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Adenoid and tonsil removal

Adenoid and tonsil removal are procedures for removing small lumps of tissue at the back of your nose and throat. 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.

You will meet the surgeon carrying out your operation to talk about your operation and following care. It may be different from what we’ve described here because it will be designed to meet your individual needs.

Adenoids and tonsils are part of your immune system. They help fight ear, nose and throat infections especially in young 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.

Tonsil removal

Tonsil removal is one of the most commonly performed surgical operations. Around six in every 10 tonsillectomies are in children.

The main reason for removing your tonsils is because you keep having tonsillitis (inflammation of your tonsils). This causes a sore throat. In certain circumstances, your GP may refer you to an ENT surgeon (a doctor who specialises in identifying and treating conditions of the ear, nose and throat). He or she may offer you tonsil removal. This is most likely to happen in the following situations.

  • You have had tonsillitis more than seven times in the last year.
  • You have had tonsillitis five times or more in each of the last two years.
  • You have had tonsillitis three or more times in each of the last three years.
  • Your sore throat is severe enough to be disabling to you.
  • You have developed a quinsy (a collection of pus between a tonsil and the wall of your throat).

Having your tonsils removed as an adult can be an effective treatment for recurrent and persistent tonsillitis.

Adenoid removal

Most operations to remove adenoids are done in children.

Your child may be offered adenoid removal at the same time as having grommets inserted for glue ear. There is some evidence that this might improve your child’s hearing a little. However, it’s not clear whether the benefits of the procedure are enough to make it worthwhile.

There is no good evidence to show that adenoid removal will help if your child is having recurrent ear infections.

If your child has enlarged adenoids and tonsils, he or she may develop a condition called obstructive sleep apnoea – this causes breathing problems at night. If this happens, your surgeon may recommend adenoid and tonsil removal.

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How an adenotonsillectomy is carried out
Having your tonsils and adenoids removed can be an effective treatment for recurrent tonsillitis
An image showing the soft tissues of the mouth and throat

Details

  • Preparation Preparing for adenoid and tonsil removal

    Your surgeon will explain how to prepare for your procedure. 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.

    You will have the operation 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 anaesthetist’s advice.

    Your surgeon will discuss with you what will happen before, during and after your operation, and any pain you might have. If you have any questions at this stage, ask your surgeon – no question is too small and can help set your mind at ease. To confirm your consent for the procedure, you may be asked to sign a consent form.

  • Alternatives What are the alternatives to adenoid and tonsil removal?

    If you have tonsillitis, your GP may recommend painkillers such as ibuprofen or paracetamol. Antibiotics aren’t usually recommended to relieve the symptoms of tonsillitis. Your GP may offer antibiotics in certain situations, for example, if you have a raised temperature or swollen glands in your neck.

    Children’s adenoids and tonsils shrink as they get older, so an operation isn't always necessary. You may want to wait and see if the problem sorts itself out in time. Discuss the pros and cons of these procedures with your GP before making a decision.

  • The procedure What happens during adenoid and tonsil removal?

    The operation usually takes around 30 minutes but this will depend on whether you're having your tonsils or adenoids removed, or both.

    There are several different methods to remove tonsils and adenoids, which include the following.

    • Traditional method – your surgeon will carefully cut your tonsils and/or adenoids out using special instruments. He or she will apply pressure to stop the bleeding, and use dissolvable stitches or heat to seal the wound.
    • Diathermy – your surgeon will use heat from an electric current to cut out your adenoids and/or tonsils. He or she may gently suck the tissue out with a special instrument and will seal the blood vessels. A similar procedure, called coblation, uses lower temperatures to remove your adenoids and/or tonsils.
    • Lasers or ultrasound waves – your surgeon will use high-energy waves to cut out your adenoids and/or tonsils and will seal the blood vessels to stop any bleeding.
    • Power-assisted adenoidectomy – your surgeon will use a microdebrider (a powered instrument with a very small rotating tip) to remove your adenoids.
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  • Aftercare What to expect afterwards

    You may need to rest until the effects of the anaesthetic have passed. Try to drink and eat as soon as you feel ready.

    You may need pain relief to help with any discomfort as the anaesthetic wears off. You will usually be able to go home when you feel ready, unless your surgeon recommends that you stay overnight. Before you go home, a nurse will give you a date for a follow-up appointment.

    Make sure someone can take you home. And ask someone to stay with you for a day or so while the anaesthetic wears off.

    General anaesthesia temporarily affects your co-ordination and reasoning skills, so you mustn’t drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.

    If your surgeon used dissolvable stitches, the amount of time they will take to disappear depends on the type of stitches you have. Ask your surgeon for more information about when you can expect them to disappear.

  • Recovery Recovering after adenoid and tonsil removal

    It usually takes about a week or two to make a full recovery from adenoid or tonsil removal. However, this varies between individuals, so it's important to follow your surgeon's advice. Rest for this time and stay at home. Keep away from crowded and smoky places, and from people with coughs and colds.

    You may find that you feel discomfort for up to a week to 10 days after your tonsil removal. It’s not unusual for your pain to increase for up to six days after the operation. If you need pain relief you can take over-the-counter painkillers such as paracetamol or ibuprofen. Your surgeon may prescribe you stronger painkillers, as well as antiemetics (medicines that help stop you feeling sick). There’s no strong evidence that antibiotics will benefit you after tonsil removal. Always ask your doctor or pharmacist for advice and read the patient information leaflet that comes with your medicine.

    Try to drink enough fluids and eat normally. Eating normally will help your throat to heal. 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 cause bleeding. See our FAQs for more information about eating and drinking.

    Your throat may look white as your skin heals. If you notice any bleeding from your throat or nose, contact your GP or hospital immediately.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with having your adenoids and tonsils removed. We haven’t said how likely these are to happen as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Common side-effects include:

    • feeling sick
    • pain – which may increase after a few days then ease
    • earache and stiff jaw or neck
    • 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 for around two to four 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 or an infection. Specific complications of operations to remove the adenoids and/or tonsils are uncommon. They include the following.

    • You may bleed after the operation and this may need a second operation to stop it. This is more likely to happen after tonsil removal.
    • Your teeth or jaw may be damaged. This can be caused by the instruments that are used to keep your mouth open during surgery.
    • You may develop an infection where your tonsil and/or adenoid tissues were removed.
    • You may have breathing problems because of swelling in your throat, or because you inhale blood or bits of tissue during the operation.
    • You may become dehydrated and lose weight if pain stops you drinking and eating properly.
    • Your surgeon may not be able to remove your adenoid tissues completely. This means that it’s possible for your adenoids to grow back and cause symptoms again (but this is very unlikely).
  • Pros and cons Pros and cons

    This information is intended to help you understand the advantages and disadvantages of adenoid and tonsil removal. Think about how important each particular issue is to you. You and your doctor can work together to make a decision that's right for you. Your decision will be based on your doctor’s expert opinion and your personal values and preferences.

    Pros

    • Having your tonsils removed can be an effective treatment for recurrent and persistent tonsillitis.
    • If your child has breathing problems linked to obstructive sleep apnoea, having his or her adenoids and tonsils removed may reduce the symptoms.
    • Having adenoids removed at the same time as having grommets inserted for glue ear may help your child’s hearing improve a little.

    Cons

    • You will need to be off work, or your child will need to be away from school, for up to two weeks.
    • It’s not unusual for you to feel some pain requiring painkillers for up to 10 days after the operation, especially with tonsil removal.
    • There’s a small chance that you will have bleeding after tonsil removal which needs a second operation to stop it.
    • Your child’s adenoids and tonsils shrink as they get older, so an operation may not be necessary.
    • Your surgeon may not be able to remove your adenoid tissues completely. This means that it’s possible for your adenoids to grow back and cause symptoms again (but this is very unlikely).
  • FAQs FAQs

    How soon can my child eat and drink after an operation to remove their adenoids and tonsils?

    Answer

    Your child can usually drink fluids as soon as he or she has recovered the general anaesthetic. Try to get your child back to their usual diet as soon as possible.

    Explanation

    After an operation to remove the adenoids and/or tonsils, your child will have a sore throat and may find it painful to swallow during the first few days. Try giving your child painkillers (such as paracetamol) half an hour before meals as this should make it easier for him or her to swallow. Start with bland food for a few days because spicy foods may irritate your child's healing wound.

    Make sure your child eats a healthy, balanced diet.This will help your child to recover; their 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 meals varied and simple. It's also important to get your child to drink regularly. Encourage your child to drink fruit juice, milk or water.

    What's the difference between a tonsillectomy, adenotonsillectomy and an adenoidectomy?

    Answer

    If only your tonsils are removed, the operation is called a tonsillectomy. If only your adenoids are removed, the operation is called an adenoidectomy. If both your tonsils and adenoids are removed, the operation is called an adenotonsillectomy.

    Explanation

    Your adenoids and tonsils are small lumps of tissue that help fight ear, nose and throat infections when you’re a child. 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.

    Adenoids get smaller as you get older, but in some children they are enlarged which causes problems.

    Swollen or enlarged adenoids 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 or enlarged adenoids and tonsils can stop you breathing for a short time during sleep – this is known as sleep apnoea.

    Swollen or enlarged 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 delay learning in some children.

    Your surgeon may recommend that you have both your adenoids and tonsils removed in an adenotonsillectomy if you have:

    • trouble sleeping because of a blocked nose
    • reoccurring or persistent sore throats and ear infections,.

    Alternatively, your surgeon may recommend that you have just your tonsils removed (tonsillectomy) or just your adenoids (adenoidectomy).

    Most operations to remove tonsils and adenoids are done in children but adults can have these operations too.

    Will an adenoidectomy stop my hay fever?

    Answer

    There isn’t any evidence to suggest that an adenoidectomy will stop hay fever.

    Explanation

    Hay fever is an allergic reaction to pollen from grasses, weeds or trees, and also possibly to moulds that are carried in the air. This is usually during the spring and summer. These plants and moulds produce allergens – substances that can cause an allergic reaction. 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’s 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.

    Will an adenotonsillectomy affect my child's voice?

    Answer

    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 their voice.

    Explanation

    Your larynx, or voice box, sits at the entrance to your windpipe (trachea).

    Your voice consists of a tone that is produced by your larynx, which is modified by what’s called the resonating chamber including your tongue, teeth, lips and nose. Enlarged adenoids and tonsils may affect how air flows through your child’s airways, making their voice sound nasally.

    After the operation, some temporary changes may occur because the adenoids and tonsils lie close to the larynx and nasal passage. Your child may temporarily still sound as if he or she is talking through their nose because of swelling. But this usually settles within two to four weeks and the nasal sound should go.

    If you’re concerned about changes in your child’s voice, contact his or her surgeon. 

    Will an adenotonsillectomy stop me snoring?

    Answer

    An adenotonsillectomy might be helpful for children. It depends what the cause of the snoring is. In adults, adenotonsillectomy is unlikely to help and there may be more effective ways to address the problem.

    Explanation

    Snoring happens when the soft palate and other tissues in your mouth, nose and throat vibrate when you breathe in, producing the snoring sound. This is because when you’re asleep, your muscles relax and affect how the air flows through your airways.

    In children, snoring can be caused by having enlarged tonsils and adenoids, which can block their airways at night. In which case, removing the tonsils and adenoids may be done to help.

    In adults, an adenotonsillectomy isn’t likely to be helpful because your adenoids get smaller as you get older. For many people, making changes to your lifestyle can help reduce snoring. You may find the following helpful.

    • Lose excess weight.
    • Reduce your alcohol intake, especially at night.
    • Stop smoking.
    • Try sleeping on your side, not your back.

    If these don’t work, talk to your doctor for advice about other treatments. There could be other physical reasons for your snoring that your doctor can treat. See our snoring topic too for more information about the causes and treatments.

  • Resources Resources

    Further information

    Sources

    • Adenoid surgery. British Association of Otorhinolaryngology Head and Neck Surgery. www.entuk.org, published 2011
    • Tonsil surgery. British Association of Otorhinolaryngology Head and Neck Surgery. www.entuk.org, published 2011
    • Alho O, Koivunen P, Penna T, et al. Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial. BMJ 2007; 334(7600):939–41. doi:10.1136/bmj.39140.632604.55
    • Marcus C, Brooks L, Draper K, et al. Clinical practice guideline. Diagnosis and management of childhood obstructive sleep apnea syndrome. American Academy of Pediatrics. Pediatrics 2012; 130(3):576–84. doi: 10.1542/peds.2012-1671
    • Tonsil and adenoid anatomy. Medscape. www.emedicine.medscape.com, published 22 February 2013
    • Recurrent tonsillitis – secondary care management. Map of Medicine. www.eng.mapofmedicine.com, published 21 January 2013
    • Management of sore throat and indications for tonsillectomy. Scottish Intercollegiate Guidelines Network (SIGN), April 2010. www.sign.ac.uk
    • Commissioning guide: tonsillectomy. ENT UK and the Royal College of Surgeons, 2013. www.rcseng.ac.uk
    • Otitis media with effusion. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2011
    • Adenoidectomy treatment and management. Medscape. www.emedicine.medscape.com, published 23 July 2013
    • Tonsillectomy treatment & management. Medscape. www.emedicine.medscape.com, published 5 April 2013
    • Suction diathermy adenoidectomy. National Institute for Health and Care Excellence (NICE), December 2009. www.nice.org.uk
    • Electrosurgery (diathermy and coblation) for tonsillectomy. National Institute for Health and Care Excellence (NICE), 2005. www.nice.org.uk
    • Tonsillectomy using laser. National Institute for Health and Care Excellence (NICE), 2006. www.nice.org.uk
    • Head and neck surgery. American Academy of Otolaryngology. www.entnet.org, accessed 29 April 2014
    • Otitis media with effusion – ENT management. Map of Medicine. www.eng.mapofmedicine.com, published 17 December 2013
    • Otitis media with effusion. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2011
    • van den Aardweg M, Schilder A, Herkert E, et al. Adenoidectomy for otitis media in children. Cochrane Database of Systematic Reviews 2010, Issue 1. doi:10.1002/14651858.CD007810.pub2.
    • Tonsillectomy and adenoidectomy in children with sleep related breathing disorders. Consensus statement of a UK multidisciplinary working party, 2010. www.rcoa.ac.uk
    • Tonsillitis – suspected. Map of Medicine. www.eng.mapofmedicine.com, published 21 January 2013
    • Dhiwakar M, Clement W, Supriya M, et al. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database of Systematic Reviews 2012, Issue 12. doi:10.1002/14651858.CD005607.pub4.
    • Aspirin. Joint Formulary Committee. British National Formulary. 65th ed. London: BMJ Group and Pharmaceutical Press; 2014 (printed version)
    • Scadding G, Durham S, Mirakian R, et al. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clinical & Experimental Allergy 2008; 38:19–42. doi:10.1111/j.1365-2222.2007.02888.x
    • Marcus C, Moore R, Rosen C, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 2013; 368:2366–76. doi:10.1056/NEJMoa1215881
    • Surgical approach to snoring and sleep apnea. Medscape. wwwemedicine.medscape.com, published 8 October 2013
    • Snoring and obstructive sleep apnoea. ENT UK. www.entuk.org, accessed 9 May 2014
    • 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
    • Adenoidectomy. Canadian Society of Otolaryngology – head and neck surgery. www.entcanada.org, published 11 October 2013
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    Reviewed by Natalie Heaton, Bupa Health Information Team, July 2014.

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