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Tonsil and adenoid surgeries��are��the most common surgical procedures��performed on children in the United States.��Tha��’s been true��for about the last 20 years, says��Vikash K Modi, MD,��Chief of Pediatric Otolaryngology - Head and Neck Surgery��at ��������Ƶ. Dr. Modi, also��Associate Professor of Otolaryngology in Pediatrics at Weill Cornell Medical College, reports that about 75 percent of his practice comprises pediatric tonsil��and adenoid surgery.����

Here��Dr. Modi��explains��when��tonsil and adenoid surgery��are necessary, and what families need to know about the procedures.��

Tonsil and adenoid response to infections

Tonsils are located on both sides of the back of the throat,��and adenoids are located in the back of the nose. ��

“Often, in response to infection,��or for other reasons, the tonsils will enlarge,��and you can see them as two  large  balls of tissue on either side of the throat,” Dr. Modi explains. �į����

Adenoid tissue may enlarge in response to respiratory tract infections, allergies, or��sometimes��for unknown reasons.��

Common reasons for tonsil and adenoid surgeries

There are two��common reasons��for tonsil and adenoid surgery:��infection and upper airway obstruction. ����

Frequent throat infection—most commonly, strep throat—is an indication for tonsillectomy��when a��child has had seven or more episodes in one year,  five episodes in two successive years,  or three episodes in three successive years. �į��

Physicians may recommend a partial or total tonsillectomy��when the tonsils and/or adenoids become enlarged and��obstruct the��airway.����

“Parents should watch for disruptive sleep patterns, such as frequent waking at night��that��occurs��with snoring, or apnea��[a cessation of breathing],” Dr. Modi says. “Sometimes parents��hear loud, irregular snoring at night,��or��notice their child is wetting��the bed��or��mouth-breathing.”��

Enlarged adenoids may cause chronic earaches and ear infections, with or without middle ear fluid.����

“Adenoid tissue is near the opening of the  eustachian  tube,�� which  ventilates the middle ear space,” Dr. Modi says.  “Large adenoids can block the  eustachian  tube  opening, leading to fluid build-up, ear infections, and hearing loss.” �į����

A��doctor may recommend an adenoidectomy ��for a child who experiences long-term or recurrent sinus or nasal infections despite adequate medical treatment��he��adds.����

When parents notice that their child is more tired than usual or��is��taking��daytime��naps, it can be a��sign of possible disrupted sleep and/or sleep apnea.������

“Apnea��can affect a child's growth and development,” Dr. Modi says. “Disrupted sleep and/or sleep apnea also���󲹲� been closely correlated with learning disabilities,��such as ADHD.��Long-term��sleep apnea can lead to cardiopulmonary issues.”��

Surgical options can include tonsil reduction (shaving)��or removal.��

If a child suffers from��sleep apnea or obstruction,��surgeons would typically��perform a��partial tonsillectomy��with��an��adenoidectomy. ��When the major challenge is��chronic��throat infections, they’d be more likely to perform a total tonsillectomy, Dr. Modi says. �į����

I��’s important to prepare��a��child for these procedures

Sometimes children may be given a sedative before surgery, and anesthesia is administered with a mask. Both may surprise children, so Dr. Modi advises parents to prepare their child for surgery.��

Parents are allowed to be with children��in the operating room until��the��child is��asleep, and��in the recovery room when��the��child wakes up. ��

“There are several books that you and your child can read together that would help to prepare for the experience,” Dr. Modi adds. “One example is��Curious George Goes to the Hospital, by M & H Rey.”����

Tonsillectomies and adenoidectomies are usually outpatient procedures

Sometimes, Dr. Modi explains, a��child may stay in the hospital overnight.����

Both procedures—which require general anesthesia—are brief. An adenoidectomy usually takes 30 to 40 minutes, and the surgeries performed together usually take between 45 and 60 minutes.��

“After a tonsillectomy, children may experience some pain and bleeding,”��Dr. Modi��says. Bleeding is less frequent with a partial��tonsillectomy, and usually occurs closer to the time of the procedure, or about a week later, when a scab falls off the surgical site.����

With a partial tonsillectomy,  a child may complain of a mild sore throat for��two to three��days after surgery. Dr. Modi says over-the-counter  medications usually��bring relief.��

Recovering from surgery

Some children feel better in just a few days, and some take as many as 14 days to recover. �į ��

“During the recovery period, make sure your child stays well hydrated,” Dr. Modi says, and suggests��avoiding carbonated drinks, and acidic drinks (like orange juice).����

A��soft diet where chewing is necessary��also is important: chewing and swallowing relieve pain and promote healing.��

Parents may notice��a��high-pitched or squeaky��change in��the child’s��voice—i��’s��usually temporary,��but may last��for��six��to��eight��weeks. ��

Children who undergo��a partial tonsillectomy��usually��return to school when  they  feel  ready,  usually��in three to five��days.����

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