A tonsillectomy is the surgical removal of the tonsils and is usually performed by an Ear, Nose, Throat Surgeon (otolaryngologist). The tonsils are balls of lymphatic tissue on both sides of the throat, above and behind the tongue. They are part of the immune system, which helps the body fight infection. Some people think that removing the tonsils may hurt the body's immune system, but research does not support this.
The adenoids may or may not be removed at the same time (adenoidectomy). Adenoidectomy is not discussed in this topic.
A general anesthetic is always used to sedate a child having a tonsillectomy. Adults may require only a local anesthetic to numb the throat.
- The surgical technique and instruments used to perform a tonsillectomy may vary depending on the surgeon’s training and preference. The more common techniques are:
- Scalpel. The oldest, and possibly the most common, cutting instrument used.
- Ultrasonic scalpel. Ultra sound energy vibrates a cutting blade (scalpel) at a rate invisible to the naked eye.
- Electrocautery. Electric energy heats the tip of a hand-held device to burn through the tissue.
- Radiofrequency ablation (RFA).
- Monopolar radiofrequency thermal ablation. Heat generated from a high-frequency alternating current used to cut through the tissue.
- Bipolar radiofrequency ablation (also known as Coblation). Energy in a conductive medium (salt water) creates a medium where the ionic bonds of the cells are disrupted, allowing the tissue to be “cut”. With this process, heat is not the primary mechanism used to cut the tissue.
All of these techniques and instruments have certain advantages and disadvantages and you may or may not be a candidate for each of these techniques. You should talk with your surgeon regarding specific advantages, disadvantages and associated risks prior to undergoing surgery.
Why It Is Done
As a rule, doctors only advise surgery to remove tonsils when there are serious problems with the tonsils. These include infections that happen again and again, long-lasting infections that do not get better after treatment and get in the way of daily activities, or when tonsils affect nighttime breathing (obstructive sleep apnea).
A tonsillectomy may be done if:
- A person has ongoing or recurring episodes of tonsillitis.
- A person has recurring episodes of strep throat in a single year despite treatment.
- Abscesses of the tonsils (peritonsillar abscess) do not respond to drainage. Or an abscess is present in addition to other indications for a tonsillectomy.
- A persistent foul odor or taste in the mouth is caused by tonsillitis and does not respond to treatment.
- A biopsy is needed to evaluate a suspected tumor of the tonsil.
- Enlarged tonsils obstruct the airway, cause sleep disorders (obstructive sleep apnea), make swallowing difficult (dysphagia) or cause other complications.
What To Expect After Surgery
The surgery may be done as outpatient surgery or, sometimes, during an overnight hospital stay.
A very sore throat usually follows a tonsillectomy and may last for several days. This may affect the sound and volume of the person's voice and his or her ability to eat and drink. The person may also have bad-smelling breath for a few days after surgery. There is a very small risk of bleeding after surgery.
A child having a tonsillectomy may feel "out of sorts" for a period of a week to 10 days. But if the child is feeling well enough, there is no need to restrict his or her activity or to keep the child at home after the first few days.
Normal or expected risks of tonsillectomy include some bleeding after surgery. This is common, especially when the healed scab over the cut area falls off.
Less common or rare risks include:
- More serious bleeding.
- Anesthetic complications.
- Death after surgery (very rare).
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