Everyone is born with a set of tonsils, fleshy masses of lymphatic tissue located at the base of the throat. If they are enlarged or chronically infected, this can affect a person’s breathing and/or swallowing and your doctor may suggest a tonsillectomy (or removal of the tonsils).
While any surgical procedure is not to be taken lightly, this is especially true when it involves a child. Yale Medicine is unique in that we have a team of pediatric otolaryngologists, or ear, nose and throat (ENT) specialists, who have additional training in treating only children—both medically and surgically when necessary.
General ENTs can treat children as well, but they have not had additional years of training in the pediatric specialty. If it is determined that your child needs surgery, you can rest assured that all of our pediatric ENTs work exclusively with pediatric anesthesiologists. This is a very important consideration for many parents.
Erik Waldman, MD, chief of Yale Medicine Pediatric Otolaryngology, is one of the few specialists in the area who has been trained to perform a partial tonsillectomy and identify patients who may be candidates for this procedure. A partial tonsillectomy provides equal benefit to the right child and results in less post-operative pain and a quicker recovery than a traditional total tonsillectomy. These kids often begin eating normally soon after their procedure and can return to school and their usual activities much faster. Narcotics are seldom warranted and post-operative bleeding almost never occurs.
Dr. Waldman also offers coblation tonsillectomy, a specialized procedure that uses radiofrequency energy and saline, a technology that reportedly is better tolerated by kids, and has been shown to cause less pain, less bleeding and fewer complications.
Why does my child need a tonsillectomy?
The tonsils are two lumps of tissue that sit side-by-side at the back of the throat. The adenoids are located higher up in the throat, behind the nose. Tonsils and adenoids are part of the body’s lymphatic system which is responsible for clearing away infections and balancing the body’s fluids. Tonsils and adenoids trap germs that enter through the mouth and nose.
Surgery to remove tonsils is typically recommended for tonsillitis that recurs frequently or for chronic or bacterial tonsillitis that doesn’t respond to antibiotics. Other common reasons a child may require a tonsillectomy include severe snoring and obstructive sleep apnea (when a child stops breathing for periods of time while sleeping), difficulty swallowing, or an abscess that does not improve with antibiotic treatment.
Before surgery is considered, your doctor will try other remedies including rest/observation, pain relievers, and/or antibiotics. Infrequent sore throats, mild tonsillitis and strep throat can often be treated nonsurgically.
What diagnostic tools are used before a tonsillectomy?
The first steps a doctor will take in determining whether a tonsillectomy is recommended include a physical exam and a detailed medical history. “If the tonsils are huge and touching each other, they usually need to be removed,” says Kimbra Dombroski, RN.
“If the tonsils are enlarged, usually the adenoids are too,” adds Dr. Waldman. However, it is impossible to see the adenoids without a camera because they are all the way at the back of the nose.
Yale Medicine doctors have access to state-of-the-art diagnostic technology to visualize the adenoids and perform other diagnostic procedures that cannot easily be done in other settings. One of these is an upper airway endoscopy. “It’s a very quick procedure, taking only 30 to 60 seconds,” Dombroski explains. “We go through the nose with a tiny tube.”
If obstructive sleep problems are suspected, your doctor may suggest that your child have a sleep study. “This doesn’t reveal the site of the obstruction, but it can show you that there is one,” Dr. Waldman says. Yale Medicine has a specialized pediatric sleep laboratory at Yale New Haven Children’s Hospital. The study measures the air flow through the nose. If the air is not moving through a child’s respiratory system or they regularly stop breathing, it could be from an obstruction having to do with the tonsils or the adenoids.
What should my child expect on the day of surgery?
Your child should not eat or drink after midnight on the day of surgery. You will arrive at Yale New Haven Children’s Hospital one to two hours before the procedure. A pediatric anesthesiologist will meet with you to answer any questions you may have and then will give your child general anesthesia.
A tonsillectomy typically takes about one hour. Most patients go home the same day. “For children who are very young, say less than 3 years old, or with significant health problems, we would keep them overnight,” says Dr. Waldman.
What is recovery from a tonsillectomy like and what are the risks of the procedure?
Most children take 7 to 10 days to recover from a typical total tonsillectomy. Pain can be controlled with over-the-counter medications and sometimes requires narcotics. Partial tonsillectomy patients recover much faster and almost never require narcotics. Other post-operative issues are typically minimal; a patient may experience bad breath or a sore throat for about a week. Some pain isn’t unusual and it’s important that patients stay well hydrated.
The majority of children return to school after about a week; a child who had a partial tonsillectomy may be ready to return after three or four days. Parents should be aware that there is still a risk of bleeding for 7 to 10 days, so doctors don’t send them back into all of their regular activities right away.
What stands out about Yale Medicine’s approach to tonsillectomy?
In addition to being one of the few area practices to perform partial tonsillectomies, Yale Medicine offers the most advanced methods of diagnosing and treating any problem that affects your child’s ear, nose or throat.
Yale New Haven Children’s Hospital has two pediatric-only sleep labs: one in New Haven, one in Bridgeport. These are designed to provide a comfortable experience for your child and also are equipped with technology for diagnosing obstructive sleep apnea.
We work closely with our pediatric sleep specialists as well as speech and swallow experts. While parents should carefully consider any surgery for their child, Dr. Waldman says that when he talks to families a month after a tonsillectomy, he has yet to meet one who is unhappy with their decision to have the surgery.