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Tonsils & adenoids

Your adenoids and tonsils are part of your immune system. Your adenoids are behind your soft palate and you can’t see them without special instruments. Your tonsils are the two round lumps in the back of your throat.

The tonsils and adenoids play an important role in helping to establish your immune system after birth. This function is pretty much done by around the age of 6 to 8 months. After this, the tonsils still contribute to the immune system by secreting antibodies, and this contribution is important until around 3 years of age. After this, the tonsils have no further meaningful role to play.

Sometimes your tonsils or adenoids become infected or enlarged. In some people they can cause frequent bacterial infections and can block airways, making it harder to breathe.

If your adenoids and tonsils are enlarged, you might notice:

  • It is hard to breathe through your nose
  • It might be hard to sleep
  • Your voice sounds like your nose is plugged up
  • A runny nose
  • Noisy breathing
  • Frequent ear infections
  • Snoring

Others might notice pauses in your breathing while you sleep.

Signs of tonsillitis, an infection of the tonsils, could include:

  • Red tonsils
  • White or yellow coating on the tonsils
  • Sore throat
  • Ear pain
  • Pain when swallowing
  • Fever
  • Bad breath

Treatment
If you have symptoms of infected or enlarged tonsils or adenoids, see your doctor. Your doctor will probably prescribe antibiotics. If you have ongoing infections or problems with enlarged tonsils or adenoids, your doctor might suggest you have them removed – Tonsillectomy.

What is a tonsillectomy?
A tonsillectomy is the removal of the tonsils that are at the back of the throat.

What are the tonsils (and adenoids) there for?
The tonsils and adenoids are part of the immune system. Their role in the body is to help form the immune system when you are a baby and then to contribute antibodies until around the age of 3 years. After that, they do not play any significant role anymore.

If the tonsils (and adenoids) are part of the defence system, why are they then removed?
The tonsils (and adenoids) are only removed when they are misbehaving. Usually this misbehaving only becomes a problem after the age of 3 years when they are no longer important to the defence system, and can therefore easily be removed. If they are causing a problem at an earlier age, a decision needs to be made whether the risks they are causing are more than the risks of the operation.

How are the tonsils removed?
There are many ways to remove the tonsils. They range from Dissection (pealing) to Laser. More recently, the Coblation tonsillectomy and thermal welding forceps technique have been devised. The ultimate outcome is very similar for any type of technique used.

Is tonsillectomy painful?
Because the procedure is done under anaesthesia, tonsillectomy is not painful at all. However, after the procedure, pain is normal. Pain lasts typically 10 days but ranges from 7 to 21 days. There is a period of a few days after the procedure (3-5) that the pain temporarily worsens. This is normal and is due to the muscles stiffening. It is also normal to experience referred pain in the ears.

I have been told that tonsillectomy in adults is dangerous. Is this true?
Tonsillectomy in adults is no more dangerous than in children. It is, however, more painful postoperatively.

What are alternatives to tonsillectomy?
Tonsillitis may be treated with antibiotics.
Surgery is only considered after you and your ENT have determined, based on the risks and benefits, that tonsillectomy is appropriate for you.

How do you prepare for the operation?
Avoid blood-thinning medication such as aspirin or similar medication for at least 2 weeks before the operation.  (Avoid Arnica tablets & Disprin)
On the day of the procedure, patients cannot have any Food or Milk or Chewing Gum for 6 hours prior to the scheduled time. Only clear fluids are allowed up to 2 hours before admission. (Apple juice & Ice Tea) Thereafter nothing should be taken orally.

What is the post-tonsillectomy recovery process?
Most children go home on the same day and should recover within a week if they eat adequately. If they do not eat and swallow, the recovery period could be as long as three weeks.

What are the indications for tonsillectomy?

  • Frequent spells of acute tonsillitis (infection of the tonsils).
  • Chronic tonsillitis, consisting of persistent, moderate-to-severe throat pain.
  • Extremely large tonsils or adenoids obstructing the airway and causing sleep apnoea (stopping or obstructing breathing at night).
  • An abscess behind the tonsil.
  • When one tonsil is much larger than the other and microscopic examination of the tonsil tissue is required to exclude certain tumours.

Post-operative instructions:
Most of the pain of the operation is due to spasm of the swallowing muscles. It is important therefore to eat as often as possible after the procedure. This will hasten the recovery period and limit pain, as well as decrease the incidence of complications such as infection and bleeding.

  • NO fruit or fruit juice must be taken for the first two weeks after the operation. Certain fruits contain enzymes, which may cause bleeding.  Generally avoid excessively spicy, acidic, salty and hot food.
  • Foods to be taken should include chips, biltong, Kentucky, McDonald’s, Plain or Vanilla yoghurt, cream soda. etc. “A nice healthy diet! “Jelly and Custard are OK but should not constitute the sole menu. Any non-fruit drinks are all acceptable.
  • If you would like to have the healing process checked, please make an appointment for approximately 2 weeks after the operation. If the patient is eating well after two weeks, a normal diet may be started without any further follow up visits.
  • Should any situation arise that causes any concern, please contact us at the rooms or come in for a visit. Slight bleeding or oozing from the nose is normal for the first one or two days. Any other bleeding must not be ignored and we must please be notified.

How do you control the pain?
Take the pain killers prescribed on time, even if you are not having pain. Preventing pain is easier than treating it after it has established. Eat and drink plenty to get the muscles moving.

What is the yellow area at the back of the throat where the tonsils used to be?
That is the scab and is referred to as slough. It is normal and does not mean that there is an infection.

Can the tonsils and adenoids come back after removal?
The adenoids can recur as they are never completely removed; only debulked. After the age of 8, they usually don’t come back. It is rare, but possible, for the tonsils to come back.

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