Adenoid and Tonsil Surgery — Ankara

What they are

Both are lymphoid tissue and contribute to immune function in childhood. The adenoid sits at the roof of the postnasal space, behind the nose, and cannot be seen from outside; the tonsils sit on either side of the throat.

Some enlargement is normal in children and they usually shrink with age. The problem begins when enlargement narrows the airway or becomes a source of recurrent infection.

Which signs matter

• Sleeping with the mouth open and snoring regularly
• Pauses in breathing during sleep, restless sleep, night sweating
• Waking tired, with problems of attention or behaviour during the day
• Nasal-sounding speech
• Recurrent middle ear infection or fluid behind the eardrum
• Reduced hearing, or slow responses to being called
• Many episodes of tonsillitis in a year
• Difficulty feeding and gaining weight

The sleep-related items deserve the most attention. Sleep apnoea in children can interrupt the phase of sleep in which growth hormone is released, and can show in school performance.

How it is assessed

Because the adenoid cannot be seen from outside, assessment is done with a flexible endoscope. The procedure takes a few seconds and most children tolerate it. This avoids both unnecessary surgery and unnecessary waiting.

Where hearing is affected, a hearing test and tympanometry to detect fluid behind the eardrum are performed. If breathing pauses are described, a sleep study may be considered.

When surgery is needed

For adenoids the most common reasons are breathing difficulty during sleep and recurrent middle ear problems. For tonsils there are two separate reasons: frequently recurring infections, or size sufficient to obstruct breathing during sleep.

Removing both together is common but not obligatory. In some children only the adenoid is removed and the tonsils are left.

Parents often worry that surgery will weaken immunity. Lymphoid tissue in the body is not limited to these two sites, and removing them has not been shown to weaken the immune system permanently.

Recovery

1. Day of surgery Performed through the mouth under general anaesthesia. There is no external incision. The child is up and about the same day.
2. First 3 days If the tonsils were removed, pain on swallowing is marked. Cold, soft food and plenty of fluids are recommended, with regular pain relief.
3. Days 4 to 7 A white layer forms over the healing area in the throat. This is normal healing rather than infection. Breath may smell.
4. Weeks 1 to 2 Pain settles and eating returns to normal. Strenuous activity is avoided because of the risk of late bleeding.
5. Month 1 Review. Changes in sleep pattern and snoring are assessed.

These are average times; recovery varies from person to person.