Tonsillectomy

Tonsillectomy

Summary

A tonsillectomy is a procedure to surgically remove the tonsils. Most often, it is performed on children who experience repeated infection and inflammation of the tonsils (tonsillitis), or who have trouble breathing due to airway obstruction. However, people of any age may undergo a tonsillectomy.

The tonsils are made up of two masses of tissue on either side of the neck. Tonsils help the body’s immune system collect germs in the body. However, in some cases these germs remain in the tonsils long enough to cause infection and inflammation of the tonsils.

Patients are urged to follow their physician’s advice in preparing for the tonsillectomy. In most cases, patients are asked not to eat or drink anything the evening before the surgery. They also may be advised to avoid certain medications for a period of time prior to the surgery.

Various techniques may be used in a tonsillectomy. In some cases, all of the tissue that makes up the tonsils will be removed. In other cases, only part of the tonsil tissue is excised. Depending on the technique used, patients may be unconscious or conscious during the tonsillectomy. Either way, anesthetia is used so the procedure is pain-free.

Most patients are allowed to go home the day of the surgery. Patients who are placed under general anesthesia typically will have to remain in a recovery room for a few hours following the procedure. It is common to experience a sore throat or ear ache following a tonsillectomy. Patients are likely to notice a sharp reduction in post-operative symptoms and discomfort within a few days. The risks associated with a tonsillectomy are similar to those for any surgical procedure. They include reactions to the anesthetia (e.g., breathing problems) and risk of bleeding or infection.

About tonsillectomy

A tonsillectomy is a surgical procedure performed to remove the tonsils. In some cases, other types of procedures may be performed to merely reduce the size of the tonsils to prevent them from obstructing the ability to breathe. Tonsillectomies are among the surgical procedures most commonly performed on children in the United States, but they may be performed on people of any age.

The tonsils are two masses of tissue on either side of the neck. They are involved in healthy immune system function by filtering germs that enter the airways. However, when the tonsils become diseased they are not effective in immunity, resulting in infection and inflammation of the tonsils (tonsillitis). Strep throat is often associated with inflamed tonsils. Problems that can be caused by tonsillitis include:

  • Recurrent sore throats
  • Ear infections
  • Breathing problems during sleep (sleep apnea) or snoring

Generally, a physician may recommend a tonsillectomy after a patient continues to experience chronic (long-term or recurring) infections despite taking antibiotics or receiving other medical treatment. In other cases, this procedure may be suggested if a patient’s tonsils are large enough that they cause sleep-related problems such as loud snoring or upper-airway obstruction.

Tonsillectomy is no longer the standard treatment for tonsillitis. Patients who have seven or more tonsillar infections each year are good candidates for a tonsillectomy, according to guidelines established by the American Academy of Otolaryngology – Head and Neck Surgery. Patients who have chronic sleep disorders related to the size of their tonsils also are urged to consider a tonsillectomy.

Tonsillectomies also are performed when a patient has a tumor on a tonsil or when a physician needs to remove the tonsils to reach the adenoids during an adenoidectomy. In recent years, some experts have questioned the necessity for the number of tonsillectomies performed each year. For this reason patients, or parents of patients, who are told that they need a tonsillectomy may want to seek a second opinion.

Types and differences of tonsillectomy

Various techniques may be used in a tonsillectomy. In some cases, all of the tissue that makes up the tonsils will be removed. In other cases, only part of the tonsil tissue is excised. The most common techniques used to perform a tonsillectomy include:

  • Cold-knife dissection. This involves removal of the tonsils with a scalpel. It remains the most commonly used method of tonsillectomy. Post-operative bleeding typically is minimal.
  • Electrocautery. Tonsillar tissue is burned away, while the remaining tissue is cauterized to reduce blood loss. The heat used in electrocautery reaches about 752 degrees Fahrenheit (400 degrees Celsius), and this may result in thermal (heat) injury to surrounding tissue, which may cause discomfort after the operation.
  • Harmonic scalpel. Ultrasonic energy is used to vibrate the blade of this type of scalpel thousands of times per second. The vibration that is generated transfers energy to the tissue, causing simultaneous cutting and clotting of the tissue. Thermal injury to surrounding tissue is less likely than in electrocautery, because the harmonic scalpel raises temperatures in the tissue to 176 degrees Fahrenheit (80 degrees Celsius).
  • Radiofrequency ablation. Probes are inserted into the tonsil and radiofrequency energy is transferred to the tonsil tissue. Scarring then occurs within the tonsil, causing it to shrink over a period of time. This procedure can be performed using light sedation or local anesthetia, and it produces minimal discomfort and requires minimal recovery time. However, tonsillar tissue remains after this procedure, so it typically is reserved for patients whose problems are associated with abnormally large tonsils that are not caused by tonsillitis. The procedure can be performed several times if necessary.
  • Carbon dioxide laser (laser tonsil ablation). A laser vaporizes and removes tonsil tissue, which both reduces the volume of the tonsil and removes recesses in which chronic infections can collect. The procedure is performed in less than 30 minutes in an office setting, using local anesthetia. As with radiofrequency ablation, discomfort is minimal and recovery time is relatively short. It is often used to treat chronic recurrent tonsillitis, chronic sore throats, severe halitosis (bad breath) or airway obstruction due to excessively large tonsils. Post-procedure bleeding rarely occurs.
  • Microdebrider. Uses a powered rotary shaving device to partially shave the tonsils. It is used when the tonsils are too big and cause an obstruction in the throat. After the procedure is finished, a natural biologic dressing is placed over the pharyngeal muscles to prevent inflammation and infection. The procedure results in reduced post-operative pain and a relatively rapid recovery.

Before and during the tonsillectomy procedure

A few days before the procedure, patients may be asked to provide a blood or urine sample. Patients are urged to follow their physician’s advice in preparing for the tonsillectomy. In most cases, patients are asked not to eat or drink anything the evening before the surgery. They also may be advised to avoid certain medications for a period of time prior to the surgery. Such medications may include:

  • Anti-inflammatory medications
  • Aspirin products
  • Herbal products such as ginkgo biloba or St. John’s wort

Patients who have a tonsillectomy may be placed under general anesthesia or local anesthesia, depending on the type of procedure performed. The procedure will unfold differently depending on the technique used to remove the tonsils. A tonsillectomy typically takes less than one hour.

Questions for your doctor about tonsillectomy

Preparing questions in advance can help patients have more meaningful discussions with the physician regarding their conditions and treatments. Patients may wish to ask their doctor the following questions related to a tonsillectomy:

  1. Why do you think I need a tonsillectomy?
  2. What are the health risks I face if I do not have a tonsillectomy?
  3. Do I have other treatment options besides a tonsillectomy?
  4. What type of tonsillectomy do you suggest? Why?
  5. How should I prepare for the procedure?
  6. Will I require local anesthesia or general anesthesia?
  7. Will I need to stay in the hospital following the procedure?
  8. How long will my recovery last? Will I need to stay in bed for a while?
  9. What types of medications can I take to ease my symptoms?
  10. Will I need to restrict my activities for a while following the procedure?
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