Tonsillectomy

A tonsillectomy involves the removal of the tonsils, and is used to treat severe or recurrent tonsillitis, among other conditions.

Definition

The surgical removal of the tonsils, which are glands in the back of the throat.

The Tonsils

Tonsillectomy

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Parts of the Body Involved

A tonsillectomy involves the throat and tonsils.

Reasons for Procedure

Tonsillectomy is most often performed for the following reasons:

  • To treat chronic or recurrent tonsillitis (four or more streptococcal infections of the tonsils per year) despite appropriate medication and other nonsurgical treatments.
    If you are considering a tonsillectomy for your child, discuss the risks and benefits with the doctor. In some cases, children outgrow their bouts of tonsillitis. Tonsils can shrink as the child gets older. Tonsillectomy can reduce the number of sore throats, especially in a child who is severely affected. But, there is no guarantee that the surgery will prevent all future bouts of sore throat. Also, as with any surgical procedure, tonsillectomy carries some risk.
  • To treat peritonsillar abscess when drainage along with nonsurgical treatments are not effective
  • To remove enlarged tonsils that are causing severe problems with swallowing, breathing, or proper dental formation

Risk Factors for Complications During the Procedure

While tonsillectomies are generally associated with few complications, any surgery carries risks due to the procedure itself or the general anesthesia. Certain conditions may increase these risks, such as:

  • Obesity
  • Smoking
  • Poor nutrition
  • Recent chronic illness
  • Previous adverse reaction to anesthesia
  • Sickle cell anemia
  • Bleeding disorders
  • Pregnancy
  • Recent or current steroid use
  • Poorly controlled diabetes
  • Scarring because of severe frequent infections

What to Expect Prior to Procedure

Your doctor will likely do the following:

  • Physical exam of the tonsils, throat, and neck, at minimum
  • Blood test
  • Possibly a urine test
  • Review of medications; some may need to be stopped or adjusted for the procedure

In the days leading up to your procedure:

  • Do not take aspirin or other anti-inflammatory drugs for one week before surgery, unless told otherwise by your doctor. You may also need to stop taking blood-thinning medications. Examples include clopidogrel (Plavix), warfarin (Coumadin), or ticlopidine (Ticlid). Talk to your doctor.
  • The night before, eat a light meal and do not eat or drink anything after midnight, including mouthwash, toothpaste, lozenges, chewing gum, and water.

During Procedure

  • Anesthesia, and possibly sedation
  • Breathing tube
  • Retractor that holds your mouth open
  • Depressor that holds your tongue down

Anesthesia

General anesthesia is most common, but tonsillectomy can be performed with sedation and local anesthesia.

Description of the Procedure

One at a time, the surgeon will grasp each tonsil with tonsil forceps and cut it away from surrounding tissues. The
tonsil is then removed with a snare or a tonsil guillotine clamp. Electrocauterization (scarring with an electrical
current) or clamps and ties are used to stop bleeding from the blood vessels at the site where the tonsils were
removed. Radiofrequency ablation can be used to reduce the volume and size of the tonsils.

After Procedure

The site where the tonsils were removed should heal within 7 to 10 days. Postoperative symptoms include, but are not limited to:

  • Swallowing problems
  • Throat pain
  • Ear pain
  • Vomiting
  • Fever
  • Bleeding from the site where the tonsils were removed

After your procedure, be sure to follow your doctor’s instructions.

How Long Will It Take?

The procedure typically takes 20 to 60 minutes.

Will It Hurt?

Anesthesia prevents pain during the procedure, but pain after the procedure is common. Your doctor may prescribe pain medication or recommend over-the-counter pain drugs for you.

Possible Complications

  • Excessive bleeding from the site where the tonsils were removed
  • Adverse reaction to the anesthesia
  • Vomiting and dehydration

Average Hospital Stay

An otherwise healthy person can usually have this procedure done on an outpatient basis. Some patients may need to stay in the hospital for up to two days.

Postoperative Care

  • Drink plenty of fluids (avoid acidic drinks)
  • Take acetaminophen (Tylenol) or other pain medication prescribed by your physician to relieve pain
  • Apply ice to relieve pain
  • Take antibiotics, if they are prescribed, to treat or prevent infection
  • Avoid talking, coughing, and singing for one week
  • Avoid swallowing hard items such as crackers and hard cookies, as they may injure the back of the throat
  • Avoid vigorous exercise for 12 to 14 days
  • Avoid spicy, acidic, and hard-to-digest foods
  • Eat soft foods such as gelatin and pudding for 3 to 4 days after surgery, and gradually return to a normal diet
  • Bathe or shower as usual

Outcome

Outcomes vary depending on the reason for the tonsillectomy. They include:

  • Fewer throat infections
  • Improved breathing and swallowing

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the site where the tonsils were removed
  • Severe or worsening pain
  • New, unexplained symptoms

Resources

American Academy of Otolaryngology–Head and Neck Surgery: entnet.org
Kids Health: kidshealth.org

Canadian Resources:

Canadian Family Physician: cfp.ca
Health Canada: hc-sc.gc.ca

References

American Academy of Otolaryngology–Head and Neck Surgery website. Available at:
entnet.org
Jones P. A review of tonsillectomy to treat sore throats in children. EBSCO Health Library website. Available at:
ebscohost.com
Updated April 2009. Accessed April 16, 2009.
Rothrock J. Alexander’s Care of the Patient During Surgery . 11th ed. Mosby; 1999.
DynaMed’s Systematic Literature Surveillance
ebscohost.com
MJ, Glasziou PP. Tonsillectomy or adeno-tonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001802.

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