Tonsillectomy: When do you actually need to get your tonsil glands removed?

Strep throat pain

Last Updated October 11th, 2019

What are tonsils and what do they do?

The tonsils are a pair of glands located at the back of the throat. They are a part of the lymphatic system, which helps the body fight with infections. They usually swell during infections. The tonsils are mostly composed of lymphoid tissues, which are made up of lymphocytes. Lymphocytes are a type of white blood cell that is involved in the production of antibodies, which help fight off disease and infection.

How do you develop tonsillitis and what are its symptoms?

Tonsilitis examinationTonsils produce and store a certain type of white blood cells and it is believed they act as the first line of defense against pathogens that enter through the mouth. This makes them very susceptible to infection and inflammation. Tonsillitis is usually caused by viruses, but sometimes it may be due to a bacterial infection as well. Children are more prone to tonsillitis as their tonsils are more active and they have lesser immunity, due to them being exposed to fewer pathogens compared to an adult.

Some of the most common symptoms of tonsillitis are:

  • Redding or swelling of the tonsils
  • White or yellow patches on tonsils
  • Discomfort while swallowing
  • Fever
  • Enlarged tonsils
  • Bad breath
  • Sore throat
  • Hoarse voice
  • Pain while coughing

Consult the doctor immediately if you have

  • Bleeding: Tonsillitis usually doesn’t cause bleeding. However, in rare cases, it may happen as certain pathogens cause sores and ulcers. As the tonsils are situated near many major blood vessels, bleeding may become life-threatening. Sometimes immediate surgery may be required to stop the bleeding.
  • High Fever: You should immediately go to the doctor if you have a fever above 101F.
  • Breathing problems: People with tonsillitis snore and this is not very uncommon. However, if you have difficulty breathing, you should immediately contact the doctor.
  • Dehydration: Tonsillitis can also sometimes lead to dehydration. If you have reduced thirst urination, weakness, headache or light-headedness, you should contact your doctor.

Diagnosis

Throat cancer diagnosisTonsillitis is usually diagnosed by a general exam. The doctor will examine your throat and look for swollen tonsils, which usually have white or yellow spots. Apart from that, the doctors may also look for signs of enlarged lymph glands of the throat.

A swab of the tonsils may also be taken to determine whether the infection is viral or bacterial. A complete blood cell count may also be taken to determine the extent of the infection. The doctor will then decide the best course of treatment and whether you require surgery or not based on the results of the tests.

What is tonsillectomy and why is it done?

Tonsillectomy is a procedure which involves the removal of the tonsils. Earlier, it was a common practice to remove the tonsils if they were infected. However, nowadays, the tonsils are only removed if:

  • The tonsillitis is severe or recurrent: The doctors will recommend surgery if your tonsillitis is severe or recurring. Usually, tonsillitis caused by strep throat is very severe.
  • The tonsils are obstructing a person’s airways: This happens when the tonsils are enlarged.
  • They are bleeding: Bleeding during is usually rare. However, if you do experience bleeding, the doctors will recommend immediate surgery. This is because bleeding can be life-threatening due to the tonsils’ proximity to many major blood vessels.
  • They have developed a rare disease: The tonsils can sometimes be affected by a rare disease like Tangier disease (whose classic symptoms include enlarged orange or yellow colored tonsils). In such cases, the tonsils have to be removed.
  • Cancer of the tonsils: Tonsil cancer is usually rare and develops in people who smoke, drink alcohol or have the human papillomavirus. The tonsils are usually removed if a person develops cancer.

Tonsillectomy Facts

Sore throat childDespite the rate of tonsillectomies coming down in current times, tonsillectomy is still a common procedure, especially in children and teenagers.

  • In adults, tonsillectomy is usually done to treat obstructive sleep problems
  • Although it’s rare, one can still get a strep throat even after undergoing a tonsillectomy.
  • It is believed that the tonsils once helped fight against patristic diseases caused by worms
  • Tonsillectomy is older than you think. The procedure has been documented in ancient Ayurvedic texts
  • The first reported tonsillectomy was done by Roman encyclopaedist Cornélio Celsus in 1st century BCE.

How is tonsillectomy done?

These are the different methods of performing a tonsillectomy

Steel dissection

Removal of the tonsils using a steel scalpel is the most common method of removing the tonsils. The patient is given general anesthesia and the tonsils are completely removed with a scalpel. During this procedure, there is minimal bleeding and the patient recovers within a day.

Electrocautery

In this procedure, heat (generated from electricity) is used to burn the tonsillar tissue and the blood loss is reduced due to cauterization. However, in most cases, the heat also affects the surrounding tissues and this results in more discomfort during the postoperative period. The patient may take more time to recover.

Harmonic scalpel

A harmonic scalpel is a surgical instrument that uses ultrasonic energy to vibrate its blades. This device cuts and cauterizes the tissue at the same time, leading to no blood loss. This procedure is considered superior to electrocautery as a harmonic scalpel can cut through thicker tissues and it produces less toxic surgical smoke.

Radiofrequency ablation

In this procedure, monopolar radiofrequency thermal ablation is used to transfer radiofrequency energy to the tonsil via probes. After the procedure, scarring occurs in the tonsil tissue which results in it shrinking over a course of several weeks. This procedure results in minimal discomfort and very less recovery time. However, this procedure is only recommended for enlarged tonsils.

Carbon dioxide laser treatment

In this procedure, an otolaryngologist uses a handheld Carbon dioxide laser to vaporize the tonsils. This procedure reduces the size of the tonsil and removes the area that is prone to recurring infections. This procedure is performed in 15-20 minutes under local anesthesia. This procedure causes very little post-operative pain and patients recover within a day.

Microdebrider

In this procedure, a microdebrider is used to perform the surgery. The microdebrider is a cylindrical instrument with a hollow tube that has motorized blades attached to its inner and outer portions. As the blades cut away tissue, the suction in the hollow tube collects all the removed debri. The microdebrider is used in performing a partial tonsillectomy, where only some tonsil tissue is removed. This procedure is also only recommended for enlarged tonsils.

Bipolar Radiofrequency Ablation

In this procedure, an ionized saline layer that disrupts molecular bonds without using heat is produced. The energy is then transferred to the tissue, which disintegrates due to a process called ionic dissociation.  This procedure, which is performed under general anesthesia, can be used to remove a part of or the whole tonsil. Therefore it is effective in treating both enlarged tonsils and tonsils with recurrent infections.

How to prepare for a tonsillectomy?

You can prepare for the surgery by following these steps:

  • Stop taking anti-inflammatory medicines: The doctor will tell you to stop all anti-inflammatory medicines (like aspirin, ibuprofen, and naproxen) two weeks before the surgery. This is because these drugs increase the risk of bleeding during and after surgery.
  • Don’t eat anything at least 12 hours before the surgery: This is done so that you don’t get nauseous from anesthesia.

Potential risks during a tonsillectomy

Strep throat painLike any other surgery, tonsillectomy is also not without risks. Some common side effects of this procedure include nausea and vomiting, throat pain, difficulty swallowing, low-grade fever, bad breath, earaches, and fatigue. However, this procedure also has some big risks that include:

Complications with Anesthesia

Tonsillectomies are done under general anesthesia and some people have an adverse reaction to this. Some of the complications are minor like nausea and vomiting, while others are life-threatening such as respiratory failure, malignant hyperthermia. If your family members have experienced complications during general anesthesia, you should immediately inform your anesthesiologist.

Bleeding after Surgery

There is a risk that you may bleed a lot during or after the surgery as the tonsils are located near some major blood vessels. Although bleeding after the procedure is rare, you should immediately contact the doctor if do bleed after surgery. Normally, post-operative bleeding is likely to occur within the first 24 hours or after 6-10 days.

Infections

The risk of developing an infection after tonsillectomy is usually rare. However, if it does happen, you should immediately call your doctor, who is likely to treat you with antibiotics. If you have an infection, you may develop the following symptoms

  • High Fever: Anything above 101 F is considered high fever. You should immediately contact the doctor as a high fever could indicate a serious infection.
  • Severe or persistent ear pain: Ear infection is a common complaint after a However, severe ear pain is a sign that you may have a more serious infection
  • Coughing and abnormal colored mucus: Symptoms of an upper respiratory infection could mean you’re tonsils are infected.

Things to keep in mind during recovery

People who undergo tonsillectomy experience some pain as they recover from the surgery. Apart from this you may also have a sore throat and feel pain in your jaws, ears or neck. There are certain steps you can take to speed up your recovery. These are

  • Rest: Try to get plenty of rest especially after the first few days of surgery. Resting can help you recover faster.
  • Keep yourself hydrated: As your throat will be sore, you can drink water by sipping or by eating ice pops
  • Watch what you eat: As you won’t be able to eat anything solid after the surgery, you can have applesauce, warm broth or clear soup in the first few days. After a while, you can consume soft foods like oatmeal, ice-cream, and pudding.
  • Taking your medicines correctly: Take medications exactly as prescribed. These medications (mostly for pain) will help you feel better during recovery.

 

 

 

 

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