Combined adenotomy with tonsillotomy in children

When a child sleeps with their mouth open for years, snores, and constantly suffers from ENT infections, sprays and rinses alone are no longer enough. Combined adenotomy with tonsillotomy in children This procedure is considered when enlarged adenoids and tonsils interfere with normal breathing and sleep. The goal of the procedure is not to "remove everything unnecessary," but to restore the child's nasal breathing, restful sleep, and normal hearing.

What is this operation?

Adenoids are nasopharyngeal tonsils (a cluster of lymphoid tissue deep in the nasopharynx) that support the immune system but, when enlarged, block nasal breathing. The palatine tonsils are two oval structures on the sides of the pharynx that, when chronically inflamed, enlarge and become the source of frequent sore throats. Combined surgery involves reducing both the nasopharyngeal and palatine tonsils during a single procedure.
Tonsillotomy is a partial removal of the tonsils, removing excess tissue while leaving a portion of the tonsil functioning. This option is chosen when it's important to preserve the tonsil's protective function while also addressing chronic inflammation and narrowing of the pharynx. The decision on the type of surgery is made by a pediatric ENT surgeon, taking into account the patient's age, symptoms, and examination results.

Indications for combined surgery

People don't seek surgery after their first sore throat or because of a week-long runny nose. It's usually a long-term process, with treatments like sprays, rinses, and pills already tried and only producing temporary results.

Reasons to consider combined surgery may include:
• severe difficulty with nasal breathing, snoring and episodes of sleep apnea;
• frequent ear infections, hearing loss, complaints of “clogged ears” and inattention in class;
• 5 or more tonsillitis per year or long-term inflammation of the tonsils with bad breath;
• constant breathing through the mouth, open mouth during sleep and during the day, rapid fatigue.

After assessing these factors and examining the child, the doctor discusses with the parents whether the surgery will provide real and lasting relief.

When should you make an appointment with an ENT doctor?

Parents often expect things to go away on their own, and only see a surgeon when their child is sleeping poorly, tires quickly, and becomes distracted. It's best to consult an ENT doctor for an in-person evaluation sooner, as soon as symptoms begin to interfere with schoolwork, sleep, and daily activities.

Reasons for consultation may be:
• loud snoring and restless sleep, frequent awakenings at night;
• breathing mainly through the mouth, dry mouth in the morning, headaches;
• "nasal" voice, slurred speech, complaints that the child has poor hearing;
• noticeable enlargement of the tonsils, which visually narrow the lumen of the pharynx;
• the feeling that the child is sick almost all the time and has difficulty coping with stress.

During the appointment, the doctor examines the nasopharynx, tonsils, and ears and decides whether combined surgery is necessary or whether conservative therapy can be continued.

How the operation is performed and preparation steps are carried out

Combined adenotomy and tonsillotomy are performed on children only after a thorough examination. Typically, a complete blood count, a coagulogram (blood clotting test), an ECG, and, if necessary, consultation with other specialists are prescribed. It is important to rule out acute infections and exacerbations of chronic diseases to reduce the risks.

Preparation for surgery usually includes:
• a conversation with an ENT surgeon and anesthesiologist (anesthesia doctor) to discuss pain relief and risks;
• limiting the intake of drugs that affect coagulation, in agreement with the doctor;
• adherence to a fasting regime: no food for 6-8 hours, no water for 2-4 hours before anesthesia;
• calmly explain to the child that he will fall asleep and wake up after the operation;
• monitoring of general condition and temperature in the preoperative days.

The surgery itself is performed under general anesthesia; the child is asleep and unaware of the procedure. The surgeon removes the enlarged nasopharyngeal tonsil and partially reduces the size of the palatine tonsils, often using endoscopic techniques (a camera mounted on a thin instrument for precise visual inspection). After the procedure, the child is transferred to a ward, where medical staff monitors their breathing, pulse, and pain level.

Restrictions and recovery

In the first hours and days after surgery, the child may be lethargic and sleepy, complaining of a sore throat or difficulty swallowing. This is an expected reaction and is controlled with pain medication as prescribed by the doctor. During the first 24 hours, the child should be fed soft, lukewarm foods, with an emphasis on fluids and bland foods.

During the recovery period, it is usually recommended:
• limit active games, running and jumping for 1-2 weeks;
• avoid very hot food, drinks, baths and saunas;
• ensure that the child does not touch his mouth and nose with his hands and does not “check” his throat;
• come to check-ups at the appointed time;
• immediately inform your doctor about high temperature, bleeding or sudden deterioration in health.

Full recovery usually takes several days to a couple of weeks. As healing progresses, parents notice their child sleeping better, breathing more easily through the nose, and getting sick less often.

Сonclusion

Combined adenotomy and tonsillotomy for children is not a "just in case" procedure, but a well-considered solution for severe breathing and sleep problems and frequent infections. The surgery helps remove the chronic obstruction and the inflammation that fuels the illness.
The decision to proceed is made after examinations and an in-person consultation with a pediatric ENT surgeon and anesthesiologist. When parents understand the purpose of the surgery and the recovery process, it helps their child navigate this stage more easily. With the right indications and adherence to recommendations, combined surgery helps restore normal breathing, sleep, and daily life, reducing the burden of endless ENT problems.