Procedure for Tonsillectomy + Adenoidectomy

What are Tonsils and Adenoids?

Lymph nodes located on either side of the throat are called tonsils. The lymph glands located behind the nose on the upper side of the throat are called the adenoids. Their purpose is to defend the body against invading bacteria, fungi and viruses. When the lymph nodes get infected, inflamed and produce symptoms, it is called Tonsillitis. This condition is prevalent in children and young adults. The condition is usually contagious. The most common cause is Streptococcal infection. If tonsillitis is left untreated, it can lead to complications and recurrence.

Symptoms of Tonsillitis or Tonsil Infection

The following are the signs/symptoms of tonsillitis:

• Sore throat
• Pain in swallowing
• Fever with or without chills
• Diarrhea
• Cough and cold
• Swelling in throat
• Redness of throat
• Ear pain
• Headache
• Breathing problems
• Sinus problems
• Difficulty in talking
• Upper airway obstruction

Tonsillectomy and Adenoidectomy

T&A surgery is a procedure that aims tonsils and adenoids removal.

Pre Surgery Care

Prior to the surgery, the patient needs to undergo a series of pre surgery care steps. They are as follows:

• Medical history is taken.
• Routine blood and urine examinations are done.
• Solid foods should be stopped before twelve hours of surgery.
• Nil by mouth before two hours of the procedure.
• Blood thinner and alternative treatments should be stopped 1 week before surgery.

Procedure of Tonsil and Adenoid Removal

It is usually done on an out-patient basis and under local anaesthesia. If the child is aggressive the procedure is done under general anasthesia.

The procedure is simple. The mouth is open wide. The tonsils and adenoids are dissected using a scalpel, from the surrounding fascia. Electrocautery or chemical cautery is used to prevent bleeding. Sutures may not be needed or if done are done using absorbable sutures. Patient is closely monitored for any post-operative bleeding.

Some Statistical Data

Tonsillitis and Adenoiditis case are frequently seen in children. Their occurrence is highest in school going children as it is a contagious disease. The surgery is highly successful and rarely presents with risks.

Approximate Cost of T and A Surgery in India

The approximate cost of T and A surgery in India is between INR 20000 to 1, 30,000. The total cost will depend on the city, experience of the surgeon and complications associated.

How Long Hospital Stay is Required During this Surgery?

The surgical procedure is completed in 1 hour. It might take 3-4 hours for the anaesthesia to wean off in case of general anaesthesia.

Indications

The T and A procedure are indicated in:

• Acute tonsillitis and Abscess
• Obstructive sleep apnoea
• Nasal airway obstruction
• Diphtheria carrier state
• Persistent and recurrent infections
• Failure of conservative treatment.

Contraindications

The T and A procedure are contraindicated when the patient is suffering:

• With severe systemic infection
• With bleeding disorders
• Immune-compromised patients
• Associated disorders of the heart and liver

Risks/Complications Associated With T and A Surgery

These are the common complications of the surgery:

• Persistent bleeding
• Persistent ear ache
• Pain in jaw and swelling
• High grade fever
• Vomiting of blood
• Persistent vomiting
• Breathing trouble
• Allergic reactions like itching, redness and rashes
• Change in voice
• Signs of dehydration

Post-Surgery Rehabilitation

Post-surgery, it is very essential for parents to ensure post-operative precautionary measures in order to prevent their infants/kids/children from any complications.

• Children who are very young are usually kept under observation for 1 day
• In case of snoring, the patient is kept under close observation as he/she might have breathing problems
• Jaw might be painful and for this medications are given
• Bleeding may occur after about a fifteen days but should be minimal. But if this bleeding is not stopping, then ENT surgeon should be consulted
• Pain during swallowing is a common symptom after surgery and will subside in a few days
• Anti-inflammatory, analgesics and antibiotics are prescribed
• Bland food and liquids are given for about few weeks
• Tonsillitis and adenoid infection can recur even after the surgery.