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Why
don't the doctors take out the tonsils and adenoids like they used to? Why
would my doctor take out adenoids but not tonsils?
Does
my child have to stay in the HOSPITAL?
How
do they take the tonsils out these days?
When
can my child go back to school and back to sports practices?
Is
my child going to bleed after the surgery?
Is
anesthesia risky for my child?
What
are the risks of taking out your tonsils and adenoids? Why don't the doctors take out the tonsils and adenoids like they
used to? No practice involving the
health care of children has excited more controversy among doctors than
has the surgical removal of the tonsils and adenoids. Tonsillectomy and
adenoidectomy (often called T&A) continues to draw large amounts of
attention. Despite some decline in the total number of surgeries performed
each year, there still remains a high rate of performance of T&A
surgery. This is attributed to the firm belief in the minds of doctors and
parents that T&A surgery is a treatment of importance and value. Tonsillectomy has been a
surgical procedure performed for thousands of years. Over the years,
widespread abuse of the operation led to growing concern over its
usefulness. At one point, certain communities promoted wholesale surgery
for entire populations of school children in public school buildings.
Skepticism regarding the true indication for subjecting such large numbers
of children to tonsillectomies began to be voiced in the 1930's. In the 1970's, more clearly
defined medical indications for surgery began to be developed. However,
there still remain wide differences of opinion concerning how extensive,
severe and long-standing the problem needs to be in order to justify
surgery. The two major indications for tonsillectomy are 1) recurrent
infections and 2) airway blockage. Recurrent tonsillitis
(infections of the tonsils) used to be the main indication for
tonsillectomy. The surgery prevented the complications of Strep
tonsillitis. However, the availability of antibiotics has markedly
decreased the need for tonsillectomy. Over the years, it has been noted
that although Strep tonsillitis could be treated successfully with
antibiotics, some children had frequent, recurrent infections causing
illness despite good antibiotic treatment. Antibiotics have also not been
as successful at treating severe recurrent tonsillitis which is caused by
bacteria other that Strep. Depending upon the frequency and severity of
these recurrent infections, some children suffered from recurrent
illnesses and lost long periods of valuable time from school. Why would my doctor take out adenoids but not tonsils? While a T&A is often
thought of and often carried out as a combined operation, each portion of
the operation, that is the tonsillectomy portion and the adenoidectomy
portion, requires attention separately to determine its particular need to
be done. The practice of performing both operations when only one is
indicated just to take advantage of the hospitalization and anesthesia is
not a recommended practice. Separate indications must be met. Although no single, rigid
criteria is appropriate for all patients, many insurance companies now
require that these same guidelines be met before approval for a
tonsillectomy will be given. The basic criteria doctors use to consider
recommending a tonsillectomy for recurrent tonsillitis is: 1.
5-7 infections in one year 2.
4-5 infections each year for 2 years 3.
3 infections each year for 3 years Each infection must be
evaluated and treated by a doctor since many children will have
self-limiting cases of viral tonsillitis which require no specific
treatment. Each treated tonsil infection
should also be associated with one or more symptoms, such as fever greater
than 101 degrees, enlarged glands in the neck, pus on the tonsils, or a
positive Strep culture. The second major indication for tonsillectomy is
airway obstruction. The tonsils can progressively
enlarge until they block the airway and interfere with breathing. Many of
these children have no history of tonsil infections. Chronic airway
obstruction has become the most common indication for tonsillectomy. In
this instance, it is usually combined with an adenoidectomy to improve
breathing through both the nose and mouth. Children with airway
obstruction may progress to the point of developing obstructive sleep
apnea, which can lead to chronic problems with the heart and lungs. More
details about sleep apnea can be found in the "Respiratory
problems" section of this site. Other indications for
tonsillectomy, which are not as common, include: 1. An
abscess around the tonsil (peritonsillar abscess) 2. Abnormal
development of the teeth and jaw bones due to airway blockage 3. Suspected
tumor of the tonsil 4. Chronic
bad breath. Does my child have to stay in the HOSPITAL? A routine tonsillectomy is
usually performed as an outpatient surgery. However, children under the
age of 3 years and those with symptoms of severe airway obstruction may be
considered for overnight observation in the hospital. Children with sleep apnea
definitely need to be hospitalized overnight with possible monitoring in
the intensive care unit. Other factors, which may prompt an overnight
hospitalization, include severe asthma, diabetes, cystic fibrosis and
patients with bleeding disorders. Your child's doctor will determine if an
overnight stay is needed and will get the authorization from the insurance
company before surgery. How do they take the tonsils out these days? The tonsillectomy operation
takes approximately 30 minutes to perform and is done while your child is
asleep under general anesthesia. A special instrument holds your child's
mouth open for a clear view of the tonsils. The entire procedure is
performed through the mouth. There are no scars of the face or neck. The
actual technique for performing the tonsillectomy varies with each surgeon
depending upon his training. Some of the most common
techniques include: 1.
The standard steel knife 2.
The laser 3.
The hot knife or electric cautery 4.
The snare (a wire placed around the tonsil) 5.
The coblator (radio frequency ablation)...Dr White's preference When can my child go back to school and back to sports practices? The expected recovery time
after a tonsillectomy is about one week. Your child may have severe pain,
which requires the use of narcotic pain medications. Because of this pain,
you will need to constantly keep encouraging your child to drink juices,
eat Jell-O or sherbet to prevent dehydration. Dehydration is the most
common complication of tonsillectomy surgery. Ice packs to the upper neck
can be soothing. Ear pain is very common, in
fact it can be worse than the throat pain in some children. This ear pain
is due to irritation of the nerve, which goes up to the ear. Giving your child sugarless
gum to chew after surgery is an effective way to get him to swallow and
use the throat muscles. This tends to promote faster healing. Children
generally miss a full week of school and should not participate in gym
class or other strenuous activities such as T-ball, ballet, gymnastics,
karate, and cheerleading for a full two weeks (14 days) after surgery to
allow for adequate healing and decrease the risk of postoperative
bleeding. Is
my child going to bleed after surgery? Bleeding is the most feared
complication after a tonsillectomy. It is not very common and ranges from
usually 2-5% in children. Bleeding can occur shortly after surgery, but it
most commonly happens 7-10 days after surgery. Bleeding is more common in
children who were not taking in adequate amounts of liquid and developed
dehydration or allowed the healing scab covering the surgical area to dry
up. Slight bleeding may occur as the scab separates from the wound. This
is usually controlled with ice packs to the neck and drinking cold liquids
to clamp down the bleeding blood vessels. If the ice packs do not stop
the bleeding, you will need to notify your child's doctor and plan to
proceed to the emergency room. Your
child may need to be taken back to the operating room where the bleeding
blood vessels can be cauterized. Blood transfusions are not commonly
needed. The risks of your child undergoing a tonsillectomy are those
related to anesthesia and those directly related to the surgery. Is anesthesia risky for my child? Prior to surgery, you should
meet with the anesthesiologist who will be putting your child to sleep.
You will then have an in-depth discussion about the risks from anesthesia.
The major risks from anesthesia include abnormal heartbeats, injury to the
voice box and teeth, inhaling mucous or stomach acid into the lungs, and a
rare reaction to anesthesia called malignant hyperthermia. What are the risks of taking out your tonsils and adenoids? The information provided on
this web site is not intended to take the place of consultation with your
physician. You should always consult a physician whenever you require
diagnosis or treatment. |
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