Tonsillectomy

A tonsillectomy refers to the surgical removal of the tonsils. Tonsils are two small glands, round in shape, located behind the mouth, on each side of the throat. They are a part of the body’s defence (immune) system that helps in fighting against infections. Tonsils start shrinking after three years of age and become less useful.

When tonsils get enlarged due to inflammation (tonsillitis), they start to interrupt breathing while the person sleeps. The condition is called sleep apnea. Sleep apnea causes an individual to wake up from sleep multiple times during the night. This, in turn, leads to reduced concentration during the day, changes in behaviour, and continuous bedwetting in children. 

A tonsillectomy provides relief from these issues and helps the individual breathe and sleep better. The removal of the tonsils does not affect the ability of the individual to fight off infections.

Tonsilitis occurs more commonly in children, however, adults can also have this condition. A tonsillectomy benefits all age groups.

Your doctor may recommend a tonsillectomy if your tonsils enlarge (due to tonsilitis for example) and cause the following:

• Obstructive sleep apnoea
• Swallowing difficulty and feeding complications in children

A tonsillectomy is also done if you tend to have recurrent throat infections or sore throat along with tonsillitis or if you have tonsil cancer. 

Tonsillectomy may be contraindicated in people with the following conditions:

• Chronic complex conditions such as central nervous system diseases, brain and spinal cord malformations, epilepsy, mental retardation, and chronic respiratory diseases.
• Craniofacial abnormalities such as cleft palate, cleft lip, other congenital deformities of the skull, face and jaw, and Down’s syndrome.
• Acute upper respiratory tract infection at the time of admission to the hospital.

The first step before the surgery is diagnosing tonsillitis. Your doctor will look for its signs like red, swollen tonsils with spots or sores. Sometimes, you may be asked to get a rapid strep test, in which the cells in your throat and saliva will be checked for the presence of bacteria. The test results arrive in 10-15 minutes. A throat culture test will also be done, the results of which take a few days to arrive. These tests will find out if your tonsillitis is caused by the Streptococcus bacteria. If your doctor suspects mononucleosis, commonly caused by a virus, then a test will be done for the same.

The following preparations are required before the surgery:

• Your doctor will conduct a physical examination and take your medical history to ascertain that you are otherwise fit enough for the procedure. This can be done a week before the procedure.
• Your doctor may order a blood test to check if you have a high risk of bleeding (such as from a bleeding disorder).
• Inform your doctor if you are taking any medicines. The doctor will let you know which medicines can be continued until the time of surgery.
• You will not be allowed to drink or eat anything at least six hours before the surgery. Water can be consumed during this period.
• You may be asked to not take any fever medicines or painkillers for a minimum of three days before the surgery.
• Avoid taking ibuprofen or herbs like ginkgo or St. John’s Wort for two weeks prior to the surgery. 
• If your child is going for the surgery, make sure he/she does not takes gum/candy on the day of the operation.
• You will be asked to sign a consent form before the surgery allowing the doctor to perform the procedure.

This procedure is carried out by an ear, nose, and throat (ENT) surgeon under general anaesthesia (to put you into sleep for the duration of the surgery). 

Before the surgery:

• You will be provided with a hospital gown to change into.
• If your child is undergoing the surgery, you will be able to accompany your child to the anaesthetic room.
• General anaesthesia will then be administered as an injection or as a gas that can be breathed in. You will fall asleep after some time with gas, and immediately after injection.
• You will then be taken to the operating room.

The surgery can be done in the following ways:

• Harmonic scalpel: The removal of tonsils and stopping of bleeding are both done using ultrasonic vibrations.
• Electrocautery: Heat from a metal wire is used to remove the tonsils and stop the bleeding after their removal. Current is passed through the wire to heat it up.
• Cold knife (steel) dissection: A scalpel is used to excise the tonsils and heat (electrocautery) or sutures are used to stop the bleeding.

Other techniques that use carbon dioxide laser, radiofrequency ablation or microdebrider also may be used to gradually reduce tonsil size.

Radiofrequency ablation uses a cold radiofrequency, at a temperature between 40-70 degree Celcius to reduce the tonsil size. A microdebrider is a device with a suction port and blades on a stick. The suction port sucks the tissue so the blades can easily cut it. The frequency and direction of rotation of the blade can be controlled through an attached console.

The two common methods of performing tonsillectomy are as follows:

• Intracapsular tonsillectomy: In this technique, the entire tonsillar tissue is removed except for some tissue on the side. The tissue is retained to protect the side of the throat. Individuals who have had this surgery recover faster and have less pain, but the tonsils could potentially grow back enough to cause symptoms. This method is apt for very young children who have sleep apnoea; however, it is not advisable for children with strep throat or tonsillitis.
• Conventional tonsillectomy: In this procedure both the tonsils are completely removed, thus ensuring that the tonsils do not grow back later. However, the drawback to this technique is that eating or drinking becomes difficult as the surgical site is painful for about 10 days.

The surgery takes about 30 to 45 minutes to complete. You will then be moved to the recovery room.

You can expect the following in the hospital after surgery:

• A nurse will frequently check your temperature, pulse, and throat. He/she will also check if you can pass urine/don't have dehydration.
• Once the effect of the anaesthesia goes away, you will be able to drink. If your health allows, you can resume a regular diet.
• You will stay in the hospital for a minimum of six hours following surgery and may be discharged on the same day. However, sometimes, an overnight stay is required.

It will take about two weeks for you to completely recover after a tonsillectomy. You can expect the following:

• You may experience a sore throat, which may increase initially and may persist for some days. It may take about 10 to 12 days to heal. The surgeon may prescribe painkillers for the same.
• Some people have an earache after the procedure. This resolves in around two to three days.
• You may also have bad breath for three to four weeks after the procedure as the tissue heals.
• Generally, dissolvable stitches are used in this procedure. These stitches dissolve within three weeks of the procedure.
• You will be able to eat normally soon after surgery. 

You may be asked to take the following care at home after surgery: 

When to see the doctor?

You should immediately visit or call your doctor if you observe the following symptoms:

• A high temperature (38.5ºC [101ºF] or above)
• Minor bleeding
• Persistent pain that is not relieved by painkillers
• Rashes on any part of the body
• Breathing problems
• Severe vomiting or nausea
• Diarrhoea
• Bad breath along with fever

The following are the possible risks of a tonsillectomy:

• Wound infection
• Bleeding
• Difficulty in breathing due to swelling after the procedure
• Sore throat for 10 to 14 days after the surgery along with difficulty in swallowing 
• Damaged teeth

Usually, a follow-up visit will not be required unless instructed by the doctor.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.