Our Summary

This research looked at children who had bleeding after having their tonsils and/or adenoids removed (PTAH) at a major children’s hospital. The study looked at all cases over a five-year period and focused on those who had bleeding more than once or who had bleeding occur 14 days or more after surgery.

Out of 291 children who experienced PTAH, 31 had bleeding more than once, and 11 had bleeding occur 14 days or more after the surgery. About 30% of these children needed another surgery to stop the bleeding, and 2 children needed to have this done more than once. Nine children needed blood transfusions. On average, there were 4 days between bleeding episodes.

The researchers found that 8.5% of children who had surgery to stop the bleeding at their first visit had bleeding again, compared to 11.4% of children who did not have surgery at their first visit. They concluded that how you treat bleeding the first time doesn’t seem to affect whether or not a child will bleed again. They also found that reasons for having the surgery or having abnormal blood clotting did not increase the risk of bleeding after day 14.

In conclusion, the researchers found that having multiple bleeds or bleeding after day 14 is quite rare and can’t be predicted. They recommend that doctors explain to children and their families before surgery that bleeding might occur, so they know what to expect.

FAQs

  1. What percentage of children had repeated bleeding after their tonsil or adenoid surgery according to this study?
  2. Does the initial treatment of bleeding after surgery affect the chances of a child bleeding again?
  3. Can doctors predict which children will have multiple bleeds or bleeding after day 14 post-surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about adenoidectomy is to be aware that bleeding after the surgery can occur, although it is rare. It is important to follow post-operative care instructions carefully and contact your doctor if you experience any unusual symptoms such as persistent bleeding, difficulty breathing, or fever. It is also important to have a discussion with your doctor before the surgery about the potential risks and complications associated with adenoidectomy.

Suitable For

Adenoidectomy is typically recommended for patients who have:

  1. Chronic or recurrent ear infections
  2. Chronic or recurrent sinus infections
  3. Obstructive sleep apnea or other sleep disorders
  4. Chronic nasal congestion or difficulty breathing through the nose
  5. Chronic or recurrent sore throat or difficulty swallowing
  6. Chronic or recurrent nasal drainage or postnasal drip

It is important for patients and their families to discuss the potential risks and benefits of adenoidectomy with their healthcare provider, as well as to understand the potential for complications such as bleeding after surgery.

Timeline

Before adenoidectomy:

  • Patient consults with ENT specialist to discuss symptoms and determine if surgery is necessary
  • Patient undergoes pre-operative evaluation and testing
  • Surgery is scheduled and patient is instructed on pre-operative guidelines
  • Adenoidectomy is performed under general anesthesia
  • Patient is monitored in recovery before being discharged home

After adenoidectomy:

  • Patient may experience throat pain and difficulty swallowing in the immediate post-operative period
  • Patient is instructed on post-operative care, including pain management and activity restrictions
  • Patient may have follow-up appointments to monitor healing and address any concerns
  • Patient gradually resumes normal activities as directed by healthcare provider
  • Patient experiences improvement in symptoms such as chronic nasal congestion, snoring, and sleep apnea

Overall, the adenoidectomy procedure aims to alleviate symptoms caused by enlarged adenoids and improve the patient’s quality of life.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with adenoidectomy, including post-operative bleeding?
  2. How common is post-tonsillectomy and adenoidectomy hemorrhage (PTAH) in children, and what are the risk factors for experiencing this complication?
  3. What are the signs and symptoms of post-operative bleeding that I should watch out for, and when should I seek medical attention?
  4. How is post-operative bleeding typically treated, and what is the likelihood of needing additional surgeries or interventions?
  5. Are there any specific precautions or measures I can take to reduce the risk of post-operative bleeding after adenoidectomy?
  6. How soon after surgery is the risk of bleeding highest, and what should I expect in terms of recovery and follow-up care?
  7. Are there any factors, such as underlying medical conditions or medications, that may increase my risk of experiencing post-operative bleeding after adenoidectomy?
  8. What is the hospital’s protocol for managing post-operative bleeding, and what should I do if I experience this complication?
  9. Are there any alternative treatments or procedures that may be considered to reduce the risk of post-operative bleeding after adenoidectomy?
  10. How will my child’s overall health and well-being be monitored in the days and weeks following adenoidectomy to detect and address any potential complications, including bleeding?

Reference

Authors: Cheung PKF, Walton J, Hobson ML, Taylor P, Chin M, Boardman S, Cheng ATL, Birman CS. Journal: Ear Nose Throat J. 2023 Apr;102(4):244-250. doi: 10.1177/0145561321999594. Epub 2021 Mar 9. PMID: 33689495