Five Things to Know About a Tonsillectomy

A tonsillectomy is the second most common ear, nose and throat (ENT) surgery performed at Arkansas Children’s and in the United States. It is one of the world’s oldest surgeries, with over 4,000 years of evolution.

Tonsils are part of the immune system and act as filters, producing antibodies when bacteria and viruses enter through the mouth or nose, helping fight infections. However, tonsils can become too large after repeated infections and do not function properly.

A tonsillectomy is a surgery to remove the tonsils, often performed at the same time as an adenoidectomy to remove the adenoid glands in a child’s upper airway.

Tonsillectomies date back to 2,000 B.C., when Hindu doctors in India first used herbal remedies and crude tools to remove the small, round pieces of tissue at the back of the throat, according to Hektoen International, a peer-reviewed journal of medical humanities. In the late 1950s, tonsillectomies were standard, with 1,400,000 performed annually, according to an article in The Atlantic.

Today, the criteria for whether a child needs a tonsillectomy has changed significantly, as well as the pediatric expertise, said Greshem Richter, M.D., FACS, FAAP, a pediatric otolaryngologist (ENT doctor), chair of otolaryngology and surgical director of the Vascular Anomalies Center of Excellence at Arkansas Children’s and professor and chair of pediatric otolaryngology services at the University of Arkansas for Medical Sciences in Little Rock.

“Even 35 years ago, large tonsils equaled a tonsillectomy. Doctors felt like it was a disease burden, and they wanted to remove the tonsils to help the patient overcome infections or inflammation that the tonsils or the adenoids were harboring,” Dr. Richter said. “Now, practices have changed. We have specific guidelines as to when we can take out the tonsils of children, specifically either for infection or for sleep-disturbed breathing, known as sleep apnea.”

Here are five facts parents and caregivers should know about tonsillectomies:

Why should parents choose a pediatric expert at Arkansas Children’s to perform their child’s tonsillectomy?

Every member of the Arkansas Children’s ENT team has specialized training and certifications in pediatric care, including anesthesiologists and otolaryngologists. Children are not small adults, making it vital for a patient’s safety to have a pediatric expert performing the surgery and knowing the right amount of anesthesia to administer. The most common way anesthesia doses are determined is by a pediatric patient’s weight. In adults, dosing is more generic.

What are the benefits of having a tonsillectomy at Champions Pavilion?

Arkansas Children’s designed the 157,916-square-foot, three-floor outpatient surgery facility located at Arkansas Children’s Hospital (ACH) in Little Rock with children in mind. Parents stay with their child until surgery, and during surgery, they wait comfortably in a private room.

“Champions Pavilion streamlines the experience for the family and child. Sometimes it is a challenge to navigate the larger hospital, which includes inpatients, and Champions Pavilion is a dedicated outpatient-designed facility,” Dr. Richter said. “You have an organization and a facility that is designed around the pediatric experience, to make it a comfortable and inviting atmosphere, so children feel at ease when they walk in for care. All team members know how to take care of children.”

What are the conditions that require a tonsillectomy?

Doctors can remove tonsils at any age, but they most commonly do so when a patient is 3 to 6 years old. They must have one or more of the following to have a tonsillectomy:

What happens during a tonsillectomy?

Tonsillectomy requires anesthesia. Once administered, the surgical team places a tube in the patient’s airway for protection.

“We extend the neck, open the patient’s mouth and remove the tonsils. We use a surgical technique called electrocautery, which uses heat to cut the tissue as we grab the tonsil and gently elevate it out of its little pockets on both sides,” Dr. Richter said. “Then, we suction out the adenoids as we cauterize them. There’s no cutting with the adenoid removal.”

Once the surgeon makes sure there is no bleeding in the throat, they begin to wake the patient from anesthesia and take them to the recovery room.

The entire procedure, from anesthetizing to waking up in recovery, usually takes less than 30 minutes.

How long is the recovery from a tonsillectomy, and what can parents expect?

A parent can expect their child to be in the recovery room for an hour to an hour and a half before being sent home. Dr. Richter said it’s important that the patient feels comfortable and is given pain medication before discharge.

Recovery can vary by patient, but typically takes about two weeks for a full recovery.

“We want them out of school during recovery because a post-tonsillectomy scab can sometimes cause bleeding at the surgery site,” Dr. Richter said. “We make sure we send them home with instructions that if there’s any bleeding and they spit out some blood or throw up some blood, then they need to come to the hospital and get it checked out.”

Parents should give their child the prescribed pain medication regularly, as the tonsil removal creates an open sore at the back of the throat that will heal over time.

“Some kids have very little pain afterward, while other kids have a lot of pain afterward, but typically they are older children,” Dr. Richter said.

* This article was written by the Arkansas Children’s content team and medically reviewed by Greshem Richter, M.D.