Tonsils and Adenoids
The
tonsils face each other from opposite sides of the
throat. The adenoids are grouped together at the back of
the throat behind the soft palate, spreading out toward
the ear, nose and sinus openings. Every child has tonsils
and
adenoids, both of which ordinarily decrease in size
after seven years of age. These structures can become
enlarged and by their mere increase in size interfere with
adequate drainage and function of those organs toward
which they extend. The tonsils may become infected,
form a true abscess, or be the source for secondary
lymph gland infections in the neck and under the jaw.
A considerable difference of opinion still remains about
when and for what reason the tonsils and/or adenoids
should be removed. All agree that the aim of the surgery
is to reduce the frequency and severity of colds, ear infections,
sinusitis and bronchitis.
What effect may adenoid infection have on the child?
Acute infection and enlargement of the adenoid tissues may accompany frequent colds, a runny nose,
cough, and bronchitis, and these respiratory infections
tend to last longer when the adenoids are implicated. The
infection often extends to the middle ear, causing painful
inflamed ears and a temporary decrease in hearing acuity.
Chronic adenoid infection can be associated with failure
to gain weight in a normal fashion, since the child with
chronic infections tends to become listless and to have a
poor appetite.
Are the tonsils removed at the same time?
If the child is under four years of age, the tonsils are
ordinarily not involved in the way that the adenoids are.
Since they are not diseased, they need not be removed.
An additional consideration is that if the tonsils are removed,
there tends to be an accelerated regrowth of the
adenoids, sometimes necessitating a secondary or revisional
operation on the adenoids.
When are the tonsils removed with the adenoids?
Children over the age of four usually have a chronic
adenoid infection accompanied by chronic tonsilitis. In
that situation both the tonsils and the adenoids are removed
in the same surgical procedure.
What are the symptoms of tonsil infection?
The acute symptoms are those of a bad cold sore
throat, enlarged glands in the neck, fever and temporary
difficulty in swallowing.
When should surgery be performed?
It should be done between infections one has to
"steal" the child from between the colds, runny nose and
ear infections. Antibiotics, the choice based on throat
cultures, should be administered 48-72 hours before the
operation. It has often been necessary to cancel and reschedule the operation because children have a way of
getting reinfected at unpredictable times.
How can you tell that the tonsils and or adenoids are
injected?
The tonsils can be seen through the open mouth, the
adenoids can be seen through the nose, and the middle
ear can be inspected through a speculum.
What can happen if the adenoidal injection persists?
The child will develop the facial expression of the
mouth breather open mouth with pinched face. Snoring,
a nasal quality to the voice and "sniffles" are further
evidence of the extension of adenoidal tissue into the back
of the nose. The ear infections can become chronic and
result in a hearing loss.
How is the operation performed?
The child is operated on either in the morning and
goes home in the evening or in the afternoon and stays
overnight. Most hospitals sensibly make provision for
the mother to be there during the entire hospital stay.
The operation is done under light general anesthesia on
the child, who has not eaten or taken fluids for the
preceding twelve hours. The child can be adequately
sedated so that there will be no fear and no recollection
of the procedure. A thorough checkup is required on
admission to the hospital to be sure there is no infection.
What can the parents do to prepare the child jor this
operation?
This is a major part of the total experience. The child
should know about going to the hospital and about the
doctor and nurses. It has proven wise to read to the
child one of several books on Going to the
Hospital. This
should be started almost two months in advance so that
the child knows the text by heart and can identify each of the people in the illustrations. Such preparation eliminates
fear of the unknown and avoids initiating a fear of
doctors and hospitals that can last a lifetime.
Tonsils and Adenoids Surgery
Are there any special postoperative instructions?
The child should have liquids for the first day and a soft
diet on the second and third. If there is any bleeding, the
surgeon should be notified immediately and the child
taken back to the hospital. The child may have an earache,
but this soon goes away. Activities are restricted
only for the first two or three days. Swimming is not
advisable until the area has completely healed, which
usually takes about fourteen days. Follow-up examinations
should be done at two weeks and at six months.
How will I know if the operation has been successful?
The operation can result in dramatic changes. The
child becomes more energetic, eats better, and gains
weight. Snoring is eliminated. In fact, the parent, grown
accustomed to the child's sleep sounds, may even become
needlessly apprehensive about the silent sleep for the
first few days. More important, the frequency and severity
of the colds, ear infections and bronchitis are
considerably ameliorated. The results can be most gratifying.
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