The tonsils are two fleshy lumps at the back of the throat. If you look in the mirror, with your mouth wide open, you can see them. The thing that dangles down in the middle is the uvula (you-view-la). The tonsils are either side of it. Healthy tonsils are pale pink in colour, sometimes with white spots. Infected tonsils are more red in colour. They may have yellow or green spots of pus, or grey ulcers, or a thick cheesy off-white coating.
Adenoids are cauliflower-like swellings at the back of the nose. You can't normally see them because they are above and behind the uvula. If the adenoids are too big, they may block the nose and cause glue ear.
Normal tonsils and adenoids act as a barrier to help fight infections. They are made of lymphoid tissue, part of the body's immune system. Bacteria, virus and other particles in air and food get trapped in their folds. Immune cells sample everything. If they detect a potentially dangerous invader, they attack and destroy it with their natural chemical weapons. Some immune cells leave the battlefield and travel to the lymph glands in the neck with a message for reinforcements. The lymph glands are like factories for immune cells and antibodies. Antibodies are chemical weapons tailored specifically to one type of virus or bacterium. If the virus is new to the body, the lymph glands may be slow to react, and the invader can gain considerable ground and cause illness. But if the virus has been encountered before, the immune cells remember its structure. They rapidly switch on production of neutralising antibodies, which prevent infection from progressing. The person is immune to that virus. Unfortunately, there are hundreds of different viruses and bacteria which can cause illness. Throughout childhood, we are constantly exposed to different viruses. This probably explains why the tonsils and adenoids grow in size until around the age of 8, then, in most cases, begin to shrink. By adult life, the adenoids should have virtually disappeared, and the tonsils should be small.
Although the tonsils and adenoids, when healthy, do help fight infections, sometimes they cause much more trouble than they are worth.
Tonsillitis can get better on its own. Simple treatment with
Many children go through a phase of repeated attacks of tonsillitis, especially when they start school and become exposed to a greater variety of viruses and bacteria. I usually recommend waiting at least a year or two, to see if the attacks will stop. A further bout of repeated attacks of tonsillitis is common in the teenage years, often following glandular fever. Again, it is sensible to wait and see for at least a year, to see if they will settle down. On the other hand, this is an important time at school for study and examinations. If it seems likely that the attacks will continue and disrupt education, operation may be the best solution.
Tonsillectomy and adenoidectomy are very safe procedures in modern medical practice. But no operation is totally risk free.
No. Tonsillectomy is relatively safe at any age, but it is more painful in adults and teenagers than in young children. There are no absolute age limits. The youngest patient I have operated on was six months, for breathing obstruction. The oldest was 93, for cancer of the tonsils.
Tonsils and adenoids are removed under general anaesthetic (fully asleep) in the operating theatre. The anaesthetist usually sends you to sleep by giving an injection. The drug injected acts very rapidly, within a few seconds. To stop the needle from hurting children, the ward nurse puts special cream on the back of the hand. It numbs the skin, so the needle doesn't hurt. Sometimes, if a vein can't be found or the child is too frightened, we send you to sleep with gas. This may take several minutes to work. Once you are asleep, the anaesthetist puts a plastic tube in your mouth. It goes to the trachea (windpipe) so that you can breathe during the operation. A special gag holds the mouth wide open. Both tonsils and adenoids are removed through the mouth. There is no external cut. Any excessive bleeding is controlled by a combination of pressure swabs, diathermy (electric cautery) and stitches. If you do need stitches, they will be self-dissolving. They will not need to be removed.
If you smoke, you should give up, because smokers are more likely to suffer complications after operation. Parents should also consider giving up, as children must not be exposed to passive smoking during recovery. Make sure you have supplies of soluble paracetamol (Calpol for children) for when you come home. Do not plan anything important during the two weeks after operation.
After the operation, you will wake up in the recovery area, where a nurse will look after you. You will be asked to spit out the plastic tube in your mouth. There may be some blood in the mouth or nose. This is quite normal and will stop after a while. When you are sufficiently awake, you will return to the ward. You will stay in bed for several hours. Your throat will feel sore, you will feel thirsty and tired, and you may be sick. Spit out any blood or secretions; if swallowed it will make you feel sick. The nurse will attend you frequently to check your pulse and breathing. If you are in any discomfort, please let the nurse know as she can you an injection to help relieve it. You will be allowed to drink as soon as the nurse is happy with your condition. You will be advised not to have too much initially as it might make you sick. Food is started as soon as you are able.
Most patients operated in the morning are able to go home later the same day. If your operation is done in the afternoon, or if your recovery is slow, you may need to stay in overnight.
It is most important to eat and drink regularly - this helps the healing process. Your saliva contains lysozymes (lie-so-zimes) - natural antibiotics, and eating helps clean the operation area. Chewing and swallowing are like physiotherapy exercises for the throat.
Contact details:
Mrs Fairley 01233 642244
Chaucer Hospital 01227 455466
St Saviours Hospital 01303 265581
Although we will do our best to help, we cannot guarantee to be available personally 24 hours a day, 365 days a year. Also, the private hospitals are set up for planned, elective surgery, and not for emergency admissions. We participate in the emergency on-call rota for ENT in East Kent, which is based in the NHS Rotary Ward at the William Harvey Hospital, Ashford.
Rotary Ward Direct tel. (3 lines)
01233 616234
01233 616239
01233 616240
Adenoidectomy - Best Treatments from the British Medical Journal
Adenoids and Tonsils - Patient UK
Tonsil surgery - ENT.UK / British Association of Otolaryngologists Head & Neck Surgeons
All information and advice on this website is of a general nature and may not apply to you. There is no substitute for an individual consultation. We recommend that you see your General Practitioner if you would like to be referred
© 2006 - 2008 All rights reserved
Mr James W. Fairley BSc MBBS FRCS MS (Lond)
GMC No. 2719566
Enquires: Mrs Sylvia Fairley RGN RCNT Dip Nurs (Lond)
tel 01233 642244 fax 01233 662840
Sandyhurst House Sandyhurst Lane Ashford Kent TN25 4NX
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