Procedure for Tonsillectomy

Tonsillectomy

Tonsillectomy is a surgical procedure in which the tonsils from either side of the pharynx are removed. Children face these problems more than the adults do. The tonsils are situated in the tonsillar fossa. It should be performed only after all other palliative treatments have failed. People often face issues pertaining to tonsils namely, tonsillitis, swollen tonsils, tonsil infection, etc. which need medical attention.

Tonsils

Tonsils are lymph nodes located on either side of the throat at the base of the tongue. Their function is to defend body against invading bacteria and viruses. Tonsillitis is the condition when these lymph nodes get infected. It is mostly seen in children and young. It is contagious and usually caused by Streptococcal bacteria. Untreated tonsillitis can lead to complications. Even after the treatment, there is always a chance of recurrence.

Tonsillitis causes

The following are the causes of tonsillitis:

• Tonsils
• Bacterial infection or viral infection
• Common cold
• Epstein-Barr virus

Tonsillitis Symptoms

• High grade fever
• Headache and body-ache
• Pain in ears
• Swelling in the neck
• Difficulty in swallowing
• Difficulty in breathing
• Difficulty in talking
• Sore throat
• Change in voice
• Vomiting
• Bleeding from throat
• Dehydration
• Upper airway obstruction

Tonsillitis treatment

Palliative treatment or tonsillitis cure consists of:

• Non-steroidal anti-inflammatory drugs like paracetamol, acetaminophen
• Antibiotics for tonsillitis course for the designated time like azithromycin, althrocin
• Steroids
• Warm water and salt gargles

Tonsillectomy Procedure

In case of children the adenoids are removed and the procedure is called adenoidectomy. In adults, the adenoids become vestigial and hence adenoidectomy is rarely performed.

Total or extra capsular-tonsillectomy is done by totally dissecting the tonsil from its surrounding fascia. During the procedure a scalpel is used. At times electrocautery is used. The electrocautery works to stop the bleeding. The surface is sutured . Application of prothrombin is recommended to clot blood.

The Tonsillectomy procedure is performed under general, or local anaesthesia depending upon the method used.

There have been many methods in use :

• Dissection and snare method
• Electrocautery
• Radiofrequency ablation
• Coblation tonsillectomy
• Harmonic scalpel
• Thermal Welding
• Carbon dioxide laser
• Microdebrider

What is the average length of stay for this surgery?

It requires 1 day prior to surgery and 4 -7 days after the surgery depending upon the post-surgical pain and hydration.

Indications

The following are the indications of Tonsillectomy:

• tonsillitis
• Obstructive sleep apnoea
• Nasal airway obstruction
• Diphtheria carrier state
• Snoring
• Peritonsillar abscess
• 7 episodes of severe infection in a year
• Recurrent throat infections
• Failure of multiple antibiotics post treatment
• Severe stomatitis, pharyngitis and peritonsillar abscess
• Associated poor school performance and behaviour problems

Contraindications

The procedure is not suggested in following situations -

• Very young children below 3 years
• With systemic infection
• With bleeding disorders
• Immuno-compromised patients
• Associated disorders of the heart and liver

Complications

Immediate complications

• Post-operative vomiting
• Post-operative pain
• Bleeding

Delayed complications

• Impact on immune system
• Tonsillectomy has been correlated with certain cancers like lymphoma, Laryngeal, Oesophageal ,Thyroid, breast cancer
• Conditions like asthma and hay fever.
• Appendicitis, Heart attack Rheumatoid arthritis, Otitis media
• Poliomyelitis, Recurrent cellulites
• Decrease in levels of serum immunoglobulin
• Risk of autoimmune disease
• Increased risk of chronic diseases

Post-operative care

• After surgery there will be sore throat causing in reduction of fluid intake. Hence it is essential to stay hydrated for at least 1-3 weeks post-surgery
• Risk of bleeding increases when the scab falls off in two weeks
• Non-steroidal anti-inflammatory drugs have to be given to manage pain
• Antibiotics against infection
• Steroids against inflammation and any associated allergy
• In case of any emergency the surgeon should be contacted immediately

Post-surgery/rehabilitation

The frequency and severity of sore throats is only barely reduced by tonsillectomy. Benefits of the surgery rarely last beyond a year or two.

It does help minimally in sleep-disordered breathing but will require further management.

Possibility of bleeding after a year or two should be checked with the surgeon and managed accordingly.