What are the other Names for the Procedure?
- Bilateral Tonsillectomy and Adenoidectomy
- Tonsil and Adenoid Removal
What is the Tonsil and Adenoid Removal surgical procedure?
Tonsil and Adenoid Removal (Tonsillectomy and Adenoidectomy) is a surgical procedure that involves a complete removal of the tonsils and adenoid glands (lymphatic tissue).
What part of the Body does the Procedure involve?
Tonsil and Adenoid Removal involves the tonsils, adenoids, the opening from the nose within the throat, and the back of the throat.
Why is the Procedure Performed?
The Tonsil and Adenoid Removal surgery is performed for the following reasons:
In case of tonsils:
- Recurring attack of tonsillitis, usually throughout the year
- Peritonsillar abscess
In case of adenoids:
- Air that passes through the nose is blocked
- Middle ear infection
What are some Alternative Choices for the Procedure?
While early episodes of infection or inflammation of the tonsils or adenoids may be managed with medication, long-standing or recurrent episodes need surgery.
What are the Recent Advances in the Procedure?
Surgical techniques, such as the use of a harmonic scalpel, laser beam, and microdebrider, are some of the more refined techniques for Tonsil and Adenoid Removal.
What is the Cost of performing the Tonsil and Adenoid Removal surgical procedure?
The cost of Tonsil and Adenoid Removal procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding Tonsil and Adenoid Removal procedure and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
Prior to Tonsil and Adenoid Removal surgical procedure:
How is the Tonsil and Adenoid Removal surgical procedure Performed?
The Tonsillectomy and Adenoidectomy procedure is usually performed under general anesthesia.
- The surgeon removes the tonsils through the mouth. The tonsils may be removed through a variety of possible techniques. This depends on the surgeon’s preference and the needs of the patient
- The surgeon may possibly use a wire loop, forceps, and scissors to remove the tonsils
- The tonsils may also be removed by use of intense heat produced using electric current (electrocautery), high frequency waves, a harmonic scalpel (with vibrating blades), or using a laser beam
- The adenoids may be removed through the mouth. The surgeon uses a mirror that is held to the back of the throat to visualize the adenoid while removing it
- An instrument called the microdebrider helps in removing the adenoid through the nose
Where is the Procedure Performed?
Tonsil and Adenoid Removal procedure is usually performed in an out-patient surgery center facility or a hospital.
Who Performs the Procedure?
A general surgeon or an otolaryngologist performs the procedure.
How long will the Procedure take?
The procedure may take about an hour to perform.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Tonsil and Adenoid Removal procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding, and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Tonsil and Adenoid Removal procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Tonsil and Adenoid Removal surgical procedure?
Before a Tonsil and Adenoid Removal surgery, the patient may have to undergo certain tests such as:
- Routine blood and urine analysis
- Other tests as requested by the healthcare provider
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Tonsil and Adenoid Removal surgical procedure?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests or periodic visits to the healthcare facility required after the procedure?
- What are the costs involved?
During the Tonsil and Adenoid Removal surgical procedure:
What kind of Anesthesia is given, during the Procedure?
General anesthesia by injection and inhalation is administered prior to the procedure.
How much Blood will you lose, during the Procedure?
There is not much blood loss during an uncomplicated Tonsillectomy and Adenoidectomy.
What are the possible Risks and Complications during the Tonsil and Adenoid Removal surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness such as autoimmune disorders or chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the Tonsillectomy and Adenoidectomy surgery are:
- Excessive bleeding
- Infection within the surgical wound
- Anesthetic complications
What Post-Operative Care is needed at the Healthcare Facility after the Tonsil and Adenoid Removal surgical procedure?
At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.
After the Tonsil and Adenoid Removal surgical procedure:
What are the possible Risks and Complications after the Tonsil and Adenoid Removal surgical procedure?
The possible risks and complications that may arise after the Tonsil and Adenoid Removal surgical procedure are:
- Excessive bleeding that sometimes may require an additional surgical procedure
- The adenoid-tissue reappears
- Any symptom that causes uneasiness such as nausea and dehydration
What is the Prognosis after the Surgery?
The prognosis after a Tonsil and Adenoid Removal procedure is generally excellent.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Pain that worsens and swelling around the surgical wound
- Bleeding or fluid drainage from the surgical wound
- Excessive coughing
- Spitting of vomiting up blood
- Signs of an infection
- Headache, muscle aches
- Fever, feeling sick
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Tonsil and Adenoid Removal surgical procedure?
At home, the following post-operative care is recommended after a Tonsil and Adenoid Removal procedure:
- Remain bedridden for the first few days following the procedure. Then, slowly proceed to resume regular/daily activities, which can aid in a faster recovery
- Using ice packs or popsicles can help to relieve any mild pain
- Reduce speaking as much as possible for the first few days after the procedure
- Avoid any situations that may result in discomfort within your throat such as coughing, clearing of the throat, etc.
- One may resume bathing or showering after the procedure
- Complete the course of prescribed medication, as advised by the physician
- Take stool softeners to prevent constipation
- Take antibiotic medication to help combat or prevent infection, as advised by the physician
- Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain, as per the physician’s advice
- Avoid all activities that are physically strenuous for about 6 weeks after surgery
- Individuals are advised to have to a clear liquid immediately after the surgery. Eating popsicles or sucking on ice cubes can relieve mild pain. Avoid foods that are hot or difficult to digest. The patient may slowly proceed to take regular diet after a while
How long does it normally take to fully recover, from the Procedure?
A complete recovery from the procedure may take a week or two.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed, as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Tonsil and Adenoid Removal surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- A outpatient surgical center facility or a hospital
- An anesthesiologist (if anesthesia was administered)
- A pathologist
- General surgeon or a otolaryngologist
The patient is advised to inquire and confirm the type of billing, before the Tonsil and Adenoid Removal (Tonsillectomy and Adenoidectomy) surgical procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA