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Tonsillectomy

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A tonsillectomy is a surgical procedure in which the tonsils are removed. Sometimes the adenoids are removed at the same time.

Tonsillectomy may be indicated when the patient:

  • Experiences frequent bouts of acute tonsillitis. The number indicating tonsillectomy varies with the severity of the episodes. One case, even severe, is generally not enough for most surgeons to decide tonsillectomy is indicated.
  • Has chronic tonsillitis, consisting of persistent, moderate-to-severe throat pain.
  • Has multiple bouts of peritonsillar abscess.
  • Has sleep apnea (stopping or obstructing breathing at night due to enlarged tonsils or adenoids)
  • Difficulty eating or swallowing due to enlarged tonsils
  • Is suspected of having cancer.

Most infections indicating tonsillectomy are a result of Streptococcus infection ("strep throat"), but some may be due to other bacilli, such as Staphylococcus, or viruses. However, the etiology of the condition is largely irrelevant in determining whether tonsillectomy is indicated. [1]

Most tonsillectomies are performed on children, though many are also performed on teenagers and adults. There has been a significant reduction in the number of tonsillectomies in the United States from several millions in the 1970s to approximately 600,000 in the late 1990s. This has been due in part to more stringent guidelines for tonsillectomy and adenoidectomy (see tonsillitis and adenoid). Still, debate about the usefulness of tonsillectomies continues. Not surprisingly, the otolaryngology literature is usually pro-tonsillectomy and the pediatrician literature is the opposing view. Enlarged tonsils are being removed more often among adults and children for sleep apnea (airway obstruction while sleeping), snoring, and upper airway obstruction. Children who have sleep apnea can do poorly in school, are tired and fatigued during the day, and have some links to ADHD. [2][3]

Tonsillectomy in adults is perhaps more painful than in children, though everyone's experience is different. Post-operative recovery may take 10-20 days, during which narcotic analgesics are typically prescribed. A diet of soft food (e.g. pudding, eggs, soft noodles, soup, etc.) is recommended to minimize pain and the risk of bleeding; the duration of diet restriction varies from patient to patient and may last from several days to two weeks or more. Proper hydration is also very important during this time, since dehydration can increase throat pain, leading to a vicious cycle of poor fluid intake. At some point, most commonly 7-11 days after the surgery (but occasionally as long as two weeks after), bleeding may occur when scabs begin sloughing off from the surgical sites. The overall risk of bleeding is approximately 1-2% higher in adults. [4] Approximately one in twenty adult patients develops significant bleeding at this time. The bleeding may quickly stop naturally, or via mild intervention (e.g. gargling cold water). Otherwise, a surgeon must repair the bleeding immediately by cauterization, which presents all the risks associated with emergency surgery (most having to do with the administration of anesthesia on a patient whose stomach is not empty). There are several different procedures available to remove tonsils, each with different advantages and disadvantages which can be discussed with your doctor. In children it may be the case that there is a noticeable change in voice [5] after the operation.[6] [7]

References

  • ^ Avior G, Fishman G, Leor A, Sivan Y, Kaysar N, Derowe A (2004). "The effect of tonsillectomy and adenoidectomy on inattention and impulsivity as measured by the Test of Variables of Attention (TOVA) in children with obstructive sleep apnea syndrome". Otolaryngol Head Neck Surg. 131 (4): 367–71. PMID 15467601.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  • ^ Ray RM, Bower CM (2005). "Pediatric obstructive sleep apnea: the year in review". Curr Opin Otolaryngol Head Neck Surg. 13 (6): 360–5. PMID 16282765.
  • ^ Windfuhr JP, Chen YS, Remmert S (2005). "Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients". Otolaryngol Head Neck Surg. 132 (2): 281–6. PMID 15692542.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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