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.)
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.
)
each year in the United States. Approximately 70% of surgical candidates are under age 18.


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?

User Contributions:

wisanti
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Apr 27, 2006 @ 11:11 am
I would like to ask about the different between intracapsular tonsillectomy and ekstratonsillectomy, could you give me more information about both tehnique. Also it that any advantage to restore the tonsilar capsule?
Dr.kamran
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Feb 19, 2007 @ 3:03 am
sir,my question is how to manage a case of bleeding tonsil after tonsillectomy regarding anaesthesia and ent surgeon,please send me answer on my address
kathy
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Jul 29, 2007 @ 8:20 pm
Does this procedure effect your voice?My 15 year old son is concerned with this could you please email me back and let me know.
Sophia
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Jan 9, 2008 @ 12:12 pm
Hi,

is there any risk or compications for adults (61 years old), to have tonsillectomy?

if so, what are they?
Joan Murphy
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Sep 21, 2008 @ 12:12 pm
before the operation do you need to shave youself or does it matter??
kc
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Feb 27, 2009 @ 3:15 pm
Hello I have heard of glossopharyngeal neuralgia caused by a tonsillectomy
Can this be caused easily by a tonsillectomy or is it a rare occurence and why it is so rare?
carmen
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Mar 26, 2009 @ 12:12 pm
My husband has alot of the symptoms(enlarge tonsils, sore throats, not sleeping at night,etc). He is a heart patient with a pacemaker defibrillator and his age is 47. I am concern because he is a heart patient. He has already gotten clearance from his heart doctor. Do you often know if heart patients have this procedure? What advice can you give?

thank you
AMY
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Dec 17, 2009 @ 9:09 am
my question is, is there any alternative way to treat enlarged tonsils
My 4 yrs son is suffering every night, he hardly swollow, he is a mouth breather, he snores, he can
t express what hurts, but I i can understand that it hurts?
I'm afraid to do the operation, Is there any other way??
Kindly please reply on my email. thanks
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Feb 13, 2010 @ 9:09 am
IN adult surgeries does the voice get altered after the surgery? My voice is that of a mentally challanged person now. And I want to know if this is normal?
leah
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Apr 13, 2010 @ 5:05 am
Hi, does this procedure effect your voice? Also is it ok for a 19 year old to go clubbing 3 weeks after operation? Please email back with an answer.
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May 5, 2010 @ 9:09 am
My son is almost one. His pediatric things that it would be best for the ENT to take his tonsils and andoids out when he has tubes placed in his ears. We have a appointment with the ENT on the 19 for a evaluation, but I just want to learn more about what to expect. Im really worried. My 5 yr old daughter had hers out in JAn, and it was no fun for any of us, but because my son is so young, I dont know if things are going to be similar or completely different. Will he need to stay in the hospital? Hes got asthma, will that effect the surgery or recovery? He had surgery when he was 5 months from a lap in his throat that would close.

He nurses still, but Im worried if he wont drink after.
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Jun 16, 2010 @ 12:00 am
My daughter is 6 yrs old. she had her tonsils taken out today. can we give cough meds along with her pain meds to help with the cough?
Angelica
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Aug 14, 2010 @ 8:08 am
Hi my name is angelica. I am 12 ears old and i got my tonsil taken out on thursday august 5 2010
and I was wondering if they bleed on the 2 week when you got down with the surgry.
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Aug 17, 2010 @ 5:05 am
My daughter is 21 months old, and is scheduled to have a adenotonsillecomy. Is there any side effects I should know of if this procedure is done at such a young age?

Regards

Cindy
Jill
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Nov 26, 2010 @ 8:20 pm
I am a 40 year old female 4 days post op. The worst part of my surgery has been my body feeling like I've been ran over by a truck. My throat has been a little sore, but nothing worse than expected. My jaw and eyes hurt towards evening and my legs, arms, neck and back feel like I've been in a fight. Is there anything that can be done about the soreness??
ann
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Jan 13, 2011 @ 9:09 am
This is my 8th day after a tonsillectomy, I'm still having severe headach, throat, neck and ears pain, is that normal.my tongue and the roof of my mouth feels swollen. Is it the meds that make me so dizzy?
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Jan 20, 2011 @ 11:11 am
Explain why a tonsillectomy in a child is less likely to involve complications than same procedure for an adult.
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Feb 19, 2011 @ 6:06 am
Hi, my husband is about to have a tonsillectomy in 2 days, he is overly worried and is concerned about leaving his three children behind. Is there any recorded deaths during procedure or is all recorded deaths post op? He also has asthma and has a hard time breathing lately and takes his ventalin when needed. Will taking ventalin post op affect the mouth/throat? He is also waiting for some teeth to be removed, how long after surgery do you recommend for him to wait?

Thankyou, I will keep an eye on my email for a reply
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Mar 30, 2011 @ 12:12 pm
Iam an online student and my instructor gave us an assignment about tonsillectomy, I was just wondering why is it in a child less likely to involve complications than the same in an adult ?
gemma b. carino
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Apr 8, 2011 @ 3:03 am
my 4yr old child undergo tonsillectomy 10 days ago, and she is suffering from earache. Is it natural after the surgery? How long will it last to come back to her normal condition?
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May 2, 2011 @ 9:09 am
is the tonsillitis lead to prolongation of pt and aptt and what is the causes of this prolongation.
please send answer to..amna-only@hotmail.com
from sudan>>>with thanks
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May 26, 2011 @ 4:16 pm
Hello
my 4 and 1/2 year old daughter has got the tonsillitis. during the last three months she suffered twice the infection and the doctors prescribed Zinnet and Augmentin antibiotic. I am afraid what is next. I do not want to go for surgery. is there any other way or any homeopathy or ayurvedic treatment available? Please do reply.
thanks
Janet
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Jun 9, 2011 @ 11:11 am
I knew of a 21 year old individual whose artery was cut during the procedure which produced severe bleeding after the scab fell off. He almost bled to death---how common is this occurance?
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Jun 17, 2011 @ 6:18 pm
My son just had T&A done I was wondering if it
Is normal for tongue to be be whiteish after
Even brushing
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Aug 15, 2011 @ 7:07 am
i am 2o years old and have been getting tonsilitis almot 6 times a year. i finally had them removed the 10th August 2011 and i am in so much pain now, there is no bleeding but i have such chronic ear ache it feels like my ear drums burst.
is this normal, becuase it is worse then the pain in my throat.
Tammi Carter
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Sep 22, 2011 @ 1:13 pm
What are different complications or risk between a Pediatric Tonsillectomy vs. Adult Tonsillectomy ?. Are the risk greater for Adults and what types of complications can result from the surgery? I need this answered ASAP please.
SANDRA
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Sep 27, 2011 @ 6:18 pm
hey my son is 2 and 3moths of age, he had tonsillectomy , adonalds and gromitt done on the 16th of sept 2011 , 11th day today and he is not speaking any more he has a nasal sounding, i have tryed verything i can and he has resued to say a word i am very worried about this > should i contact the hospital were he had this done pls advise me becuse am going out of my head.
Rahul
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Oct 6, 2011 @ 1:01 am
sir, i am 27 and was operated by qualified doctor 7 years back, for removal of tonsils. Since last seven years i didn't face any problem but since last few days i am facing a lot of problems. I am not able to swallow my food, have sleepless nightx due to sore ache. Please suggest.
Luna
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Nov 25, 2011 @ 5:17 pm
Hi,
My 19months old daughter had tonsiilectomy on the 18th of November 2011. After the operation she stopped eating and drinking. She was kept in the hospital for 4 days. Everyday she is drinking only 250/300ml water, juice. She used to be bottle fed and used to drink 500ml milk everyday but after the operation she is not touching the bottle at all.Though she is still active. I am giving her some pain relieves madicine and atibiotics which is given by doctor. Do you think She will be alright? or I've to take her to the hospital again. Please suggest.
Gwen
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Dec 23, 2011 @ 10:22 pm
Please Explain Why A Tonsillectomy In A Child Is Lee Likely To Ivolve Complications Than The Same Procedure For An Adult.
Joyce
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Dec 27, 2011 @ 5:17 pm
Hi,
I'm a 38 year old that had my tonsils taken out Oct 20th 2011. And I still have a problem tasting foods and liquids they all have a bitter taste or after taste to it.And my muscles in my throat seem to feel tight when I swallow yet.I had told my doctor for my check-up app and was told to take prilosec otc for 14 days did that and no difference. I thought it was all part of a healing process for my age but, I am getting fustrated with not being able to taste my foods a drinks. Please help
auntie
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Dec 31, 2011 @ 11:23 pm
My Nephew had his tonsils taken out a week ago.. My sister is planning on going to the snow for new years... I told her it was to early to take him out.. I told her to be careful because he could get an infection.. Am I over reacting?
kyrian
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Jan 28, 2012 @ 3:15 pm
hi
is it possable for tonsilectomy to'be done twice within 12 months? I was operated on for tonsilitis 5 months ago but now i am still feel the same symtoms i was feelling before the operation. Please if this is normal or if the tonsilitis is back again.
Rick
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Mar 7, 2012 @ 8:20 pm
I would like to ask the same question Janice asked; #17. could you explain to me why a tonsillectomy in a child is less likely to involve complications than the same procedure for an adult.
joseph
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Mar 8, 2012 @ 9:21 pm
please advice me!

i do have tonsilitis , im taking eretromycin 1/day and cloaxacillin 3/day but it seems recovery
is too slow, but my very concern is that, in a few week is my flight going to Qatar and i need to recover asap for my medical unless i am sending back. what will i do?
jessica
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May 11, 2012 @ 7:07 am
for joseph, i suggest that you take co-amoxiclav, i just don't know the dosage for you. i also do have tonsilitis a week ago, i started taking that medicine before at 625mg 2x a day. i was cured after 3 days but of course i still need to continue taking that medicine for 4 more days. right now i was advised to do tonsillectomy because my tonsils were getting worst, my dosage for the co-amoxiclav was already at 1g (or 1000mg) 2x a day still and the doctor doesn't advise me to take antibiotics anymore because its also not good to take medicine if its too much. i swear that the medicine that i'm saying would really help you out. try to ask your doctor about it. :)

~~i just want to ask, what are the do's and dont's after tonsillectomy. i didn't ask my doctor about it yet. just so scared about my upcoming operation. :) hope to hear feedback from this blog.:)
jeff horton
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Jun 19, 2012 @ 5:17 pm
Would like to know the difference in complications from child vs adult. Which is the worst, and why?
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Nov 5, 2012 @ 7:07 am
I am having an enlarged tonsils for one and half year, although now the pain has decreased but still it causes a lot of irritation. Doctor advised me for a surgery but I have my apprehensions about the surgery as it would pain a lot after the surgery besides i wont be able to eat hard foods for a period of 10-15 days. So what shall i don in this case
desiree aquino
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Apr 23, 2013 @ 8:20 pm
i'm about to have tonsillectomy in the end of this month and this blog makes me really scare.

is there any postive cmments regarding the procedure? any good experience?
Sabir
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Oct 7, 2013 @ 10:22 pm
hi, I have a tonsils problem.. I had acute fullotis that white dots on tonsils, but that is now recovered with anti biotics but still I feel my tonsils are hard and have a little pain in it. and along with it I feel fever and body pain, this is happening for last 2 months. ENT specialist adviced to cut off the Tonsils.

So all I need to know is if I cut my tonsils off. would I face any complications in near future??

Please advice.
Joanna
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Apr 11, 2014 @ 1:01 am
Hi, my son is only 1 and half yr old and he have difficulty of breathing during asleep because of his kissing tonsils, could it be possible to get smaller as he age? Or could it be possible to be removed at his age.?
tinna
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Jul 30, 2014 @ 11:11 am
I am a status post tonsillectomy patient.i was operated last july 25,i didn't feel any unusual signs and symptoms for 4days.but now,i am experiencing and suffering from ear pain and difficulty in speaking.what would i take?is it normal?and how about my voice?

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