Tonsils: Out or in? Why or when?

The tonsils are visible masses of lymph tissue located in the upper part of the throat. When they become infected – which they often do in childhood – the entire area becomes inflamed and small white flecks may appear.

Despite effective antibiotics to treat strep infections, the need to remove the tonsils has remained about the same over the years due to a better understanding of the way tonsils can affect children’s breathing, especially breathing through the nose.

Removal of tonsils and adenoids is often recommended when their swelling interferes with swallowing or breathing or when a child suffers chronic snoring, mouth-breathing, sleep pauses and sleep apnea. Tonsillectomy is also recommended when a child develops tonsillitis more than six times in one year, four times a year for two years in a row or three times a year for three years straight.

Think your child may need a tonsillectomy and/or adenoidectomy?

Here are some of the reasons your pediatrician may send your child to an ear-nose-throat specialist to evaluate him for removal of tonsils and/or adenoids (lymph tissue located in the space above the soft roof of the mouth which cannot be seen by looking in the mouth):

  • Recurring strep throat infections
  • Excessive snoring
  • Constant open-mouth breathing
  • Sleep pauses or sleep apnea
  • Painful swallowing
  • Chronic sinusitis and/or ear infections
  • Dental malocclusion
  • Long face syndrome, a condition in which chronic open-mouthed breathing influences children’s facial and dental development

Tonsillectomies and adenoidectomies are often performed differently than they were a generation ago. Dr. Craig Derkay, a pediatric ENT specialist at CHKD, says some of the new surgical techniques currently in use often mean shorter, less painful recuperations.

While the electrocautery blade and stainless steel scalpel are still the most popular tools for removing tonsils, surgeons also use devices that create heat energy like coblaters, the harmonic scalpels and suction-microdebriders. At CHKD, surgeons select the technique that best suits the child’s age and underlying reason for surgery. For instance, for children who need tonsillectomies because of breathing problems, Dr. Derkay often uses a microdebrider, which has small rotating blades inside a metal wand that is attached to a suction hose. For children suffering from recurrent tonsillitis, he uses the electrocautery blade.

If your child needs a tonsillectomy, your surgeon will discuss the best options with you. But no matter what technique is used, patients are still allowed frozen treats like popsicles and ice cream for the first few days after surgery.

Outpatient surgery for tonsillectomy

An ear-nose-and-throat surgeon who specializes in treating children will decide if a child needs a tonsillectomy. The surgery can be done on an outpatient basis if the child is 3 years of age or older and otherwise healthy.

At the surgical facilities of Children’s Hospital of The King’s Daughters, children are treated with kid gloves. Their special needs receive top consideration as we help them prepare for surgery. They can have a pre-surgery visit with a child life specialist to ease anxieties – both the parents’ and the child’s. When they arrive on surgery day, they enter a world they understand – filled with toys and caring people who know children best. When it comes time for surgery, the child is escorted from the well-stocked playroom to the OR while riding a bike, kiddie car or wagon or walking or in the comforting arms of a staff member. After the brief surgery, the parents join their child in the recovery room for several hours as the child recuperates under close observation by skilled pediatric nurses.

Children are encouraged to drink lots of fluids after the operation, which can mean a slushy-type of drink – much like a Slurpee – that is made to order right in CHKD’s recovery room with the child’s flavor preference. At home, popsicles, ice cream, yogurt, pudding and milkshakes are also recommended, especially since the child has been without food for such a long while before and during surgery.

Dr. Derkay is a pediatric otolaryngologist with EVMS at CHKD.