According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), the number of tonsillectomies performed in the U.S. has gone steadily down since the 1970s, when it was nearly a rite of passage for American children. Still, tonsillectomy remains one of the most common childhood surgeries in the U.S., with about 289,000 procedures performed annually in kids younger than 15. Kids with bleeding disorders are no more likely than unaffected children to need their tonsils or adenoids surgically removed. But for those who do, as with any surgery, meticulous advance planning is necessary.
Following are some basic facts and important considerations.
What are the tonsils and adenoids?
The tonsils and adenoids are small lymphoid organs that are part of the immune system. They help trap harmful bacteria and viruses that enter the body through the mouth or nose. The tonsils are located on both sides of the back of the throat. The adenoids, which are visible only with special medical instruments, are behind the nose and the roof of the mouth.
What goes wrong with the tonsils and adenoids?
They can become infected and get sore, conditions known as tonsillitis and adenoiditis. In many cases where surgery is required, both the tonsils and adenoids are removed. However, sometimes only one set needs to be removed.
Symptoms of tonsillitis and adenoiditis.
Frequent sore throats from recurrent strep or other infections and breathing problems, including sleep apnea, are the major symptoms. Enlarged or infected adenoids may also lead to hearing loss caused by fluid trapped in the eustachian tubes, which connect the nose and ears.
When to see the doctor.
A sore throat and difficulty eating, drinking or swallowing are signs you should go to the doctor. In addition, seek care for ongoing sleep problems, including snoring and suspected sleep apnea. Your doctor may prescribe a sleep study to determine if your child has sleep apnea.
Deciding on surgery.
In February, the AAO-HNS issued updated guidelines for clinicians regarding tonsillectomy in children. While the biggest changes pertain to medicines (i.e., children undergoing tonsillectomy should not receive antibiotics during surgery and children younger than 12 shouldn’t take any medication containing codeine after surgery), the guidelines strongly advocate a watchful waiting approach before electing to have surgery, even for kids who have recurrent infections. Watchful waiting could include treatment with antibiotics or other medicines.
Risks for children with hemophilia, von Willebrand disease and other bleeding disorders.
The main complication from adenotonsillectomy for children with bleeding disorders is bleeding. Special precautions to manage bleeding must be taken before, during and after the surgery. The pediatric hematologist at your hemophilia treatment center should coordinate with your child’s pediatric otolaryngologist (ear, nose and throat, or ENT, specialist) to devise a treatment plan tailored to your child. The plan may include extra doses of factor surrounding the surgery. If possible, a children’s hospital is the best location for a child with a bleeding disorder to have tonsil and adenoid surgery.
After the adenoids and tonsils are removed, children must eat easy-to-swallow foods such as scrambled eggs, applesauce, pudding and Jell-O. Kids are also discouraged from being too active. In addition to factor, doctors may prescribe an antifibrinolytic drug that promotes blood clotting in the mouth, such as Amicar, to help heal the wound.
• Learn more about tonsillitis and adenoiditis at the American Academy of Otolaryngology-Head and Neck Surgery website ENThealth
• Read updates to the American Academy of Otolaryngology-Head and Neck Surgery’s Clinical Practice Guideline: Tonsillectomy in Children