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Adenotonsillectomy
Adenotonsillectomy safely removes both the tonsils and adenoids in children and young adults with recurrent throat infections or obstructive sleep apnoea — transforming sleep quality, breathing, and overall health with a high success rate and lasting results.
Overview
Adenotonsillectomy is the simultaneous surgical removal of both the tonsils and adenoids — addressing upper airway obstruction, eliminating sources of recurrent infection, and maximally improving nasal and oral airway patency in a single anaesthetic episode. This combined procedure is one of the most commonly performed surgical procedures in paediatric ENT worldwide and has an excellent safety profile. The vast majority of children experience transformative improvement in sleep, breathing, school performance, and overall wellbeing after recovery.
Types of Adenotonsillectomy
The technique for tonsil and adenoid removal has advanced significantly with several methods offering different benefits in post-operative pain, bleeding risk, and recovery speed.
- Cold Steel Dissection (traditional reliable technique — widely used)
- Coblation Tonsillectomy with Adenoidectomy (significantly reduced post-operative pain)
- Microdebrider Intracapsular Tonsillectomy (partial tonsil removal — faster recovery)
- Electrocautery Adenotonsillectomy (standard diathermy technique)
- Laser Adenotonsillectomy (laser energy used in selected specialised centres)
Risk Factors for Recurrent Tonsillitis and Adenoid Hypertrophy
Recurrent tonsillitis and adenoid enlargement are driven by immune, infectious, and environmental factors. Understanding these helps identify children who will benefit most from surgical intervention.
- Repeated streptococcal throat infections causing progressive tonsil scarring and enlargement
- Allergic rhinitis contributing to chronic nasal inflammation and adenoid enlargement
- Passive cigarette smoke exposure increasing susceptibility to upper respiratory infections
- Daycare or school environment facilitating frequent bacterial and viral infections
- Immune system immaturity in young children making them prone to recurrent infections
- Family history of tonsil and adenoid problems
Adenotonsillitis Symptoms
Recurrent tonsillitis and adenoid enlargement significantly affect a child's health, sleep, schooling, and quality of life. These symptoms indicate the need for ENT specialist evaluation.
- Recurrent sore throat with tonsillitis (typically 5 or more episodes per year)
- Persistent mouth breathing from combined nasal and oropharyngeal obstruction
- Loud snoring and disrupted breathing during sleep
- Obstructive sleep apnoea with witnessed pauses, gasping, or choking at night
- Daytime sleepiness and declining school performance
- Difficulty swallowing large food pieces from very enlarged tonsils
- Recurrent ear infections and glue ear causing conductive hearing loss
- High fevers during tonsillitis episodes causing significant distress
Key Benefits
Discover the advantages of choosing our adenotonsillectomy services.
Eliminates recurrent tonsillitis episodes and the repeated antibiotic courses associated with them
Relieves upper airway obstruction and the loud nightly snoring affecting the whole family
Treats obstructive sleep apnoea allowing restorative sleep and improved daytime functioning
Improves school performance and concentration through better sleep quality and hearing
Reduces the frequency of febrile episodes and associated parental anxiety and GP visits
Clinical Features
The technology, techniques and clinical approach behind our adenotonsillectomy.
Combined tonsil and adenoid removal in a single anaesthetic episode for maximum benefit
Multiple surgical techniques available including coblation for significantly reduced post-operative pain
Both procedures performed through the natural oral and nasal openings — no external incisions
Adenoid removal performed under endoscopic visualisation ensuring thorough and complete excision
Dedicated paediatric anaesthetic and nursing team present throughout the procedure
Preparation Instructions
- Complete a pre-operative assessment with the ENT surgeon and paediatric anaesthesiologist
- Perform routine blood tests including CBC, coagulation, and blood group
- Stop aspirin, ibuprofen, and NSAIDs at least 10 days before surgery to minimise bleeding risk
- The child must fast for 6 hours (solids) and 2 hours (clear fluids) before the procedure
- Postpone surgery if the child has an active upper respiratory tract infection
- Prepare the child emotionally with age-appropriate explanation of what to expect
- Bring comfort items and soft foods (yoghurt, ice lollies) for the recovery period
- Arrange for at least one parent to stay with the child for the first 24 hours after surgery
The Procedure
Step-by-step guide to what you can expect during your adenotonsillectomy procedure.
Specialist ENT Evaluation and Surgery Planning
Your ENT surgeon reviews the frequency and severity of tonsillitis episodes, the degree of tonsillar and adenoid hypertrophy, sleep study results if available, and audiological findings to confirm that adenotonsillectomy is the most appropriate and beneficial treatment for your child.
Smooth General Anaesthesia for Your Child
Our paediatric anaesthesiologist administers general anaesthesia safely and gently so your child is completely asleep throughout the entire procedure. Parents are supported throughout the pre-operative waiting period and given regular updates by our dedicated nursing team.
Tonsil Dissection and Removal
Each tonsil is carefully dissected from its tonsillar fossa using the chosen technique — cold steel, coblation, or microdebrider — ensuring complete removal of all tonsillar tissue from the tonsillar pillars on both sides while minimising blood loss throughout the procedure.
Adenoid Tissue Removal
With the tonsils removed, your surgeon passes an endoscope to visualise and completely remove the adenoid pad under direct vision, ensuring all obstructing adenoid tissue is excised while protecting the Eustachian tube openings on both sides.
Thorough Haemostasis Throughout
Meticulous haemostasis is achieved after both tonsil and adenoid removal using bipolar diathermy, suction cautery, or local haemostatic agents. Your surgeon verifies that all bleeding is completely controlled and the airway is clear before the anaesthetic is reversed.
Discharge Education and Emergency Guidance
Before your child goes home, our ENT nursing team provides you with comprehensive written discharge instructions — covering pain relief scheduling, soft diet, fluid intake, activity restrictions, warning signs requiring immediate return, and your follow-up appointment details.
What to Expect
Adenotonsillectomy is performed under general anaesthesia in 30 to 45 minutes with all instruments passed through the open mouth — no external incisions. Children typically wake comfortably and most eat soft foods and drink within 2 to 3 hours. The majority are discharged the same day or after a short overnight stay, and parents notice immediately that their child breathes much more quietly and freely.
Recovery
Throat pain is expected for 7 to 10 days — worst on days 3 to 7 as the surgical scab forms — maintain regular around-the-clock pain relief during this period. Ensure plenty of fluids throughout recovery as dehydration worsens pain significantly. Keep your child away from school and crowds for 2 weeks to reduce infection risk during healing. Seek immediate emergency care if your child develops any fresh bright red bleeding from the mouth or nose — this is a surgical emergency.
Frequently Asked Questions
Common questions about adenotonsillectomy.
Related Services
Explore other services in our E N T department.
Tracheostomy
Adenoidectomy
Bilateral Modified Neck Dissection
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