Definition & Overview

Tonsillectomy is a surgical procedure primarily developed and performed to treat tonsillitis, the chronic inflammation of the tonsils. Tonsils are a small pair of glands containing white blood cells that help fight infections. They are found at the back of the throat and would typically swell when infected. In the majority of cases, tonsillitis is resolved with a round of antibiotic. However, in severe or chronic cases in which the condition occurs several times a year, complete tonsil removal can be recommended.

These days, tonsillectomy can also be performed to treat a variety of disorders including apnoea or sleep disordered breathing, other breathing problems, and other diseases of the tonsils.

Who Should Undergo & Expected Results

Tonsillectomy is recommended for patients with:

  • Chronic tonsillitis, which symptoms include difficulty swallowing, fatigue, and fever
  • Enlarged tonsils leading to respiratory obstruction
  • Severe dysphagia
  • Sleep disorders caused by underlying cardiopulmonary complications
  • Chronic bacterial throat infection that does not respond to medication and impedes swallowing and breathing
  • Accumulation of pus behind the tonsils
  • Tonsillitis caused by febrile convulsions
    Tonsillectomy can also be performed as a diagnostic procedure if cancer is suspected. This involves collecting tissue samples for a biopsy.

As for the expected results, removing these small glands help increase airway space, giving relief to those who suffer from unusually loud snoring. The procedure can also prevent further infection and other complications.

Tonsillectomy is considered a relatively simple surgical procedure and in the majority cases, it only requires an overnight hospital stay for children while adults are normally allowed to go home after surgery. Painkillers are prescribed for about a week or two to manage sore throat and other complications. Rapid recovery from tonsil removal is expected with patients being able to resume normal activities after a few days of rest.

How Does the Procedure Work

There are several methods to perform a tonsillectomy. One is called bipolar diathermy dissection which is preferred in many cases as it minimises blood loss. This is done by closing off the blood vessels between the tonsils and the surrounding muscles using electrical forceps. The tonsils are then removed one at a time. This procedure is performed if complete tonsil removal is required to ensure that none of its tissues are left behind.

Another method is called intracapsular tonsillectomy and involves the use of an electrical probe to break down and remove the proteins in the tonsil tissue. The probe contains a saline solution heated by electrical current and causes the breakdown of the glands inside the tonsil lining. This method reduces the risk of exposing the underlying muscles and blood vessels. This type of tonsillectomy is typically done to address sleep apnoea or loud snoring.

Possible Complications and Risks

There is always the risk of bleeding during any surgical procedure and tonsil removal is no exception. Bleeding could occur during bipolar diathermy dissection, while the surgeon is still in the process of cauterising or closing off the affected blood vessels. However, this type of bleeding is easily controlled and is rarely considered a major complication.

Pain is expected after tonsillectomy and would need medication to manage. In some cases, the ears are also affected and patients also experience stuffy nose. These can cause children to reduce their liquid and food intake.

Also, the back of the throat would appear white and would have an unpleasant smell after surgery.

Meanwhile, uncommon complications include damage to some parts of the mouth due to the insertion of metal instruments and jaw pain.

Caregivers should also be on the lookout for recurring symptoms of tonsillitis or even persistent loud snoring even after surgery. This could be caused by tonsil regrowth, which requires repeated surgery.

References

  • Goldstein NA. Evaluation and management of pediatric obstructive sleep apnea. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 184

  • Wetmore RF. Tonsils and adenoids. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 383.

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