A tonsillectomy and adenoidectomy (T&A) is a common surgical procedure involving the removal of both the tonsils and the adenoids. This combined surgery addresses issues stemming from chronic infection or enlargement of these lymphoid tissues. It is frequently performed, particularly in children, to improve a patient’s overall health and quality of life.
Understanding the Tonsils and Adenoids, and Indications for Removal
The tonsils and adenoids are specialized patches of lymphoid tissue that are part of the body’s immune system. The tonsils are two oval-shaped pads at the back of the throat. The adenoids are situated higher up, behind the nose and soft palate, making them invisible without special tools. These tissues function as a first line of defense, trapping pathogens that enter the body and activating immune responses.
The primary indications for surgically removing these tissues fall into two main categories: chronic or recurrent infection and airway obstruction. Recurrent infections, such as tonsillitis or strep throat, are a common reason for removal. Surgery is often indicated when a person experiences seven or more episodes in a single year, or frequent episodes over two or three consecutive years. This frequent infection can impair the tissues’ function, turning them into a reservoir for bacteria.
The other major indication is Obstructive Sleep Apnea (OSA) or other forms of sleep-disordered breathing. Enlargement of the tonsils and adenoids (hypertrophy) can physically block the upper airway, leading to loud snoring and pauses in breathing. In children, this obstruction is the most common reason for T&A, as it can be linked to daytime tiredness, behavioral issues, and poor school performance.
The Surgical Procedure: What Happens in the Operating Room
The T&A procedure is performed under general anesthesia, ensuring the patient is completely asleep and pain-free. The surgery itself is relatively short, often lasting between 30 and 60 minutes. Surgeons access the tonsils and adenoids through the patient’s mouth, meaning no external incisions are made.
Several techniques are used for tissue removal, all aiming to minimize bleeding and trauma. One common method is electrocautery, which uses heat from an electrical current to cut the tissue and seal blood vessels simultaneously. Another technique is coblation, which uses radiofrequency energy and a saline solution to dissolve the tissue at lower temperatures. For adenoid removal, a specialized instrument called a curette may be used to scrape the tissue away.
Preparation and Immediate Post-Operative Expectations
Preparation involves specific logistical steps, including fasting instructions to ensure the stomach is empty prior to anesthesia. Patients must stop eating or drinking for a certain period before surgery, typically around eight hours for food, to prevent complications. The surgical team will also review all current medications. Patients are often required to stop taking certain anti-inflammatory drugs or supplements that could increase the risk of bleeding.
Immediately following surgery, the patient is moved to the Post-Anesthesia Care Unit (PACU) for close observation. Nurses monitor the patient’s breathing, heart rate, and blood pressure as they wake up. Monitoring for any signs of immediate post-operative bleeding is a primary focus.
The goal is generally to discharge the patient home the same day, making it an outpatient surgery for most individuals. However, certain patients, such as those younger than three years old or those with severe Obstructive Sleep Apnea, may require an overnight hospital stay for continuous respiratory monitoring. Criteria for discharge include being fully awake, having stable vital signs, and being able to tolerate oral fluids without excessive nausea or vomiting.
Managing the Recovery Process at Home
The full recovery period typically lasts between one and two weeks, with the first few days being the most uncomfortable. Pain management is a central focus. A scheduled regimen of pain medication, such as acetaminophen or ibuprofen, is usually recommended to stay ahead of the discomfort. It is helpful to administer pain medicine about 30 minutes before attempting to eat or drink.
Maintaining hydration is the most important element of recovery, as dehydration is a common reason for returning to the hospital. Cool liquids, such as ice water, diluted juice, or cold milk, are best and help to soothe the throat. Acidic drinks like orange juice and carbonated beverages should be avoided because they can irritate the surgical site.
Dietary restrictions involve eating soft, bland foods, such as:
- Yogurt
- Applesauce
- Mashed potatoes
- Scrambled eggs
Crunchy, sharp, or spicy foods must be avoided because they could scrape the healing wound beds. Swallowing and chewing, despite the pain, is encouraged as it helps promote healing.
Patients should limit strenuous activity, heavy lifting, or rough play for up to two weeks to reduce the risk of bleeding. The scabs that form where the tonsils were removed typically fall off five to ten days after surgery, which is a time when the risk of bleeding slightly increases. Patients should contact their surgeon immediately if there is significant bright red bleeding, a fever higher than 101.5°F, or inability to drink enough liquids to stay hydrated.