What are the tonsils?

Tonsils are composed of lymphoid tissue located on both sides of the back of the throat. Often, the tonsils will enlarge and you can see them as two “golf balls” of tissue in the throat.

What function do they serve?

The tonsils are near the entrance to the breathing passages where they react to bacteria and viruses entering through the throat and produce antibodies to help the body fight infection.

Why are the tonsils removed?

• Enlarged tonsils may cause obstruction of the upper airway. Signs of this include:
  • loud snoring
  • pauses in the breathing (sleep apnea)
  • frequent waking at night occurring with snoring
  • excess fatigue
  • irritability
  • eating/swallowing problems
  • speech which sounds muffled or garbled
  • bed wetting

The size of the tonsils is important only if they are causing problems. If they are large but not affecting the child’s breathing, a tonsillectomy is not warranted.

• Frequent throat infections are another indication for tonsillectomy (removal of tonsils). It is considered for any child who has had 6 or more episodes in one year or recurrent problems for 2-3 years.

• Difficulties with speech and dentition may result from large tonsils and provide another indication for tonsillectomy. Because of the chronic mouth breathing that may occur, dental abnormalities can develop.

Will removing the tonsils change the immune system?

To date, multiple studies have shown that tonsillectomy does not weaken the immune system.  Children do not suffer more infections without their tonsils; other lymphoid tissues in the body produce sufficient antibodies to fight infection.

How are the tonsils removed?

Tonsillectomy is a very safe procedure and the second most commonly performed surgery in children.  A tonsillectomy is usually done on an outpatient basis and takes approximately 20-30 minutes. On the day of the procedure you will meet and speak with the pediatric anesthesiologist. He/she will carefully monitor your child throughout the procedure. The tonsils are removed under general anesthesia with your child asleep. An IV will be placed after he/she is asleep. The tonsils are removed by dissecting them out of the adjacent throat tissue. Afterwards, your child will go to the recovery room to allow him/her time to wake up fully and recover from the effects of anesthesia. If there are no complications with vomiting, he will be discharged home. If your child is under 3 years of age or having difficulties with vomiting, he may be admitted for observation overnight and discharged home the next day.

What should I do to prepare my child for surgery?

• It is important to avoid giving aspirin or ibuprofen (Advil or Motrin) 10 days before and after the surgery. If your child needs a medication for pain control prior to the surgery, acetaminophen (Tylenol) is fine.
  
• No blood work is needed prior to the surgery unless advised by the doctor.
  
• A tour of the operating room is available. This gives the child an opportunity to meet the staff and to associate the hospital with a pleasant experience. Information regarding this tour is available in the surgery packet.

What are the risks of tonsillectomy?

Most surgical procedures share the general risks of anesthesia, bleeding and infection. The anesthetic risk is, in general, proportional to the health of the child; serious problems are very rare. Bleeding occurs in approximately 1-2% of children after a tonsillectomy. This most often occurs 5-8 days after surgery, when the scab or white patch that has formed in the back of the throat falls off.  Things to look for include vomiting, coughing or spitting up blood. If this occurs, you should contact our office immediately and prepare to come to the hospital to be seen. Ensuring that the child is well hydrated and eating/chewing reduce the risk of bleeding. No vacations away from San Diego should be planned for 2 weeks after the surgery because of this risk. Serious post operative infections are very rare.

Are there any special instructions when my child comes home?

• Children usually experience severe throat pain after a tonsillectomy. We suggest giving Tylenol. Do not give aspirin, Advil, or Motrin. We will also provide you with a prescription for a stronger medication, Tylenol with codeine, to help with more significant pain after surgery. The duration of pain varies, but ranges from several days to as long as 10 days. The sooner the child is eating and back to regular activities the quicker the pain will be gone. Chewing gum or gummy bears also helps with the pain.
  
• Occasionally, children complain of an earache. This is due to irritation of the nerve that services both the ears and the back of the throat. It should resolve as the throat heals.
  
• Your child should eat a normal diet with regular chewing foods. It is very important to encourage plenty of fluids. If the child is old enough, we also recommend chewing gum.
  
• Your child is to resume normal activities as soon as possible, including returning to school.
  
• A mild temperature can occur after a tonsillectomy. If this exceeds 103 degrees, contact our office.
  
• Bad breath post-operatively can occur. This will improve as healing takes place.
  

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