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Tonsillectomy and Adenoidectomy

Many children have health issues that require the removal of their tonsils, adenoids or both. We know you are the ultimate protector of your children’s health, and it can be overwhelming to find the best place to treat enlarged tonsils and/or adenoids.

At CHOC Children’s, our team of pediatric otolaryngologists (ENTs) provide our patients with innovative, comprehensive and clinically advanced care. Our physicians are all fellowship trained in pediatric otolaryngology, bringing a specialized expertise to children’s care not found at adult practices. CHOC’s commitment to research and ongoing education means we are always at the forefront of pediatric ENT care.

Clinician is checking child's tonsils

Intracapsular Tonsillectomy

Tonsillectomy is one of the most common procedures performed on children in the United States. In a traditional tonsillectomy, the tonsils are removed completely which exposes the muscles surrounding the throat. This results in considerable post-operative discomfort and pain, especially when trying to eat after surgery. In addition, when the scab heals and falls off, there is a risk of bleeding as well.

The ENT team at CHOC Children’s offers intracapsular tonsillectomy (IT) as an alternative to traditional complete tonsillectomy. In this procedure, a small portion of the tonsils are left behind. The muscles surrounding the throat are covered by the remaining tonsil and are not exposed, which makes eating after surgery much less painful and there is much lower risk of bleeding after surgery. Compared to a traditional tonsillectomy, an intracapsular tonsillectomy involves much less pain, earlier return to regular diet, smaller chances of readmission due to dehydration and much lower risk of postoperative bleeding.

Questions About Intracapsular Tonsillectomy

Do the tonsils regrow?

The regrowth rate of intracapsular tonsillectomy at CHOC procedure is 0.5-1%.

Does an intracapsular tonsillectomy take longer than a traditional tonsillectomy?

No. The procedure takes the same amount of time, 30 to 45 minutes.

Has this procedure been practiced in other places?

Intracapsular tonsillectomy is growing in popularity in the United States. Elsewhere in the world such as Sweden, this procedure is the preferred method of tonsil removal.

Does my child need pain medication after this procedure?

Usually children will require only over-the-counter pain medication for a few days after surgery. Some children do not even require any pain medication.

How old does my child have to be for intracapsular tonsillectomy?

There are no age restrictions for this procedure.

To learn if intracapsular tonsillectomy is the right choice for your child, please make an appointment

American Health Journal: Tonsils and Adenoids

In this segment of American Health Journal, Dr. Gupreet Ahuja describes the difference between tonsils and adenoids, and goes on to tell us what the reasons would be for removal.

Preparing for a Tonsillectomy/Adenoidectomy

We know the experience of your child undergoing surgery can be stressful. Our certified child life specialists help lower anxiety by introducing patients and their families to the hospital environment, procedures and equipment. Through therapeutic medical play and age-appropriate surgery preparation, they help kids feel comfortable – even escorting them to the operating room.
It takes most children 7-10 days to recover from surgery. Some children feel better in just a few days while some take as many as 2-3 weeks to recover.
Drinking: The most important part of recovery is drinking plenty of fluids to avoid dehydration. Encourage your child to drink fluids (eg. water, popsicles, pudding, yogurt, ice cream). Citrus fruits and juices should be avoided because the acidity can be uncomfortable to drink. Please call the office if you are worried that your child is not drinking enough or if there are signs of dehydration (i.e. urination only 1-2 times per day; crying, but no tears).
Nausea: Some children experience nausea and vomiting from the general anesthetic during the first 24 hours after surgery. However, this issue usually resolves on its own. Occasionally, children may have a small amount of the liquid come out the nose when drinking. This should resolve within a few weeks.
Eating: Children may be reluctant to eat due to pain, but recover sooner when eating and chewing are resumed as normal. We recommend avoiding hard, crunchy and sharp-edged foods after surgery such as potato chips, nachos, popcorn and crusty breads. It’s okay for children to not eat as much, as long as they are drinking enough fluids.
Fever: A low-grade fever is normal for several days after surgery. Please call the office if the temperature is over 102 degrees F.
Activity: Most children rest at home for several days after surgery. Generally, children may return to school when they are eating and drinking normally, no longer taking pain medication and sleeping through the night. This is 7-10 days for most children, but may be up to 14 days for some. Children should not participate in gym class, sports, swimming or heavy activity for two weeks. Please do not travel away from the area for two weeks after surgery.
Breathing: Snoring and mouth breathing are normal after surgery because of swelling. Breathing should improve within 1-2 weeks after surgery.
Scabs and Bleeding: A membrane or scab will form where the tonsils and adenoids were removed. The scabs are thick and white and may cause bad breath. This is normal. They usually fall off 1-3 weeks after surgery and are swallowed a little at a time.
Except for small specks of blood from the nose or in the saliva, bright red blood should NOT be seen. Bleeding happens infrequently and may occur up to two weeks after surgery. Contact us immediately and go directly to the closest emergency room if there are more than a spoon or two of bright red blood coming out of the mouth or nose, or if your child vomits up clots of blood. Bleeding usually means the scabs have fallen off too early, and this usually requires immediate medical attention.
Please call to schedule a post-surgery follow-up visit around 3-5 weeks after surgery to assess your child’s recovery. If there are problems or questions before that time, please call the office.

Frequently Asked Questions

The tonsils are two pads of tissue located on either side of the back of the throat. These pads of tissue produce antibodies to help fight infection. When the tonsils become inflamed, this is called tonsillitis.
The adenoids are a pad of tissue located behind the nose and the roof of the mouth. Adenoids also help fight infection. When the adenoids become inflamed, this is called adenoiditis.
The tonsils and adenoids are removed in a surgical procedure through the mouth with no external scars. Tonsillectomies and adenoidectomies are performed under general anesthesia. The anesthesiologists at CHOC are experts; they have vast experience with children so you can rest easily knowing your child is safe in our care. Read more about pediatric anesthesia.
Common reasons for removing tonsils and/or adenoids include:
• Upper airway obstruction (heavy snoring, sleep apnea), which means enlarged tonsils and/or adenoids are blocking the airway and causing difficulty breathing
• Recurrent tonsil infections or strep throat
• Chronic inflammation of the middle ear, which can cause ear infections and chronic ear fluid
The procedure takes 30-45 minutes.
Your child may remain in recovery for up to a few hours after surgery or overnight if admitted to the hospital.

Otolaryngology (ENT) Locations

Exterior view of CHOC Children's Specialists Otolaryngology location

CHOC Children’s Specialists Otolaryngology

Building: St. Joseph Medical Tower | 1010 W. La Veta Ave., Suite 640 | Orange, CA 92868 | 714-633-4020

Map showing location of CHOC Children’s Specialty Center, Newport Beach

CHOC Children’s Specialists Otolaryngology – Newport Beach

446 Old Newport Blvd. | Newport Beach, CA 92663 | 714-633-4020

Map showing location of CHOC Children’s Specialty Center, Irvine

CHOC Children’s Specialists Otolaryngology, Irvine

250 E. Yale Loop | Suite 200 | Irvine, CA 92604 | 714-633-4020

Map showing location of CHOC Children’s Specialists Otolaryngology, Seal Beach

CHOC Children’s Specialists Otolaryngology, Seal Beach

770 Pacific Coast Highway | Seal Beach, CA 90740 | 714-633-4020

Map showing location of CHOC Children's Health Center Mission Viejo

CHOC Children’s Health Center, Mission Viejo

26691 Plaza, Suite 130 | Mission Viejo, CA 92691

Long Live Childhood

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