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VCU Department of Otolaryngology, Virginia Commonwealth University VCU Department of Otolaryngology VCU Medical Center VCU

VCU Department of Otolaryngology

Pediatric Otolaryngology - Throat

Tonsils and Adenoids consist of lymph node tissue at the back of the throat and nose. The purpose of this tissue is to trap bacteria and viruses and fight infection. When the child has a cold and other respiratory infections, these tissues swell up and become very red. Repeated infections can cause the tonsils and adenoids to become chronically inflamed and swollen. The child can suffer from near continuous ear and throat infections, streptococcus throat infections, halitosis (bad breath), sinus infections, difficulty swallowing, voice changes, snoring and sleep disturbances. Tonsillectomy and adenoidectomy (T &A) are surgeries performed by an otolaryngologist to remove the infected and enlarged tissues.

A child, who has chronically enlarged tonsils and adenoids, may also have problems that do not seem to relate to the mouth and throat. If the child snores all night long and shows signs of periodic gasping during his sleep, he may have a sleep disturbance sometimes referred to as sleep apnea. This child may show circles under his eyes, have below average weight, wet the bed at night, show signs of hyperactivity during the day or have a lack of energy. The child is tired from lack of a good night's sleep when he can get periods of deep sleep called REM sleep. Since growth occurs during REM sleep, this child is prevented from age appropriate growth. Bedwetting (enuresis) is common if sleep is disturbed.

The hyperactivity, which irritates parents and teachers, is a result of a sleep disturbance preventing a good night's sleep. The hyperactivity is a result of the child trying to stay awake during the day. So, the inability to stay in one's seat is not always a need for powerful drugs. Sometimes, the child suffers from lack of energy due to poor sleep and will prefer to sit in front of the television instead of participating in other activities. This child may experience obesity and overall unhappiness.

When the otolaryngologist has evaluated the child and the treatment options include a tonsillectomy and adenoidectomy, the parents are taught about their important role during the first two weeks of the post-operative period. This time period will be thought of as the toughest period they have ever experienced as a parent. They must make their child drink liquids at a time when the child is crying about how sore his throat is feeling.

Post-operatively, the child will receive a prescription for Tylenol with codeine to ease the throat pain. For the first few days, the medicine should be given on a schedule so that the throat is a comfortable as possible. The child must drink at least one half cup of liquid per hour while awake to prevent dehydration. Sips of non-carbonated and non-citrus drinks in between keep the back of the throat moist at all times. Moisture in the throat tissues and a well-hydrated body help prevent bleeding from the tonsil and adenoid surgical areas. Scabs (eschar) at the surgical areas need to stay in place for two weeks so that the blood vessels underneath them heal properly.

When the child has finished healing, he may seem different to the parents. Fewer throat infections mean fewer sick days. If the child snored pre-operatively, the parents may find themselves checking the child at night to see if he is still breathing because it is so quiet. Bedwetting and hyperactivity seem to occur less frequently, if at all. The previous less active child should be encouraged to get involved in activities, which get him physically moving. Weight loss and improved self-esteem are the best benefits to this child.


Virginia Commonwealth University Medical Center
School of Medicine
Department of Otolaryngology
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