Tonsillectomy and Adenoidectomy

Your doctor may have suggested that a T&A (Tonsillectomy and Adenoidectomy) be considered as the definitive treatment of your child’s throat ailment. The following information will serve as a guide as to what to expect from this treatment option.

Who needs a T&A?

There are various indications for a Tonsillectomy and Adenoidectomy. If your child suffers from recurrent or chronic tonsillitis despite antibiotic treatment (please refer to the section outlining information on Tonsillitis in this website), snoring, obstructive sleep apnea (pauses in breathing while sleeping), bad breath, malocclusion or dental abnormalities, chronic mouth-breathing, tonsillar stones (white pieces of material that looks like cottage cheese and have a foul smell), peritonsillar abscess (infection that has spread to the deeper structures of the throat and neck), or persistent fevers, ulcers in the mouth or swollen lymph nodes.

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What is expected before surgery?

Your Primary Care Physician or Pediatrician will refer you to an Ear, Nose and Throat (ENT or Otolaryngologist) Specialist. At that visit, the specialist will examine your child and take a history documenting the information necessary to justify the procedure so that the Insurance Company understands the need for the T&A. Be sure to let your child know that surgery will not be performed at that initial visit. Many children assume that they are having surgery the same day as their initial visit and are very anxious about this. The most invasive thing that may occur is a throat swab, but even that is usually not necessary since the referring physician has likely already performed a throat swab for documentation purposes.  

You will be asked to avoid certain medications at least one week prior to surgery that might complicate the surgery such as Motrin®, Advil®, ibuprofen® or Aleve®. These medications tend to thin your blood and may put the patient at risk of bleeding. Although, do not be alarmed if your surgeon recommends using these same medications post-operatively for pain management in certain circumstances (usually younger children who cannot use narcotics).

The office staff will arrange for a surgical date that meets your needs and will take care of insurance questions and pre-certification of the surgery.

What is expected the day of surgery?

You will be contacted a day or two in advance, informing you of your scheduled surgical time. Depending on the time your surgery is scheduled or any unusual medical conditions your child has, you may be asked to show up for surgery about 1-2 hours before the scheduled surgery start time. Please remember to follow the advice of the staff as to having nothing to eat or drink before surgery. Not understanding the importance of NPO (not eating or drinking prior to surgery) status can delay or even cancel your case. If you still have questions regarding eating and drinking before surgery, do not hesitate to call the day before surgery is scheduled for the answers you need.

Upon arrival for surgery, your child will be checked-in and given an identifying “name tag” or wristband. The nursing staff will verify the surgery being performed and medications and allergies your child may have. These questions will be verified multiple times for safety purposes.

Most young children will not have an IV or needle inserted into the vein for fluid hydration until they are asleep. However, there are some rare exceptions to this policy. In most cases, your child will be given a light sedative by mouth shortly before going into the operating room to help relieve any anxiety. Our staff does an excellent job dealing with your fears surrounding surgery and anesthesia. We have mastered this over the years and you will agree with our expertise when the day is over.

In general, the surgical time for a Tonsillectomy and Adenoidectomy is only about 20 minutes long. It often takes more time to do the required paperwork in the operating room than it does to actually perform the procedure.

Your surgeon will meet you just prior to surgery to ensure you have no last-minute questions or concerns. The surgeon will again meet with you as soon as surgery is completed to discuss the case and reassure you that all went well. At that time, the surgeon will give you an idea of what to expect in the recovery period, time out of school/sports, dietary restrictions, and medications needed to keep your child comfortable.

After about a 30-45 minute recovery, you will be asked to come back to the Recovery Room and visit with your child. During this period, your child may either still be asleep or be tearful. This is very natural, as your child is trying to wake up from anesthesia. Please follow the guidance of your Recovery Room Nurse, who has the expertise to manage your child’s needs.

What is expected after surgery?

You should plan on your child needing one week off school and sports. It is important to follow the nurse’s instructions on how to best keep your child hydrated (fluids are very important, more so than solid food). The nurse/surgeon may suggest pain medications such as Tylenol® (acetaminophen), ibuprofen (Motrin® or Advil®), or narcotics (depending on child’s age and whether obstructive sleep apnea exists or not). Patients will be given different directions regarding pain medications depending on their special circumstances.

Most children have a T&A performed as an “outpatient”. Those situations where the child must be admitted and the surgery performed as an “inpatient” for an overnight stay in the hospital are when the child usually suffers from either moderate to severe obstructive sleep apnea, complex medical issues such as heart problems, or children under the age of 3 years of age. Children under the age of 3 are at risk of dehydration and thus are usually kept overnight in the hospital for fluid hydration.