Tonsil and adenoid removal in Bari: tonsillectomy and adenoidectomy

What are the tonsils and adenoids?

The palatine tonsils are two small masses of lymphoid tissue, that is, tissue involved in the body's defences, at the sides of the throat at the back of the mouth. The adenoids are similar tissue located higher up, in the nasopharynx: the area behind the nose where the nasal passages meet the throat.

The tonsils and adenoids are most active in childhood, and the adenoids usually shrink as children grow. Tonsillectomy is removal of the tonsils and adenoidectomy removal of the adenoids: the two operations can be done separately or together.

When is tonsillectomy needed?

Tonsillectomy is considered when the tonsils cause repeated or significant problems, in adults as well as children. The decision takes into account how often the episodes occur, how severe they are and their impact on daily life. The main indications are:

• recurrent bacterial tonsillitis, generally more than 4–5 episodes a year, with fever, a severe sore throat and time off school or work;
• very enlarged tonsils (tonsillar hypertrophy) that obstruct breathing during sleep, with snoring or OSAS (obstructive sleep apnoea), repeated pauses in breathing during the night;
• recurrent peritonsillar abscesses, collections of pus next to the tonsil that cause severe pain and difficulty opening the mouth.

Adenoids in children: when is adenoidectomy needed?

Enlarged adenoids (adenoid hypertrophy) are common in children and can block the airway behind the nose. The child breathes through the mouth, snores, and may have a nasal voice and restless sleep.

Enlarged adenoids can also interfere with the Eustachian tube, the small channel that connects the nose to the ear. This can lead to glue ear (otitis media with effusion), a build-up of fluid behind the eardrum that can reduce hearing. Adenoidectomy is considered for persistent nasal obstruction, sleep apnoea or recurrent glue ear.

Tonsillectomy and adenoidectomy are common operations in children. The indications, and the most suitable time to operate, are always assessed at the consultation together with the parents. In adults the adenoids have usually shrunk and problems are less frequent.

What happens at the consultation before surgery?

The ENT consultation starts with a discussion of the symptoms, followed by an examination of the throat, nose and ears. To see the adenoids, a nasal endoscopy may be carried out with a thin camera passed into the nostril; the examination is quick and usually well tolerated.

Depending on the case, the doctor may request further tests: for example a hearing test and tympanometry, which measures how the eardrum moves, if glue ear is suspected, or a sleep study for sleep apnoea. Standard pre-operative tests are carried out before surgery.

How are tonsillectomy and adenoidectomy performed?

Both operations are performed under general anaesthesia and through the mouth, with no external incisions. The tonsils are removed with a conventional technique or with a laser.

The adenoids can be removed endoscopically: the endoscope, a thin telescope connected to a camera, lets the surgeon see the nasopharynx directly, an area that is difficult to view with the naked eye.

The operation usually takes less than an hour. The hospital stay is generally short, day surgery or one night of observation, depending on age, the procedure and general health. Dr Nicola De Candia gives personalised advice after the consultation.

What is recovery like after tonsillectomy?

After tonsillectomy, a sore throat is the main symptom and the pain may spread to the ears. Recovery generally takes 10–14 days and is usually more painful in adults than in children.

Whitish patches form in the throat where the tonsils were: they are part of normal healing and come away on their own over the following days. Bad breath and mild swelling are also common. After adenoidectomy alone, recovery is generally quicker, often just a few days.

Eating and drinking well is part of the treatment. For the period your doctor advises, it is a good idea to:

• drink plenty of water in small sips, even when swallowing is uncomfortable;
• choose soft, cool foods, such as yoghurt, ice cream, mashed potato, smoothies and lukewarm soups;
• avoid hard, crunchy, spicy, acidic or very hot foods;
• avoid sport and physical exertion until your doctor says otherwise.

What are the risks of tonsillectomy and adenoidectomy?

Like any operation under general anaesthesia, these procedures carry some risks, which are explained at the pre-operative consultation before you sign the consent form. The most important risk after tonsillectomy is bleeding.

Bleeding can occur in the first few hours or later, up to about two weeks after surgery, when the patches come away. Bright red blood from the mouth or nose, or spitting or vomiting blood, needs urgent medical attention: contact the doctor immediately or go to the nearest emergency department (Pronto Soccorso).

Other possible complications, which are generally uncommon, include:

• dehydration, if pain makes it hard to drink enough;
• infection of the operated area;
• a temporary nasal voice, especially after adenoidectomy;
• rarely, injury to the teeth, lips or tongue during surgery;
• partial regrowth of the adenoids, which sometimes causes symptoms again.

Who should I see for tonsil and adenoid removal in Bari?

Dr Nicola De Candia has been a specialist in Otolaryngology (ENT) since 1991 and has worked as an ENT consultant since 1994. He has trained in endoscopic sinus surgery on courses in Italy and abroad and teaches “Endoscopic sinonasal techniques” at the ENT specialist school of the University of Bari, skills that are also relevant to endoscopic adenoidectomy.

If a child snores, breathes through the mouth or has frequent ear problems, or an adult has repeated tonsillitis, a consultation can establish whether surgery is appropriate. The practice is at Via Niccolò dall'Arca 19, Bari, near Bari Centrale station. Appointments can be booked online on MioDottore or by phone on 080 5219334.