Tonsillectomy

Definition

Tonsillectomy is a surgical procedure to remove the tonsils. The tonsils are part of the lymphatic system, which is responsible for fighting infection.

Purpose

Tonsils are removed when a person, most often a child, has any of the following conditions:

• obstruction
• sleep apnea (a condition in which an individual snores loudly and stops breathing temporarily at intervals during sleep)
• inability to swallow properly because of enlarged tonsils
• a breathy voice or other speech abnormality due to enlarged tonsils
• recurrent or persistent abscesses or throat infections

Physicians are not in complete agreement on the number of sore throats that necessitate a tonsillectomy. Most would agree that four cases of strep throat in any one year; six or more episodes of tonsillitis in one year; or five or more episodes of tonsillitis per year for two years indicate that the tonsils should be removed.

Demographics

A tonsillectomy is one of the most common surgical procedures among children. It is uncommon among adults. More than 400,000 tonsillectomies are performed

Tonsils are removed through the mouth (A). The surgeon uses a scissors to cut away the tonsils, and a forceps to pull them away (B). (

Illustration by GGS Inc.

)

Description

A tonsillectomy is usually performed under general anesthesia, although adults may occasionally receive a local anesthetic. The surgeon depresses the tongue in order to see the throat, and removes the tonsils with an instrument resembling a scoop.

Alternate methods for removing tonsils are being investigated, including lasers and other electronic devices.

Diagnosis/Preparation

Tonsillectomy procedures are not performed as frequently today as they once were. One reason for a more conservative approach is the risk involved when a person is put under general anesthesia.

In some cases, a tonsillectomy may need to be modified or postponed:

• Bleeding disorders must be adequately controlled prior to surgery.
• Acute tonsillitis should be successfully treated prior to surgery. Treatment may postpone the surgery three to four weeks.

Aftercare

Persons are turned on their side after the operation to prevent the possibility of blood being drawn into the lungs (aspirated). Vital signs are monitored. Patients can drink water and other non-irritating liquids when they are fully awake.

Adults are usually warned to expect a very sore throat and some bleeding after the operation. They are given antibiotics to prevent infection, and some receive pain-relieving medications. For at least the first 24 hours, individuals are instructed to drink fluids and eat soft, pureed foods.

People are usually sent home the day of surgery. They are given instructions to call their surgeon if there is bleeding or earache, or fever that lasts longer than three days. They are told to expect a white scab to form in the throat between five and 10 days after surgery.

Risks

There is a chance that children with previously normal speech will develop a nasal-sounding voice. In addition, children younger than five years may be emotionally upset by the hospital experience. There are risks associated with any surgical procedure, including post-operative infection and bleeding.

Normal results

Normal results include the correction of the condition for which the surgery was performed.

Morbidity and mortality rates

Morbidity other than minor post-surgical infection is uncommon. About one in every 15,000 tonsillectomies ends in death, either from the anesthesia or bleeding five to seven days after the operation.

Alternatives

There are no alternatives to surgical removal of the tonsils. Drug therapy may be used for recurrent infections involving the tonsils.

See also Adenoidectomy .

Resources

BOOKS

Bland, K.I., W.G. Cioffi, M.G. Sarr. Practice of General Surgery. Philadelphia: Saunders, 2001.

Braunwald, E., D.L. Longo, J.L. Jameson. Harrison's Principles of Internal Medicine, 15th ed. New York: McGraw-Hill, 2001.

Goldman, L. & J.C. Bennett. Cecil Textbook of Medicine, 21st ed. Philadelphia: Saunders, 1999.

Schwartz, S.I., J.E. Fischer, F.C. Spencer, G.T. Shires, J.M. Daly. Principles of Surgery, 7th ed. New York: McGraw Hill, 1998.

Townsend, C., K.L. Mattox, R.D. Beauchamp, B.M. Evers, D.C. Sabiston. Sabiston's Review of Surgery, 3rd ed. Philadelphia: Saunders, 2001.

PERIODICALS

Remacle, M., J. Keghian, G. Lawson, J. Jamart. "Carbon-dioxide Laser-assisted Tonsil Ablation for Adults with Chronic Tonsillitis: A 6-month Follow-up Study." European Archives of Otorhinolaryngology 260, no.4 (2003): 243-6.

Silveira, H., J.S. Soares, H.A. Lima. "Tonsillectomy: Cold Dissection Versus Bipolar Electrodissection." International Journal of Pediatric Otorhinolaryngology 67, no.4 (2003): 345-51.

Werle, A.H., P.J. Nicklaus, D.J. Kirse, D.E. Bruegger. "A Retrospective Study of Tonsillectomy in the Under 2-Year-Old Child: Indications, Perioperative Management, and Complications." International Journal of Pediatric Otorhinolaryngology 67, no.5 (2003): 453-60.

Yaremchuk, K. "Tonsillectomy by Plasma-Mediated Ablation." Archives of Otolaryngology Head and Neck Surgery 129, no.4 (2003): 498-9.

ORGANIZATIONS

American College of Surgeons. 633 North St. Clair Street, Chicago, IL 60611-32311. (312) 202-5000. Fax: (312) 202-5001. E-mail: http://postmaster@facs.org. http://www.facs.org .

American Academy of Otolaryngology-Head and Neck Surgery. One Prince St., Alexandria, VA 22314-3357. (703) 836-4444. http://www.entnet.org/index2.cfm .

American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329. (800) 227-2345. http://www.cancer.org .

American Osteopathic College of Otolaryngology-Head and Neck Surgery. 405 W. Grand Avenue, Dayton, OH 45405. (937) 222-8820 or (800) 455-9404, fax (937) 222-8840. Email: http://info@aocoohns.org.

OTHER

Columbia University School of Medicine. [cited May 5, 2003] http://www.entcolumbia.org/t-aproc.htm .

Eastern Virginia Medical School. [cited May 5, 2003] http://www.evmsent.org/ped_ops/tonsillectomy.html .

National Library of Medicine. [cited May 5, 2003] <http://www.nlm.nih.gov/medlineplus/ency/article/003013.htm ; .

University of California-San Diego. [cited May 5, 2003] <http://www-surgery.ucsd.edu/ent/PatientInfo/instructions_tonsill ctomy.html> .

University of Florida. [cited May 5, 2003] <http://www.ent.health.ufl.edu/patient%20info/T&A.htm� E; .

L. Fleming Fallon, Jr., MD, Dr.PH.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

A tonsillectomy is performed in an outpatient facility associated with a hospital by a general surgeon or otolaryngologist (physician who specializes in treating disorders of the ear, nose, and throat).

QUESTIONS TO ASK THE DOCTOR

• What will be the resulting functional status of the body after the operation?
• Is the surgeon board certified in head and neck surgery?
• How many tonsillectomy procedures has the surgeon performed?
• What is the surgeon's complication rate?
• Has the surgeon operated on children?