Tonsillitis and Adenoiditis Tonsillitis is an inflammation of the tonsils, the small, round pieces of tissue that are located in the back of the mouth on the side of the throat. Tonsils help fight infection by producing antibodies. Tonsils can be seen by shining a light in the throat. Adenoiditis is an inflammation of the adenoids, lymph tissue that is located in the space above the soft roof of the mouth (nasopharynx). Adenoids cannot be seen by looking into your child’s nose or throat. Adenoids help fight infection, but they can cause problems if they become enlarged or infected. What are the symptoms of tonsillitis? Symptoms vary greatly depending on the cause of the infection, and they can occur suddenly or gradually. Although each child may experience symptoms differently, here are the most common: sore throat fever (either low-grade or high-grade) headache decrease in appetite not feeling well nausea and vomiting stomach aches painful swallowing visible redness or drainage in the throat Always consult your child’s physician for a diagnosis because the symptoms of tonsillitis may resemble other conditions or medical problems. What are the symptoms of adenoiditis, or enlarged adenoids? Symptoms vary greatly depending on the cause of the infection, and they can occur suddenly or gradually. Although each child may experience symptoms differently, here are the most common: breathing only through the mouth noisy breathing loud snoring nasal speech periods at night when breathing stops for a few seconds Always consult your child’s physician for a diagnosis because the symptoms of adenoiditis may resemble other conditions or medical problems. How do you treat tonsillitis and adenoiditis? Your child’s physician will determine the specific treatment needed based on: your child's age, overall health, and medical history the extent of the infection the type of infection your child's tolerance for specific medications, procedures, or therapies expectations for the course of the infection your opinion or preference Treatment depends on the cause of the infection, the severity of the infection, and the number of times the child has developed infections. Your child's physician may order antibiotics to help with the infection. Your child may be referred to an otolaryngologist (physician specializing in disorders of the ear, nose, and throat) to have the tonsils and adenoids removed. This surgery is called a tonsillectomy and adenoidectomy. The tonsils and adenoids are often removed at the same time, but sometimes just the tonsils or just the adenoids are removed. Why is a tonsillectomy and adenoidectomy recommended? Otolaryngologists differ in their views as to why this surgery is needed. The following reasons are the most common: sleep apnea, or periods at night when your child stops breathing trouble swallowing tumor in the throat or nasal passage bleeding from the tonsils that cannot be stopped significant blockage of the nasal passage and uncomfortable breathing The following are some guidelines put forth by the American Academy of Otolaryngology-Head and Neck Surgery: three episodes of tonsillitis per year enlarged tonsils causing upper airway obstruction, dental malocclusion, sleep disorders, or difficult swallowing (dysphagia) recurrent abcesses of tonsils (peritonsillar abscess) The episodes of infection should be associated with the following: fever above 101°F discharge on the tonsils positive strep throat culture The following are more controversial reasons for the removal of the adenoids and/or tonsils: loud snoring recurrent ear infections hearing loss chronic sinusitis (infection in the sinuses) constant mouth breathing frequent colds cough bad breath What are some reasons that DO NOT require removal of the tonsils? Each child should be evaluated on an individual basis, but the following conditions usually do not require removal of the tonsils: large tonsils without any other symptoms (Some children simply have large tonsils that will decrease in size between the ages of eight to 12.) school absence (Tonsil removal will not increase school attendance even though your child may miss school due to different symptoms, such as a sore throat.) poor appetite, allergies, or seizures What happens during tonsillectomy and adenoidectomy? Tonsillectomy and adenoidectomy (surgical removal of the tonsils and adenoids) is one of the most common major surgical procedures performed on children in the United States. About 400,000 surgeries are performed each year. The need for tonsillectomy and adenoidectomy will be determined by your child's otolaryngologist and discussed with you. These surgeries are performed using general anesthesia and on an outpatient basis. This means that your child will have surgery and then go home the same day. Some children may be required to stay overnight, such as, but not limited to, children who: are not drinking well after surgery have other chronic diseases or problems with seizures have complications after surgery, such as bleeding are younger than three years of age Before the surgery, you will meet with some members of the healthcare team. The team includes: an otolaryngologist: a physician who specializes in the medical and surgical treatment of problems of the ear, nose, and throat an anesthesiologist, who will administer your child’s anesthesia and will monitor him/her during surgery same-day surgery nurses, who will prepare your child for surgery operating room nurses, who will assist your child’s physicians during surgery nurses in the post-anesthesia care unit (formerly called the recovery room), who will care for your child as he/she emerges from general anesthesia Prior to surgery, your child’s anesthesiologist will perform a history and examination of your child and develop a plan of general anesthesia. The anesthesiologist will discuss this plan with you and you may ask him/her any questions you may have. During the surgery, your child’s otolaryngologist will remove your child's tonsils and adenoids through the mouth. There will be no cut on the skin. In most cases, after the surgery, your child will go to the post-anesthesia care unit where he/she will be monitored closely. After your child is fully awake and doing well, a nurse will bring your child back to the same-day surgery area. If everything is going well, you and your child will be able to go home. If your child is going to stay the night in the hospital, your child will be brought from the post-anesthesia care unit to his/her room. Usually, the parents are in the room to meet the child. Bleeding is a complication of this surgery and should be addressed immediately by the surgeon. If the bleeding is severe, your child may return to the operating room. What follow-up care is needed after tonsillectomy and adenoidectomy? The following are some of the instructions that may be given to you to help you care for your child: encourage fluid intake provide pain medication, as prescribed follow any dietary restrictions your physician recommends no heavy or rough play for a duration of time recommended by the surgeon What are the risks of tonsillectomy and adenoidectomy? Any type of surgery poses a risk to a child. About two to three percent of children begin bleeding from the surgery within the first two weeks after the surgery and may require additional surgery. Some children may have a change in the sound of their speech due to the surgery. The following complications may occur: bleeding (may happen during surgery, immediately after surgery, or at home) dehydration (due to decreased fluid intake; if severe, fluids through an intravenous, or IV, catheter in the hospital may be necessary) fever difficulty breathing (swelling of the area around the surgery; may be life-threatening if not treated immediately)
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