Adenoids & Tonsil

• Noasal block and Difficulty breathing through the nose
• Breathing through the mouth / Keep mouth open especially during sleep
• Noisy breathing
• Snoring while sleeping
• Stops breathing for a few seconds while sleeping (called sleep apnea)
• Hyponasal voice/ as if nostrils are pinched

• The tonsils are visible through the mouth, but the adenoids are not directly visible
• To view Adenoids, postnasal mirror or nasopharyngoscopy (Rigid or fibreoptic) is usually required. Nasendoscopy is reliable in assessing the size of the adenoids.
• X-Ray of the soft tissue of nasopharynx / Occasional CT scan is done.
• Observation or Video recording of the child while sleeping may be helpful.
• Polysomnography may be advised to see oxygen levels in the blood.

Tonsil surgery is less common now, large tonsils do not necessarily mean the child needs to have them removed. The tonsils are normally large during childhood and begin to shrink in size after the age of 7-8 years.

Children who benefit from tonsil surgery include those with the following:

• Obstructive sleep apnea
• Extreme discomfort when talking and breathing
• lack of weight gain: Children may not eat sufficiently because of pain
• Multiple throats or ear infections (Seven or more infections in 1 year, five or more infections a year over 2 years, or three or more a year over 3 years)

Adenoidectomy is recommended for the following:

• Recurring nasal congestion and sinus infections
• Blockage of the back of nose: Enlarged adenoids may cause “mouth breathing”, snoring, or sleep apnea (stop breathing for brief periods during sleep).Because of blockage of upper airway Oxygen levels in the blood may be low, and children may wake up frequently and feel sleepy during the day. Rarely, obstructive sleep apnea can cause serious effects on lung and heart.
• Chronic ear infections and hearing loss: Adenoids block eustachian tubes (tube connecting backspace of the nose to middle ear) resulting in fluid accumulation in the middle ear.
• lack of weight gain: Children may not eat sufficiently because of pain or because breathing takes constant physical effort

• Adenoids— Traditional curettage method, microdebrider-endoscopic, electrocautery or suction coagulator
• Tonsil— Cold blunt dissection method, Bipolar Diathermy, LASER or Radiofrequency

• Anesthetic risk – serious anesthetic complications can occur, but are very unusual. Bleeding is rare.
• The Tonsillar and adenoid “bed” usually becomes superficially infected, and can cause 7-10 days of bad breath, but serious infections are very rare.
• Adenoids should be removed with careful consideration and examination to avoid effect on speech and/or swallowing. To be avoided in patient with sub mucous cleft palate.
• Bleeding is potential complication of tonsillectomy and before embarking on surgery family history of any abnormal bleeding should be excluded and patient’s coagulation profile is to be examined.