Tonsillectomy

Alternative names
Tonsils removal

Definition
Tonsillectomy is the surgical removal of the tonsils.

Description

The tonsil glands serve as agents against infections. However, in some people, particularly in children who have large tonsils, these glands perform less efficiently and can cause frequent throat and ear infections or may obstruct breathing. In these cases, surgery to remove the tonsils is of benefit.

While the patient is under general anesthesia, the ear-nose-throat (ENT) surgeon holds the mouth open to expose the tonsils. The tonsils are then cut away with an instrument or a cautery (burning instrument). Bleeding is controlled, and the cut heals naturally without stitches.

Indications

Tonsillectomy is advisable when tonsillitis attacks are so frequent or severe that they affect a child’s general health or interfere with school, hearing, or breathing. However, some physicians believe tonsillectomies are done more often than necessary, so a second opinion should be obtained when there is any doubt.

Specifically, the guidelines for surgery are:

     
  • 7 or more episodes of tonsillitis in 1 year  
  • 5 or more episodes per year over a 2-year period  
  • Enlarged tonsils that interfere with breathing  
  • An abscess in the tonsils  
  • Grossly asymmetric tonsils

Tonsillectomy may be advised if the tonsils are enlarged and obstructing access to the adenoids during an adenoidectomy or if the physician suspects the presence of a tonsil tumor.

Risks

Risks for any anesthesia include the following:

     
  • Reactions to medications  
  • Breathing problems

Risks for any surgery include the following:

     
  • Bleeding  
  • Infection

In rare instances, post-surgical bleeding can go unnoticed and can cause serious consequences. Frequent swallowing may be a sign of bleeding from tonsils.

Other risks include injury to the uvula (soft palate).

Expectations after surgery
In most cases, the surgery clears problems immediately. After surgery, the number of throat infections is reduced, but not completely eliminated.

Convalescence

Tonsillectomy is usually done on an outpatient basis, with the patient returning home the same day as the surgery. Rarely, patients are observed overnight in the hospital and return home the day after the surgery. Complete recovery can take 2 weeks.

Expect some throat and ear pain in the first days following surgery. The use of ice packs to relieve pain may be helpful, and sucking on an ice cube or eating ice cream may provide adequate comfort. In addition, pain-relief medication may be prescribed. During recovery, it is recommended to eat soft, easy-to-swallow food and to drink a lot of cold fluids.

The use of humidifier at home can also bring some comfort. Your child may experience alternating good and bad days for 2 weeks after surgery. It is a good idea to keep your child away from crowds or ill people for 7 days, since the throat is highly susceptible to infections during this period.

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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