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Tonsillectomy

Tonsillectomy by Krisha McCoy, MS

Anatomy and Physiology
Your tonsils, located on either side of the back of your throat, are part of your immune system. They help your body fight off infection by filtering out harmful bacteria and other germs that enter through your nose and mouth.

Your adenoids are located higher in your throat, behind your nose above your soft palate. Like your tonsils, they also help fight infection.

Reasons for Procedure
Tonsillectomies are most often performed in people who have chronic or frequently recurrent episodes of tonsillitis. Tonsillitis occurs when the tonsils are so overwhelmed with fighting an infection that they become inflamed.

Symptoms of tonsillitis include: enlarged, red tonsils, fever, sore throat, painful swallowing, and/or swelling of the lymph nodes in front of the neck.

Your adenoids may also become inflamed. Inflammation of the adenoids can block the eustachian tubes, which can lead to middle ear infections or inflammation. In younger children, inflamed tonsils and adenoids often go hand-in-hand. For them, adenoidectomies are commonly performed at the same time as tonsillectomies. Adults and children over the age of six, however, usually do not require adenoidectomies. Loading image. Please wait...

Treatments
A tonsillectomy and adenoidectomy should only be considered when non-surgical treatment options have failed. Most cases of tonsillitis are caused by a viral infection and gradually improve with rest, fluids, and over-the-counter pain relievers. Tonsillitis caused by bacterial infections, such as strep, generally responds to antibiotics.

However, a tonsillectomy may be indicated if you have had: seven or more episodes of tonsillitis in one year, five or more episodes of tonsillitis per year over a two-year period, severe tonsillitis that has not adequately responded to antibiotic treatment, or an infection that has spread to the area around your tonsils two or more times.

Procedure
In the days leading up to your procedure: Arrange for a ride to and from the hospital. Do not take aspirin, aspirin-containing medications, or other nonsteroidal anti-inflammatory medications. Do not take any new medications, herbs, or dietary supplements without first discussing them with 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. Most tonsillectomies last between 20 and 60 minutes. A tonsillectomy is almost always performed under general anesthesia, which will put you to sleep for the duration of the procedure.

During this procedure, your surgeon will hold your mouth open with a retractor and keep your tongue out of the way with a tongue depressor.

Your surgeon will then grasp each tonsil one at a time with forceps and cut it away from the surrounding tissues.

After each tonsil is removed, your surgeon will use electrocauterization to stop any bleeding. The wound left behind generally heals naturally without stitches.

Removal of the adenoids is similar to the removal of the tonsils. Your surgeon will grasp each adenoid with forceps and cut it away from the surrounding tissues, then stop any bleeding with electrocauterization.

Risks and Benefits
Complications associated with tonsillectomy and adenoidectomy are rare, but may include: bleeding, persistent pain, burns or injury to teeth, lips, gums, or facial skin, infection, changes in tongue sensation, abnormal scarring that causes narrowing of the throat, adverse reaction to the anesthesia.

The benefits of a tonsillectomy and adenoidectomy are that they: eliminate the possibility of tonsillitis and adenoiditis in the future, may eliminate bad breath, or halitosis, if this has been a problem, may improve night time breathing and reduce snoring, may improve daytime nasal breathing and reduce mouth breathing, may reduce the accumulation of fluid in the middle ear by allowing the eustachian tube to properly drain.

In a tonsillectomy, adenoidectomy, or any other procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate choice for you.

After the Procedure
After your procedure: You will be taken to the recovery area until the effects of the anesthesia wear off and you are able to take sips of fluids by mouth; this usually takes 8-10 hours. You may be able to go home the same day as your procedure, but some patients require an overnight stay at the hospital. You will be advised to drink plenty of liquids to avoid dehydration; it may be easiest to consume liquids and cold desserts at first, since your throat may be sore. Complete recovery usually takes between 10 days and two weeks. After you leave the hospital, call your doctor if you experience: a fever above 101 degrees, increasing redness, swelling, pain, bleeding, or discharge in the area of the procedure, persistent throat and ear pain that lasts for more than two weeks, inability to drink fluids.

Sources:

  • About tonsillectomy and adenoidectomy: surgical removal of the tonsils and adenoids. American College of Surgeons website. Available at: http://www.facs.org/public_info/operation/tonsiladen.pdf. Accessed February 20, 2004.
  • Adenotonsillectomy. Queensland Government website. Available at: http://www.health.qld.gov.au/informedconsent/ConsentForms/ent/adenotonsillectomy.pdf. Accessed February 20, 2004.
  • Tonsillectomy. National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003013.htm. Accessed February 20, 2004.
  • Tonsillitis. National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003013.htm. Accessed February 20, 2004.
  • Tonsillectomy and adenoidectomy. National Library of Medicine website. Available at: http://www.nlm.nih.gov/medlineplus/tutorials/tonsillectomy/ol049101.pdf. Accessed February 20, 2004.


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