Generally, there are two reasons why a child may need tonsils or adenoids removed.  Most patients believe the most common reason to remove tonsils is to treat sore throats.  However, the most frequent reason for tonsillectomy and adenoidectomy is airway obstruction.  Seventy-five percent of patients have a tonsillectomy and adenoidectomy for this reason.   See American Academy of Otolaryngology Indications for Tonsillectomy and Adenoidectomy                                        Go To Top

A tonsillectomy is performed to treat recurrent infections, especially if it is associated with a "Strep Throat," which keeps coming back several times a year after antibiotic treatment.  If medicine cannot treat or prevent the infections and the infections come back often, a tonsillectomy may be indicated.  Several studies have shown that a tonsillectomy is an effective treatment for children with frequently recurring tonsillitis (chronic tonsillitis).  View Abstract.  Click on colored text for word definitions !! 
   
 

The most common reason for tonsillectomy and adenoidectomy is is to remove enlarged tonsils and adenoids which block a child's breathing passages.  The nose may be so blocked by the adenoid (which is located behind the nose and above the back of the throat--see the below pictures) that a child can't smell, has a congested nose, and talks like he has a cold all the time.  If the tonsils are to large, a child may not eat well, taking only small, soft foods.  The child may also have some choking and mouth breathing. Often, a child snores very loudly, may not breathe well while asleep, and may actually stop breathing for several seconds.  If severe and not treated, this can put strain on the heart and lungs.  It has been shown that removal of the tonsils and adenoids is effective in treating obstructive sleep apnea in children.  View Abstract   View Abstract.   

The picture on the far right shows an enlarged adenoid blocking the nasal passage.  The picture on the near right shows 4+ kissing tonsils blocking the oral airway.  Both children needed to have these tissues removed to establish an adequate airway.
Tonsillar asymmetry without other indications (i.e.,abnormal appearance, symptoms or history) is often a benign finding and usually does not require treatment..  View Abstract


 
However, not all airway obstruction in children is caused by hypertrophic adenoids or tonsils.  Here is a case of an 8 year old child with sleep apnea who had very small tonsils and adenoids but nasal airway obstruction due to a nasal septal spur and swollen nasal membranes.
   
  

 
Search PubMed for Quinsy Tonsillectomy   
 
Search PubMed for Peritonsillar Abscess
 

Adenotonsillectomy is major surgery.  Children used to stay overnight but in the USA this surgery is commonly performed on an outpatient basis.  Surgery usually lasts from 30 minutes to an hour, but sometimes takes longer.  During this time, you can wait in the preoperative waiting room or other part of the hospital. 

There are many different surgical techniques for removing the tonsils.  Tonsils have been removed using a  knife, electrocautery, laser, harmonic scalpel and coblation tonsillectomy.  All of these techniques have their advantages and disadvantages.  Some such as the laser was very popular in the 1980's but fell out of favor after it was shown to have delayed healing and increased the time the patient is under general anesthesia.  The microdebrider is slow and does not control bleeding giving it little advantage using a scalpel.  What is important is the experience of your surgeon.  This is one surgery you do not want to go to the lowest bidder.  Find an experienced surgeon who is skilled with a particular technique and has good outcomes.  Do not worry so much about the exact technique used.

Time Tested:  The oldest and most time tested techniques are HOT  and COLD tonsillectomy.  In HOT dissection the tonsils are removed with an electrocautery.  In COLD dissection, a surgical knife is used to remove the tonsils.  Both techniques have comparable post-operative bleeding rates but COLD dissection has been shown to produce less pain.   View Abstract   However, Lee, et.al,  found that the HOT dissection had a significantly higher secondary bleeding rate View Abstract and has more post-operative pain than COLD dissection.  

   
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