Tonsils and adenoids: What exactly are they?

Tonsils and adenoids are part of a ‘ring’ of glandular/lymphoid tissue encircling the back of the throat. Tonsils are visible at the back of the mouth, one on each side. The adenoid is found high in the throat, right behind the nose and needs special instruments or an x-ray to view it.

Tonsils and adenoids act as ‘policemen’ and help to form antibodies to ‘germs’ that invade the nose, mouth and throat. This function may be important for young children up to three years of age, but there is no evidence that it is important after that. Studies have shown that children who have had their tonsils/adenoids removed suffer no loss in their immunity to diseases.

Should your child's tonsils or adenoids be removed (tonsillectomy or adenoidectomy)?

Tonsils or adenoids should be removed in cases of:

  1. Recurrent tonsillitis: Frequent acute infections causing high fever and sore throat
  2. Snoring / obtructive sleep apnoea: Enlarged adenoids/tonsils causing nose and throat obstruction to breathing while asleep. Left untreated, may lead to complications involving heart and lungs
  3. Chronic otitis media with effusion: Persistent fluid in the middle ear causing hearing impairment
  4. Peritonsillar abscess: Pus forming around the tonsillar bed
  5. Tumours: While these are rare, they may occur in children e.g. lymphoma

Medical treatment for recurrent tonsillitis and otitis media with effusion

Antibiotics may be prescribed to treat recurrent tonsillitis and otitis media with effusion. If treated successfully, surgery may be avoided.

For children who snore or face breathing difficulties due to enlarged adenoids/tonsils, CPAP (Continuous Positive Airway Pressure) may be considered to keep the upper airway open.

Surgical removal of tonsils / adenoids for children

Surgical removal of tonsils or adenoids is done under general anaesthesia and requires admission to the hospital. Generally, about a 48-hour hospital stay is required. Shortly after admission, blood and other tests may be carried out as appropriate. The child will be required to fast overnight i.e. no food or drink after 12 midnight before the operation.

For a younger child, a shorter period of fasting might be sufficient, depending on the anaesthetist’s assessment. The operation is done through the oral cavity. No incision will be made on the face or neck.

If your child has a fever or cough just before the surgery, you must inform your doctor about it. The surgery may need to be postponed if your child is found unfit for surgery. If the child has any history or family history of bleeding disorders, or any previous problems with anaesthesia, it must be brought to the doctor’s attention.

Soon after the surgery, your child might still be sleepy, and may vomit from the effects of general anaesthesia. This will wear off over a little time. After a few hours, your child will be allowed to drink water and eat ice cream. Encourage sips of cool clear liquid when the child is fully conscious. A soft diet is usually given the next morning. Slightly blood-stained sputum may be produced, but this is expected.

Read on for more information on how to take care after a tonsillectomy (surgical removal of tonsils) and adenoidectomy (surgical removal of adenoids).

Ref: T12