Pediatric ENT

Unfortunately, there may be a time when medical therapy (antibiotics) fails to resolve the chronic tonsil infections that affect your child. In other cases, your child may have enlarged tonsils, causing loud snoring, upper airway obstruction, and other sleep disorders. The best treatment for both of these conditions may be the removal of the tonsils and adenoids. 

The procedure to remove the tonsils is called a tonsillectomy; excision of the adenoids is an adenoidectomy. Both are usually performed concurrently; hence the procedure is known as a tonsillectomy and adenoidectomy, or T&A. The American Academy of Otolaryngology-Head and Neck Surgery recommends that children who have three or more tonsil infections in a year undergo a tonsillectomy and adenoidectomy. This procedure is also indicated for a child with loud snoring and obstructions when they are sleeping. Tonsillectomy and adenoidectomy is an outpatient surgical procedure lasting about twenty minutes and performed under general anesthesia. Usually, a child will remain at the hospital or surgery center for 2-3 hours after surgery for observation. For some children, overnight observation is required. 

Dr. McCool and Dr. Bhuta are Board Certified physicians for the Children’s Hospital of Alabama and have taken care of children in the Birmingham area for the past 15 years. If your child suffers from repeated throat and tonsil infections or has loud snoring with restless sleep, contact McCool and Bhuta Ear Nose and Throat Specialists for an evaluation.

When the tonsillectomy patient comes home

Most children require ten to fourteen days to recover from a tonsillectomy and adenoidectomy. If the adenoid alone is removed, your child may recover in seven days. The following guidelines are recommended.

Drinking: The most important requirement for your child’s recovery is hydration. Make sure they are drinking plenty of fluids, beginning with clear liquids such as water, juice, and sports drinks. Some patients experience nausea and vomiting after the surgery caused by the general anesthetic. This usually occurs within the first twenty-four hours and resolves in a couple of days. Contact Dr. McCool and Dr. Bhuta if there are signs of dehydration-mainly, infrequent urination that is darker in color. 

Eating: Generally, there are no food restrictions after surgery. The sooner the child eats and chews, the quicker the recovery. Tonsillectomy patients may be reluctant to eat because of post-operative pain; consequently, some weight loss may occur, which is gained back after a normal diet is resumed.

Fever: A low-grade fever may be observed several days after surgery. Contact your physician if the fever is greater than 102º.

Activity: Patients should avoid strenuous activity for two weeks. A return to work or school is permitted one week following surgery. Travel away from home is not recommended for two weeks following surgery.

Breathing: Your child may have abnormal snoring and mouth breathing due to swelling in the throat after surgery. Breathing should return to normal when swelling subsides, 10-14 days after surgery.

Scabs: A scab will form where the tonsils and adenoids were removed. These scabs are thick, whitish-gray, and can cause bad breath. This is not unexpected. Most scabs fall off in small pieces five to ten days after surgery.

Bleeding: You should not see any bleeding from your child’s nose or mouth after surgery. If you see any signs of bleeding, even a small amount, at any time of night or day, contact Dr. McCool and Bhuta’s office immediately, and you will be directed on what to do. 

Pain: Nearly all children undergoing a tonsillectomy/adenoidectomy will have mild to severe pain in the throat after surgery. Some may complain of an earache, because stimulation of the same nerve that goes to throat also travels to the ear. We will prescribe appropriate pain medications based on the patient’s age and weight. 

Sleep-disordered breathing is an umbrella term for several chronic conditions in which partial or complete cessation of breathing occurs many times throughout the night. When the cause is obstructive, such as enlarged tonsils and adenoids, it is called Obstructive Sleep Apnea, or OSA. When a child’s airway obstructs during sleep, his/her blood oxygen level will decrease. The sympathetic nervous system is stimulated, blood pressure rises, the brain is aroused, and sleep is disrupted. These repeated obstructions interrupt normal sleep patterns, including the deep, restorative sleep, with many unhealthy consequences. 

Consequences of untreated Pediatric OSA

• Snoring: A problem if a child shares a room with a sibling and during sleepovers. 
• Sleep deprivation: The child may become moody, inattentive, and disruptive both at home and at school. Classroom and athletic performance may decrease along with overall happiness. The child will lack energy, often preferring to sit in front of the television rather than participate in school and other activities. This may contribute to obesity. 
• Abnormal urine production: OSA causes increased nighttime urine production, and in children, this may lead to bedwetting.
• Growth: Growth hormone is secreted at night. Those with OSA may suffer interruptions in hormone secretion, resulting in slow growth or development. 
• Attention deficit disorder (ADD) / attention deficit hyperactivity disorder (ADHD): There are research findings that identify OSA as a contributing factor to attention deficit disorders.

Diagnosis of OSA

The first diagnosis of OSA in children is made by the parents’ observation of snoring that is often very loud. Other observations may include actual obstructions, followed by gasping episodes. Restless sleep as well as unexplained bedwetting may occur. Social symptoms are difficult to diagnose but include alteration in mood, misbehavior, and poor school performance. (Note: Every child who has sub-par academic and social skills does not have OSA. However, if a child is a serious snorer and is experiencing mood, behavior, and performance problems, sleep disordered breathing should be considered.)

A child with suspected SDB should be evaluated by an otolaryngologist such as Dr. McCool or Dr. Bhuta. If the symptoms are significant and the tonsils are enlarged, a tonsillectomy and adenoidectomy are indicated. Conversely, if the symptoms are mild and the tonsils are small, observation may be recommended. In some cases, sleep study for your child may be ordered. 

Treatment for sleep disordered breathing

Enlarged tonsils are the most common cause for obstructive sleep apnea in the pediatric population.  Thus, a tonsillectomy and adenoidectomy is the most effective treatment, and has a 90 % success rate. 

Dr. McCool and Dr. Bhuta are Board Certified physicans for the Children’s Hospital of Alabama, and have taken care of children in the Birmingham area for the past 15 years. If your child has loud snoring with restless sleep, contact McCool and Bhuta Ear Nose and Throat Specialists for an evaluation.