The tonsils and adenoids are collections of lymphoid tissue located in the head and neck, functioning as part of the body’s immune system. The palatine tonsils are the two visible masses at the back of the throat, situated on either side of the pharynx. The adenoids, also known as the pharyngeal tonsils, are positioned higher up, behind the nose and soft palate. Both sets of tissue trap pathogens entering through the mouth and nose, initiating an immune response. When these tissues become a source of chronic problems, a surgeon may recommend a combined procedure called an adenotonsillectomy.
Why Tonsils and Adenoids Are Removed
The decision to remove these tissues is based on specific medical criteria. One primary indication is recurrent throat infection. Guidelines suggest surgery is appropriate if a patient experiences at least seven documented infections in one year, five per year for two consecutive years, or three per year for three consecutive years. These infections must be confirmed by symptoms like fever, tonsillar exudate, or a positive strep test.
The most common reason for removal today is upper airway obstruction, specifically Obstructive Sleep Apnea (OSA), caused by enlarged tonsils and adenoids. When the tissues swell, they can partially or completely block the airway during sleep, leading to snoring, gasping, and interrupted breathing patterns. This condition can affect a patient’s quality of life, potentially causing issues like daytime fatigue, behavioral problems, and difficulty in school performance. Less common indications include multiple peritonsillar abscesses or asymmetric enlargement that raises suspicion for malignancy.
Preparing for the Operation
Before the surgical date, a thorough pre-operative consultation is required. The surgeon and anesthesiologist review the patient’s medical history, paying close attention to any known bleeding disorders or a family history of adverse reactions to anesthesia. Specific blood tests may be ordered to check clotting function, as a risk of post-operative bleeding exists.
Patients must follow a strict regimen regarding medications and food intake. They are instructed to avoid non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin for approximately two weeks prior, as these medications interfere with the blood’s ability to clot. The most important instruction is the requirement to fast (NPO) for a specified number of hours before the procedure. This fasting is a safety measure to prevent complications, such as aspiration, while the patient is under general anesthesia.
How the Procedure is Performed
The removal of the tonsils and adenoids is an outpatient procedure performed under general anesthesia, ensuring the patient is unconscious and pain-free. Once the patient is asleep, a specialized retractor holds the mouth open, allowing the surgeon clear access to the back of the throat. The entire procedure is performed through the mouth without external incisions.
Surgeons use various techniques to remove the tonsils, differing primarily in how the tissue is dissected and how bleeding is controlled.
Tonsil Removal Techniques
One traditional method is cold knife dissection, where a scalpel separates the tonsil from the surrounding muscle. Bleeding is stopped afterward using sutures or electrocautery. A common contemporary approach uses electrocautery, which employs an electrical current to simultaneously cut the tissue and seal the blood vessels with heat, minimizing blood loss.
Other modern techniques include radiofrequency ablation, often referred to as Coblation, which uses a low-temperature radiofrequency field to dissolve the tonsil tissue while preserving surrounding healthy tissue. Some surgeons use a microdebrider, a motorized instrument that shaves away the tonsil tissue while suctioning the debris. This is sometimes used for an intracapsular tonsillectomy, where a thin layer of tonsil tissue is left behind to protect the underlying muscle.
Adenoid Removal
The adenoids are located high in the nasopharynx. They are typically removed using an adenoid curette or with suction cautery. The soft palate is retracted to ensure clear visualization. Once the tissues are removed, the surgical sites are checked for hemostasis before the patient is moved to recovery.
What to Expect During Recovery
Immediately following the procedure, the patient is closely monitored in the Post-Anesthesia Care Unit (PACU) as they wake up. Initial side effects can include nausea, vomiting, or temporary grogginess, which usually subside within the first 24 hours. Pain in the throat is expected and may also be felt as ear pain, known as referred pain, which is normal and managed with prescription and over-the-counter pain medication.
Hydration is the single most important aspect of the post-operative recovery period, as drinking fluids helps soothe the throat and prevents dehydration, which can worsen pain. Patients are encouraged to drink cold liquids immediately after surgery, and a soft, non-acidic diet is recommended for the first week or more. Well-tolerated foods include:
- Ice cream
- Yogurt
- Mashed potatoes
- Soft cooked cereals
Sharp, crunchy, or highly acidic foods should be avoided to prevent irritation to the surgical site.
The full recovery period is typically around 10 to 14 days, with the most intense pain often occurring between days five and eight. During this time, a thick, white or yellowish membrane forms over the surgical area, which is a normal part of the healing process. A small amount of blood-tinged saliva is common, but any significant, bright red bleeding requires immediate medical attention. Patients are advised to avoid strenuous activity and to remain in close proximity to medical care during the first two weeks of healing.