours, please call us or go to the emergency room.
·
If your child has a fever
greater that 101.5 for more than 48 hours, please call us.
FOLLOW-UP
·
All
the postoperative visits are scheduled with one nurse practitioners, Wendy
Mackey or Lisa Gagnon. We would like to see your child three
to six weeks following the surgery for a postoperative check. Please call (203) 245-0496 to schedule an
appointment.
If you
ever have questions or concerns, we would be happy to talk to you or see your
child at any time. (203) 245-0496