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Tonsillectomy and Adenoidectomy

When should the tonsils and/or adenoids be removed?

Tonsillectomy and adenoidectomy are indicated in persons with repeated or persistent infections, particularly if they interfere with everyday activities. The American Academy of Otolaryngology defines repeated infections in children as seven episodes in one year, or five episodes in each of two years, or three episodes in each of three years.

Tonsillectomy and adenoidectomy are also warranted in situations where there is enlargement of the tonsils and adenoids to such an extent that it causes severe sleep problems (snoring and breath holding), sleep apnea, dental abnormalities, and difficulty swallowing. Adenoid enlargement alone, or in combination with tonsillar enlargement, can cause nasal obstruction, recurrent ear infections, or sinusitis. If these conditions are resistant to medical therapy, surgery is indicated.

In adults, the severity, frequency, and hardship associated with repeated infections are considered more important than the absolute number. Chronic infections characterized by bad breath and/or tonsillar stones causing significant disability are also indicators for tonsillectomy.

Tonsillectomy and adenoidectomy are strongly considered in those patients who are suffering, or may suffer serious complications of infection. These include peritonsillar abscess, history of streptococcal complications (rheumatic heart disease, glomerulonephritis), or neck abscess. Suspicion of malignancy or tumor is a definite reason for surgery.

>In should be emphasized that all decisions for or against removing the tonsils or adenoids are dependent upon the individual patient's particular situation. Additional factors, such as tolerance of antibiotics, concurrent medical problems, school achievement/progress, and family preferences are also important factors in the decision process.

Although adenotonsillectomy is a very safe procedure, surgery can be a frightening experience—especially for children. Dr Tamez takes the time to educate and reassure both child and parents. It is important for parents and caregivers to answer the child's questions and address his or her concerns in a way that is appropriate for the age of the child.

It takes Dr. Tamez about 30 minutes to perform. Traditional surgery involves removal of the entire tonsil or adenoid and partial (intracapsular) surgery involves removing only the inflamed tonsillar tissue. Partial tonsillectomy experience less post-operative pain and may recover more quickly than those who undergo traditional surgery. In rare cases, remaining tonsillar tissue can enlarge or become infected following partial removal, requiring additional surgery. Dr Tamez using Coblation (involves using cool radio frequency current to remove tonsillar tissue; may produce less postoperative pain and a faster recovery. Dr Tamez recommends Motrin and Tylenol postoperatively. Aspirin should not be used in children due to a risk for a serious condition called Reye's syndrome. In February 2013, the U.S. Food and Drug Administration (FDA) issued a strong recommendation against (contraindication) using codeine (e.g., Tylenol with codeine) to relieve pain in children who have undergone tonsillectomy and/or adenoidectomy. Codeine, which is converted into morphine by the liver, may be metabolized too quickly in some children, resulting in a life-threatening or fatal overdose of the drug. According to the FDA, children with obstructive sleep apnea (OSA) are especially at risk.

REFERENCES:

American Academy of Otolaryngology - Head and Neck Surgery. Tonsils and Adenoids.