Paediatric ENT
TONSILS ADENOIDS AND GROMMETS – CHILDREN
TONSILS
Are there alternatives to having the tonsils removed?
How long will my child be in hospital?
Your child’s throat will be sore
ADENOIDS
What are the alternatives to having the adenoids removed?
How long will my child be in hospital?
GROMMETS
How long do grommets stay in for?
Does my child have to have grommets?
What are the alternatives to grommets?
Can I do anything to help my child?
Can my child swim with grommets in?
What else should I know about grommets?
TONSILS
What are tonsils?
Tonsils are small glands in the throat, one on each side. They are there to fight germs when you are a young child. After the age of about three years, the tonsils become less important in fighting germs and usually shrink. Your body can still fight germs without them.
Why take them out?
We only take tonsils out if they are doing more harm than good. We will only take your child’s tonsils out if he or she is getting lots of sore throats, which are making him or her lose time from school. Sometimes small children have tonsils so big that they block their breathing at night.
Are there alternatives to having the tonsils removed?
Your child will not always need to have his or her tonsils out. You may want to just wait and see if the tonsil problem gets better by itself. Children often grow out of the problem over a year or so. The doctor should explain to you why he or she feels that surgery is the best treatment. Antibiotics may help for a while, but frequent doses of antibiotics can cause other problems. A low-dose antibiotic for a number of months may help to keep the infections away during an important period such as during examinations. There is no evidence that alternative treatments such as homeopathy or cranial osteopathy are helpful for tonsil problems.
Before your child’s operation?
Arrange for your child to have a couple of weeks off school. Let us know if he or she has a sore throat or cold in the week before the operation – it will be safer to put it off for a few weeks. It is very important to tell us if your child has any unusual bleeding or bruising problems, or if this type of problem might run in the family.
How is the operation done?
Your child will be asleep. We will take his or her tonsils out through the mouth, and then stop the bleeding. This takes about 20 minutes. Your child will then go to a recovery area to be watched carefully as he or she wakes up from the anaesthetic. He or she will be away from the ward for about an hour in total.
How long will my child be in hospital?
In some hospitals, tonsil surgery is done as a day case, so that he or she can go home on the same day as the operation. Other hospitals may keep children in hospital for one night. It may depend on whether your child has their operation in the morning or the afternoon. Either way, we will only let him or her go home when he or she is eating and drinking and feels well enough.
Possible complications
Tonsil surgery is very safe, but every operation has a small risk.
The most serious problem is bleeding. This may need a second operation to stop it. About two children out of every 100 who have their tonsils out will need to be taken back into hospital because of bleeding, but only one child out of every 100 will need a second operation. Please let us know before surgery if anyone in the family has a bleeding problem.
During the operation, there is a very small chance that we may chip or knock out a tooth, especially if it is loose, capped or crowned. Please let us know if your child has any teeth like this.
Some children feel sick after the operation. We may need to give your child some medicine for this, but it usually settles quickly.
Your child’s throat will be sore
Your child’s throat will get better day-by-day. Give him or her painkillers regularly, half an hour before meals for the first few days. Do not give more than it says on the label. Do not give your child aspirin – it could make your child bleed. (Aspirin is not safe to give to children under the age of 16 years at any time, unless prescribed by a doctor).
Eat normal food
Eating food will help your child’s throat to heal. It will help the pain too. Always give him or her a drink with every meal. Chewing gum may also help the pain.
Your child may have sore ears
This is normal. It happens because the throat and ears have the same nerves. It does not usually mean that your child has an ear infection.
Your child’s throat will look white
This is normal while the throat heals. You may also see small threads in your child’s throat – sometimes these are used to help stop the bleeding during the operation, and they will fall out by themselves.
Some children get a throat infection after surgery, usually if they have not been eating properly. If this happens you may notice a fever and a bad smell from your child’s throat. If this happens call your GP or the hospital for advice.
Keep your child off school for 10 to 14 days
Make sure he or she rests at home away from crowds and smoky places. Keep him or her away from people with coughs and colds. Your child may also feel tired for the first few days.
Bleeding can be serious
Only an operation can fix a bent septum, but a nose spray or drops can help treat swelling in the nose which might be making your nose feel blocked.
If septal deformity is the cause of your nasal blockage there is no treatment other than surgery to correct the septum.
ADENOIDS
What are the adenoids?
Adenoids are small glands in the throat, at the back of the nose. They are there to fight germs in younger children. We believe that after the age of about three years, the adenoids are no longer needed. Your body can still fight germs without your adenoids.
Why take them out?
We only take them out if they are doing more harm than good.
Sometimes children have adenoids so big that they have a blocked nose, so that they have to breathe through their mouths. They snore at night. Some children even stop breathing for a few seconds while they are asleep. The adenoids can also cause ear problems by stopping the tube which joins your nose to your ear, from working properly. For children over three years of age, removing the adenoids at the same time as putting grommets in the ears seems to help stop the glue ear coming back. Removing the adenoids may also make colds that block the nose less of a problem for your child.
What are the alternatives to having the adenoids removed?
Your adenoids get smaller as you grow older, so you may find that nose and ear problems get better with time. Surgery will make these problems get better more quickly, but it has a small risk. You should discuss with your surgeon whether to wait and see, or have surgery now. For some children, using a steroid nasal spray will help reduce congestion in the nose and adenoids, and may be helpful to try before deciding on surgery.
Antibiotics are not helpful and only produce temporary relief from infected nasal discharge. They have side effects and may promote ’super-bugs’ that are resistant to antibiotics. You may change your mind about the operation at any time, and signing a consent form does not mean that your child has to have the operation.
Other operations?
If we are taking adenoids out because of ear problems, we may put in grommets at the same time. If your child has sore throats or stops breathing at night, we may also take their tonsils out at the same time. We will tell you what these operations involve if we are going to do them.
Before the operation
Arrange for a week off school. Let us know if your child has a sore throat or a cold in the week before their operation – it may be safer to put it off for a few weeks.
How is the operation done?
Your child will be asleep for the operation. We will take out the adenoids through his or her mouth, and then stop the bleeding before he or she is woken up.
How long will my child be in hospital?
In some hospitals, adenoid surgery is done as a day case, so that the child can go home on the same day as the operation. Some surgeons may prefer to keep children in hospital for one night. Either way, we will only let him or her go home when he or she is eating and drinking and feels well enough.
Most children need about a week off nursery or school. They should rest at home away from crowds and smoky places. Stay away from people with coughs and colds.
Possible complications
Adenoid surgery is very safe, but every operation has small risks.
The most serious problem is bleeding, which may need a second operation to stop it. However, bleeding after adenoidectomy is very uncommon. In a survey of all adenoid surgery in England, bleeding happened in one in 200 operations. It is very important to let us know well before the operation if anyone in the family has a bleeding problem. During the operation, there is a very small chance that we may chip or knock out a tooth, especially if it is loose, capped or crowned. Please let us know if your child has any teeth like this.
Some children feel sick after the operation. This settles quickly.
A small number of children find that their voice sounds different after the surgery. It may sound like they are talking through their nose a little. This usually settles by itself within a few weeks. The child’s nose may seem blocked up after the surgery, but it will clear by itself in a week or so.
Sore throat and ears
Your child’s throat may be a little sore after the operation. Prepare normal food. Eating food will help your child’s throat to heal. Chewing gum may also help the pain.
Your child may have sore ears. This is normal. It happens because your throat and ears have the same nerves. It does not mean that your child has an ear infection.
Give painkillers as needed for the first few days. Do not use more than it says on the label. Do not give your child aspirin – it could make your child bleed. (Aspirin is not safe to give to children under the age of 16 years at any time, unless prescribed by a doctor).
Bleeding can be serious
Bleeding can be serious
If you see any bleeding from your child’s throat or nose, you must see a doctor. Either call your GP, call the ward, or go to your nearest hospital casualty department.
GROMMETS
What are grommets?
Grommets are very small plastic tubes (they can also be made of titanium), which sit in a hole in the eardrum. They let air get in and out of the ear. This keeps the ear healthy.
Why do we use grommets?
Some people get fluid behind the eardrum. This is sometimes called ‘glue ear’. It is very common in young children, but it can happen in adults too. We don’t know exactly what causes glue ear.
Most young children will have glue ear at some time, but it doesn’t always cause problems. We only need to treat it if it is causing problems with hearing or speech, or if it is causing lots of ear infections.
How long do grommets stay in for?
Grommets usually fall out by themselves as the eardrum grows. They may stay in for six months, or a year, or sometimes even longer. You may not notice when they drop out.
Does my child have to have grommets?
Glue ear tends to get better by itself, but this can take a while. We like to leave children alone for the first three months, because about half of them will get better in this time. After three months, we see the child again and decide whether we need to operate.
If the glue ear is not causing any problems, we can just wait for it to settle by itself. If it is causing problems with poor hearing, poor speech or lots of infections, it may be better to put grommets in.
If we do put in grommets, the glue ear may come back when the grommet falls out. This happens to one child out of every three who has grommets put in. We may need to put more grommets in to last until your child grows out of the problem.
What are the alternatives to grommets?
Some doctors may use nose drops or nasal sprays to see if they help. Steroid nasal sprays may help some children if they are able to use them. Antibiotics and antihistamines do not seem to help this type of ear problem. Alternative treatments, such as cranial osteopathy do not seem to be helpful.
Taking out the adenoids may help the glue ear get better, and your surgeon may want to do this at the same time as putting grommets in.
Ahearing aid can sometimes be used to treat the poor hearing and speech problems that are caused by glue ear. This would mean that your child would not need an operation.
Can I do anything to help my child?
Speak clearly, and wait for your child to answer. Make sure he or she can see your face when you speak. Call your child’s name to get them to look at you before you speak. Let nursery and school teachers know that your child has a hearing problem. It may help for your child to sit at the front of the class.
After the operation
Your child should be able to go back to school or nursery the day after the operation.
Are grommets sore?
Grommets are not usually sore at all. You can give your child painkillers if you need to. Grommets should improve your child’s hearing straight away. Some children think everything sounds too loud until they get used to having normal hearing again. This usually takes only a few days.
What about ear infections?
Most people with grommets do not get any ear infections. If you see yellow fluid coming out of the ear, it may be an infection. It will not be as sore as a normal infection, and your child won’t be as ill. If you get some ear drops from your doctor, the problem will quickly settle. Some doctors may give antibiotics by mouth instead of antibiotic ear drops.
Can my child swim with grommets in?
Your child can start swimming a couple of weeks after the operation, as long as they don’t dive under the water. You do not need to use earplugs – the hole in the grommet is too small to let water through. You do need to avoid getting dirty or soapy water into the ear, so in the bath or shower plug your child’s ears with a cotton-wool ball covered in Vaseline.
What else should I know about grommets?
It is OK to fly in an aeroplane with grommets. The pain from the change in pressure in the aeroplane cannot happen when the grommets are working.
We need to check your child’s hearing after grommets have been put in, to make sure their hearing is better. Sometimes when a grommet comes out, a small hole is left behind. This usually heals up with time, and we rarely need to operate to close the hole. The grommet can leave some scarring in the eardrum. This does not affect the hearing.
