What are Tonsils and Adenoids?
If one likens white blood cells to soldiers fighting the human body’s war against infection, then lymphoid tissue is analogous to the fort in which they reside. Tonsils and adenoids are the most well known collections of this lymphoid tissue, although lymphoid tissues are found throughout the body. Tonsils are paired lumps found on either side of the tongue in the back of the mouth while the adenoids are a single mass found high in the throat behind the nose (in an area called the nasopharynx).
Tonsils and adenoids range in size from hardly noticeable to so large that they fill the throat and affect breathing. Children are especially prone to having big tonsils and adenoids, as their immune systems are very active. Occasionally, tonsils and adenoids, by obstructing the airway and/or becoming sites of chronic infection, do more harm than good for the body and need to be removed in a process called tonsillectomy.
What are the Risks of Tonsillectomy and Adenoidectomy?
Tonsillectomy and Adenoidectomy, or surgery on the tonsils or adenoids, is done under general anesthesia, which is often the most frightening aspect of the procedure for both the parents and children. Although there are risks associated with anesthesia, these can be minimized by a well trained staff, which specializes in caring for children. As a result, modern pediatric anesthesia is remarkably safe. To minimize the anxiety for both children and parents, we allow a parent to accompany the child during the induction of anesthesia in the O.R. (until he or she is comfortably asleep). In addition, anesthesiologists are available to answer questions before the tonsillectomy or adenoidectomy surgery.
The most important risk from the surgery itself is bleeding postoperatively. If bleeding occurs, it usually does so about five-10 days after surgery, when the healing process allows the “scab” to separate from the tissue beneath the surgical site. Noticeable bleeding (i.e. blood in the mouth) happens in two-four percent of the tonsillectomy patients and is extremely rare after adenoidectomy alone. Post-operative bleeding is usually managed in the operating room where, after anesthesia is induced, the source is found and cauterized.
When we speak or swallow, the soft palate seals off the throat behind the nose to prevent air or fluid leaking out of the nose. Rarely, removing the adenoids temporarily affects this seal and results in a nasal voice and/or reflux of liquids into the nose. If this happens, these symptoms usually are very short lived, although occasionally it takes weeks for them to completely disappear.
The other concern after surgery is dehydration from poor fluid intake. The child will have a sore throat after tonsillectomy (usually it is mild with adenoidectomy alone), which usually is controlled with oral pain medications. Rarely, some children have severe pain that compromises their ability to swallow sufficient liquids and they become dehydrated. If this happens, they are admitted to the hospital for IV fluids until they can drink.
Other potential complications such as scarring of the throat, infection or excessive blood loss during tonsillectomy or adenoidectomy surgery all extremely rare. Overall, Tonsillectomy and Adenoidectomy is a very safe and well-tolerated procedure and kids usually recover fully within three-seven days.
What is Obstructive Sleep Apnea?
Obstructive sleep apnea is the most severe end of the spectrum of night time breathing difficulties known as sleep disordered breathing. At the other end is simple snoring. When tissue partially blocks the airway to the extent that there is resistance to airflow, it vibrates and produces sound (snoring). As the resistance increases, airflow during sleep can become so decreased that breathing stops despite the body’s efforts (obstructive sleep apnea). This not only deprives the body of oxygen, but also results in broken, non-restful sleep. When it is severe, obstructive sleep apnea can cause heart strain and abnormal rhythms, behavioral problems and growth disturbances. Bedwetting and frequent sleepiness are less dramatic side effects of disturbed sleep.
Although there are many causes of sleep disordered breathing, children with this condition usually have increased tonsils and adenoids and benefit greatly from their removal.