Tonsillectomy is surgery to remove the tonsils. These two fleshy oval-shaped pads are located on either side of the back of the throat. Tonsillectomy is needed when the tonsils become infected frequently (tonsillitis) or non recovering infection and because of enlarged tonsils blocking normal breathing and rarely to treat cancer or a tonsil that won't stop bleeding. Tonsillectomy is one of the more common surgeries in children, but it's done less often in adults. Adult patients with swollen, infected tonsils may require a tonsillectomy under general anesthesia if their problem recurs too often.

Definition

Tonsillectomy is surgery to remove the tonsils. These two fleshy oval-shaped pads are located on either side of the back of the throat. Tonsillectomy is needed when the tonsils become infected frequently (tonsillitis) or non recovering infection and because of enlarged tonsils blocking normal breathing and rarely to treat cancer or a tonsil that won't stop bleeding. Tonsillectomy is one of the more common surgeries in children, but it's done less often in adults. Adult patients with swollen, infected tonsils may require a tonsillectomy under general anesthesia if their problem recurs too often.

 

Indications

1. Patients with 3 or more infections of tonsils and/or adenoids per year despite adequate medical therapy.

2. Hypertrophy (enlargement) causing dental malocclusion or adversely affecting oral-facial (mouth-face) growth documented by orthodontist.

3. Hypertrophy causing upper airway obstruction (sleep apnea) severe dysphagia (trouble swallowing), sleep disorders, or cardiopulmonary complications.

4. Peritonsillar abscess unresponsive to medical management and drainage documented by surgeon, unless surgery performed during acute stage

5. Persistent foul taste or breath due to chronic tonsillitis not responsive to medical therapy.

6. Chronic or recurrent tonsillitis associated with the streptococcal carrier state and not responding to beta-lactamase-resistant antibiotics.

7. Unilateral tonsil hypertrophy presumed euplastic. Although without other indications (abnormal appearance, physical examination, symptoms or history) most asymmetries can be followed conservatively.

8. Recurrent acute otitis media or chronic serous otitis media. Adenoidectomy should not be performed with the insertion of the first set of myringotomy (ear) tubes unless there is another indication for adenoidectomy besides chronic otitis media. However, repeat surgery for chronic otitis media should consist of adenoidectomy with myringotomy (with or without myringotomy (ear) tube placement.)

 

Preparing the patient for anesthesia and surgery

• Aspirin and Ibuprofen products should not be given for at least 2 weeks before operation.
• It is important to notify the doctor if the child/patient has personal or family history of bleeding tendencies.
• Blood testing is not routinely done in children before surgery unless there are special medical circumstances.
• Generally, 8-10 hrs before to the operation, no food or liquids may be taken by mouth, including chewing gum, mouthwashes, throat lozenges, toothpaste, water. Anything in the stomach may be vomited when anesthesia is induced. However this is dangerous. Depending on the age of the child, a clear liquid such as water or fruit juice may be given until 4-5 hrs before.
• If it's a child it is important to reassure and also tell him off the possibilities of a sore throat even after surgery for a couple of days.
• The surgery is usually done under either general or local anesthesia.
• Give children a lot of support and assistance and be there for them emotionally and physically.

 

Procedure

Operation is performed in the hospital by a specialist Ear Nose and Throat surgeon (Otolaryngologist). The operation is done through the patient's mouth, and the tongue is kept depressed with a surgical instrument called "Davis Gag" which keeps mouth open and the tongue depressed. During the procedure the surgeon removes the tonsils from the side of the throat by carefully scraping away using a special tweezers. Stitches during this procedure are very few to nil, as there are no cuts or incisions here. It usually lasts about 30-45 minutes. Tonsils are removed alone, though sometimes if found to be inflamed and infectious the adenoids are to be removed much in the same procedure using a using an instrument called "St Clair Thomson's Adenoid Curette". The operation then is called Adenotonsillectomy.

 

Complications

Tonsillectomy is a major surgery. Like other surgeries, it has certain risks.

Risks during and immediately following the procedure include:

• Reactions to anesthesia. Medication to make you sleep during surgery (general anesthesia) can sometimes cause mild or serious reactions.
• Tongue soreness or swelling. The tool used to keep your mouth open during a tonsillectomy may make your tongue numb or sore right after the procedure. This is temporary.
• Bleeding during surgery. In rare cases, severe bleeding occurs during surgery and requires additional treatment and a longer hospital stay.

Risks during recovery include:

• Bleeding during healing. After a tonsillectomy, about one in five adults have bleeding that won't stop. Bleeding occurs less often in children, but can still occur. It usually occurs a week or so after surgery, but may happen sooner or up to two weeks later. This type of bleeding is believed to occur when the scab comes off the tonsil area. It can be caused by eating hard-edged food, such as chips, or by strenuous activity. This requires a trip to the emergency room to check the extent of the bleeding.
• Complications with anesthesia if you need surgery to stop bleeding. Follow-up surgery with anesthesia to stop the bleeding can be dangerous because you probably will have food in your stomach. This could place you at risk of inhaling (aspirating) food or liquids.
• Infection. Rarely, surgery can lead to an infection that requires further treatment.
• Delayed recovery. Some people take longer to heal than do others after a tonsillectomy. Although children usually recover in less than two weeks, it can take a month or longer for some adults. It's difficult to predict exactly how long it will take for you or your child to recover.
• Pain. Both children and adults have throat pain after the procedure. However, adults may have more pain than do children, and in adults, pain generally lasts longer. In some cases, adults have throat pain bad enough to make swallowing difficult for several weeks.

Post Operative Care & Complications

• First and foremost the patient is kept with their head low and lying to one side.
• At no time would they be permitted to lie on their back or be left unattended till they regain consciousness.
• Complications in this operation are very rare, usually seen in the form of bleeding almost immediately, or after several days. This is a very minor complication, which is easily corrected by the surgeon, but the patient is always advised to contact immediately after noticing the bleed.
• No diet restrictions are imposed on the patient following surgery. The sooner the patients start eating solid food, the better for them. They should follow a simple diet of soft foods and liquids, for the first one to two days. There is no restriction in activity if the patient fells up to it. The patient might start to snore and tends to breathe through his mouth, due to pain, for a few days, which is normal.
• In the week that follows the surgery, the patient will and might have some moderate to mild pain in the throat and ear, along with fever, nausea and vomiting. Sometimes especially in children there could be a slight change in the sound of the voice. Formation of thick white scabs over the place where the tonsil were removed can be seen. This is however normal, and might cause bad breath. There is no reason to worry, as it will fall off in about 10 days. In most cases, the patient swallows it unknowingly.
• Follow-up is important after 7-10 days to 2 weeks, and it is advisable to definitely keep the appointment.