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Pediatric Obstructive Sleep Apnea and Recurrent Tonsillitis
The information in this document will provide you with some information on tonsillitis, obstructive sleep apnea and tonsillectomy/adenoidectomy. The information is not exhaustive, and you may have additional questions. Not all the information will apply to your child. Please, do not hesitate to ask the clinic staff or your doctor if you have additional questions or comments.
The two most common reasons we perform tonsillectomy and/or adenoidectomy are obstructive sleep apnea (OSA) and recurrent tonsillitis. Children with OSA usually have enlarged tonsils and/or adenoids. The tonsils are located in the back of the mouth; the adenoids are located behind the nose and above the palate (they cannot be seen by usual examination). The tonsils and adenoids can become so large that they block the mouth and nasal airway. The result can be loud snoring, sleep disruption and/or apnea (airway collapsing or closing off while trying to breathe).
Children with OSA may develop serious problems over time. Some children may acquire high blood pressure in the lungs and heart problems (congestive heart failure). Some develop elevated blood pressure. Very severe cases can be life threatening and require emergency treatment. Studies have shown that children with OSA tend to perform more poorly in school than children without OSA. Surgical treatment (removal of tonsils and adenoids) results in an improvement in their performance; medications such as antibiotics or nasal steroids are not effective. Children with behavior disturbance such as ADD have higher risk of having OSA.
Recurrent tonsillitis refers to repeated tonsil infections. Antibiotics, especially for streptococcal tonsil infections, are mainstream treatment. If your child is not responding to antibiotics, or having to take antibiotics constantly or repeatedly, then a tonsillectomy should be considered. Multiple repeated tonsil infections can spread to structures around the mouth resulting in severe infections and/or airway obstruction. Adenoidectomy can be considered at the time of surgery if the adenoid is infected or enlarged.
Tonsillectomy and/or adenoidectomy is a surgical procedure where the tonsils and/or adenoids are removed. There are potential risks that must be known and weighed against the risks of not having surgery. General anesthesia is required so that the procedure can be performed safely and comfortably. We perform around two hundred tonsillectomy procedures per year. Surgery usually takes about one-half hour. Your child may be given a liquid sedative to take before surgery should they be nervous or if separation anxiety is likely. The sedation acts so that your child will not remember anything from the moment the sedation takes until he/she is with you in the recovery room.
The most common complaints after surgery are throat, tongue, neck, and ear pain. Pain is usually most noticeable between the third and fifth day after surgery. Medication provided for the pain will be crucial to enable your child to be comfortable and to permit adequate fluid intake.
Bleeding can also occur. The risk is about 2% and can occur up to 14 days following surgery. Scabs can peel off during the healing process and result in bleeding. If you notice any spitting up or throwing up of blood, you need to contact your doctor. Older children can swallow a small amount of ice water to stop the bleeding. The risk of bleeding is increased if aspirin, ibuprofen or similar medicines are used. Do NOT use any medicine for fever or pain, except what your doctor gives you or plain Tylenol®, for two weeks before and after surgery.
If the adenoids are removed, the most noticeable effect is usually a foul odor from the healing nasal cavity for one to two weeks. Some children will sound differently when talking or you may notice some liquid spilling into their nose during swallowing. These changes typically disappear after two to three weeks. If it lasts longer, we may need to reexamine your child. Pain from adenoid surgery usually involves the neck and lasts for three to five days.
Removal of the tonsils and/or adenoids will not adversely affect your child’s ability to fight infection. There are hundreds of lymph nodes in the head and neck region alone that will be able to compensate for the loss of “two” lymph nodes (tonsils and adenoids). The success rate for recurrent tonsillitis and/or obstructive sleep apnea is very high. Children with recurrent streptococcal tonsillitis typically have no more “strep” infections. Children with recurrent viral non-streptococcal tonsillitis may have occasional sore throats, but also do much better following surgery. Children with obstructive sleep apnea tend to have complete elimination of their apnea, and a marked reduction of their snoring. Many parents are initially nervous the first few days following surgery, because the loud snoring has disappeared.
A video (approximately 8 minutes) describing tonsillectomy/adenoidectomy is available for viewing in our office library. Inform our office staff if you are interested.
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