Tonsillectomy and Adenoidectomy
Removing the lymphoid tissue that blocks the throat in children and adults.
What it is
Tonsillectomy is the surgical removal of the tonsils (two oval lymphoid tissues at the back of the throat). Adenoidectomy is the removal of the adenoids (a similar tissue mass behind the nose, where the nasal cavity meets the throat). The two procedures are typically performed together because tonsils and adenoids enlarge as a pair, and both contribute to airway obstruction when overgrown.
Why we do it
In children, enlarged tonsils and adenoids are the single most common cause of obstructive sleep apnea. They physically narrow the throat and block the back of the nose, forcing the child to mouth-breathe and producing the classic pattern of snoring, restless sleep, bedwetting, daytime fatigue, behavioral issues misdiagnosed as ADHD, and stunted growth. Removing them is curative in 70 to 80 percent of pediatric sleep apnea cases. In adults, tonsillectomy is performed for chronic recurring infection, persistent sleep-disordered breathing despite CPAP, or as part of a multi-level airway plan.
What happens during the procedure
Performed under general anesthesia through the open mouth, with no external incisions. The tonsils are removed with a coblation or electrocautery instrument that simultaneously cuts and seals blood vessels. The adenoids are removed by visualizing them through a mirror or endoscope above the soft palate. The procedure takes 30 to 45 minutes for most patients.
Who it’s for
Children (typically ages 3 and up) with documented sleep apnea, snoring with daytime symptoms, recurrent strep infections (more than 7 in a year, 5 per year for two years, or 3 per year for three years per the Paradise criteria), or chronic mouth breathing with adenoid facies (the elongated face shape that develops with chronic upper-airway obstruction in growing children). Adults with the same indications, particularly those who cannot tolerate CPAP.
Recovery and what to expect
Pain is the main challenge, particularly on days 4 through 8 when the white healing membrane begins to slough. Cold liquids, soft foods, and consistent pain medication are essential. Most children return to school in 7 to 10 days. Adults take 10 to 14 days. The single most important post-op behavior is staying well-hydrated, which both speeds healing and reduces pain.