Tonsillectomy

Introduction

Tonsillectomy is the name given to the surgery performed to remove the tonsils located at the back of the throat.

If your tonsils are diseased due to recurrent inflammation and infection, you may need to have them surgically removed. An individual has two tonsils, each on either side of the throat. Tonsils are oval-shaped tissue pads.

They contribute to the body’s immune system through the work of the white blood cells. The large quantities of white blood cells in your tonsils assist with killing germs. Tonsils further hinder germs from gaining access into your body via the nose or mouth.

Causes and symptoms of tonsillitis

Bacterial or viral infection of your tonsillitis will cause an inflammation. When this happens, you are likely to have problems with swallowing food. You may also develop a fever. Also, tonsillitis can lead to the swelling of glands around the neck. You are likely to develop a scratchy voice. Your tonsils may also develop white or yellow spots.

Younger children might experience vomiting or stomach ache. This may escalate into other more serious problems like sleep apnea and heavy snoring. A tonsillectomy will help correct this problem by surgically removing the diseased tonsils.

Types of tonsillitis

Tonsillitis is categorized based on the causative agent and their duration of occurrence.

Under the causative agent category, we have two types of tonsillitis:

• Viral tonsilitis: A viral attacks accounts for the vast majority of tonsilitis, up to 70 percent.
• Bacterial tonsillitis: Bacterial infection also accounts for the other cases of tonsillitis. In particular, the Streptococcus bacteria is a causative agent for tonsillitis.

Tonsillitis can also be categorized as acute, chronic or recurrent, depending on the duration of the symptoms.

• Acute tonsillitis: In acute tonsillitis, the symptoms are short-lived, often lasting between 3 and 4 days.
• Chronic tonsillitis: Here, the patient will manifest with an enduring sore throat. They are also likely to emit a foul-smelling breath. Chronic tonsillitis may also present with additional symptoms to those evident in acute tonsillitis. They include for example, the lymph nodes in your neck region could become tender. You are also likely to have a chronic sore throat.
• Recurrent tonsillitis: These are the persistent bouts of acute tonsillitis. For instance, when a patient presents with the symptoms of acute tonsillitis several times a year, this is categorized as a form of recurrent tonsillitis.

Treatment options for tonsillitis

The treatment for tonsillitis is partly determined by the causative agent. There is a host of treatment options that you can rely on to cure your tonsils.

Home remedies

Some of the home remedies that have proven useful in treating tonsillitis include:

• Ensuring you get enough rest
• Drink lots of fluids, both cold and warm, to ease the throat pain
• A humidifier in your room can also be useful
• Put a pinch of salt in warm water and gargle in your month
• You can also ease the pain in your throat by sucking on lozenges
• Over-the-counter medication such as ibuprofen can also help to relieve the pain
• Adding raw honey to warm beverages is also helpful as honey contains antibacterial properties

Homeopathy

Some of the most widely utilized homeopathy medication for treating tonsillitis are:

• Mercurius solubis: This medicine is effective in treating tonsillitis that causes congestion and pain in the throat. Individuals who secrete excessive saliva due to tonsillitis will also benefit from this medication.
• Hepar sulphur: This medication is best when tonsillitis causes chilliness and mild fever
• Belladonna: Belladonna has excellent anti-inflammatory properties and helps to release the inflammation and pain caused by tonsillitis. It is also useful when tonsillitis cause headache, pain in the throat, and general fatigue

Allopathy

In treating tonsillitis, your doctor will consider the primary causative agent and the type of tonsillitis. For bacterial and viral tonsillitis, there are various over-the-counter medication that can be of help, such as ibuprofen and acetaminophen. If the tonsillitis is due to group A streptococcus, your doctor will prescribe penicillin. You will be advised to take the medication orally for 10 days. In case of recurrent tonsillitis, GABHS pharyngitis may be prescribed. If the infection has recurred following a dose of oral penicillin, your doctor will most likely prescribe IM benzathine penicillin G. An antibiotic prescription taken for the duration between 3-6 weeks may be effective in avoiding recurrent tonsillitis.  

Procedures/methods available under surgery

Your doctor might recommend a tonsillectomy especially if you have recurring episodes of tonsillitis.

There are various forms of tonsillectomy that include:

Cold scalpel surgery

This is the oldest surgical procedure to remove tonsils. The surgeon uses a scalpel to remove the tonsils completely. Doctors use general anesthesia for this procedure. There is minimal bleeding involved post-surgery.

Ultrasonic dissection

Under this technique, the surgeon uses a special scalpel vibrating at a very high frequency. This vibration generates energy from the special scalpel. The energy generated is in turn transferred to the tissues resulting in the incision and coagulation of the affected tissues. The surgeon achieves a high level of precision using this special scalpel. Ultrasonic dissection takes place under general anesthesia. The technique is beneficial with minimal post-operative bleeding.

Bipolar radio frequency ablation

This technique involves the use of radio frequency waves in the form of a charged saline layer. The ionized layer aids in breaking tissue bonds while leaving the surrounding tissues intact. The technique is useful in treating enlarged tonsils as it aids in size reduction. Alternatively, bipolar radio frequency ablation helps with the complete removal of your tonsils. Patients benefit with quick recovery and lesser post-operative pain.

Laser tonsillectomy

Laser tonsillectomy is a pioneering procedure that utilizes laser to minimize the size of your tonsils with no surgery involved. The state-of-the-art laser procedure allows patients to avoid the pain associated with conventional surgery. Moreover, the procedure is convenient and can be comfortably administered in the surgeon’s office. Laser tonsillectomy vaporizes the outer surface of your tonsils. This aids in size reduction of the tonsils and helps avoid their removal.

The procedures also help to eliminate infections. Surgeons administer local anesthesia to perform laser tonsillectomy and it takes about 60 minutes. This allows you to resume your everyday activities within a day or two of surgery. Laser tonsillectomy has a very high success rate in comparison with the other surgical procedures. There is no bleeding involved and the risk of infection is almost zero.

When to go for surgery

You might want to consider a tonsillectomy under the following conditions:

• There has been a recurring episode of tonsillitis
• Tonsillitis leads to other problems like sleep apnea
• If the infection leads to the formation of an abscess around the tonsils
• In case you develop breathing problems due to inflamed tonsils
• If the inflamed tonsils causes frequent and loud snoring
• In case of bleeding tonsils
• If the diagnostic tests show that your tonsils have turned cancerous

Surgery options for tonsillitis  

In choosing to have a tonsillectomy, you may be interested in the cost involved, the convenience of the healthcare facility, availability of medical expertise and whether your insurance will cover for this procedure. The procedure can take place in your doctor’s office/small clinic or at a large hospital.

Doctor’s office/small clinics

If you decide to have the procedure at your doctor’s office, you will receive personalized attention and care by your doctor. The familiarity of this environment helps to ease the tension during the procedure. However, you are unlikely to benefit from a recuperating facility at your doctor’s office should this become necessary. Also, some of the small clinics may lack in the facilities needed to conduct specific procedures.

Hospitals

Private and public hospitals also offer tonsillectomy procedures. The advantage of having a tonsillectomy at a large hospital is that the surgeon in these facilities have accumulated years of experience between them. They are therefore highly competent and efficient at what they do. Moreover, surgeons with lots of experience are better able to handle any complications effectively. However, you will probably miss the personalized attention offered at your doctor’s office. Another disadvantage of having a tonsillectomy at a large hospital is that you are likely to encounter delays in service delivery due to the bureaucratic systems that characterize these facilities.  

Cost of tonsillectomy in different setups

The cost of a tonsillectomy varies depending on several factors:

• When to go for surgery- fees differ from one healthcare facility to another depending on its location and whether it is a private practice or public hospital
• The city where the procedure is taking place: some cities in India charge almost twice what others do for the same procedure
• The duration of stay at the healthcare facility: If you need time to recuperate at the healthcare facility, you may end up paying more depending on the number of days admitted
• Surgeon’s consultation fees: This is likely to vary from one practice to another, depending on the surgeon’s level of experience and demand for their services

The cost of a tonsillectomy in India varies based on location. For example, surgery centers, clinics and hospitals in the city center or metropolitan cities charge an exorbitant price in comparison with healthcare center and clinics in smaller remote towns. For this reason, the cost of a tonsillectomy in India range from as low as Rs. 15,000 to as high as Rs. 85,000. In Chennai and Bengaluru, the maximum cost for a tonsillectomy is Rs. 1,00,000 and 1,20,000, in that order. Noida and Pune have the lowest maximum price, at Rs. 45,000 and Rs. 50,000, respectively.

Post-op care and diet

The post-op care begins as soon as you are wheeled away from the operating room. If you have undergone open surgery or there has been complications with the procedure, you may have to spend more time at the recuperating ward until you are stable enough to get discharged. This allows the healthcare team monitor your progress closely. If on the other hand the procedure was very successful and you underwent laser surgery, you may be allowed to go home after a few hours at the healthcare facility.

You are likely to experience some discomfort while sleeping, eating or drinking. Such discomfort is normal and may range from severe to mild. If you are in pain after surgery, your doctor can prescribe medication to relieve such pain. Other activities that will help to ease the pain include:

• Installing a humidifier in your room
• Using ice on your neck
• Gargling cold water

Consume a lot of fluids post-surgery to minimize the risk of dehydration. Some of the excellent sources of liquid to help avoid dehydration includes water, ice cream and apple juice.

Important signs of dehydration

• Dark urine
• A decrease in the frequency of urination
• Lethargy
• Dryness of skin
• Elevated body temperature

You are likely to mouth breathe or snore while asleep. This is quite normal following surgery and is due to the swelling.

Expect a resumption to normal breathing after 10-14 days post-surgery.

Avoid acidic or spicy foods as they may cause pain and bleeding. Go for soft foods as you can chew them easily.

It is advisable to get as much rest as possible after surgery. This will help with your quick recovery. Do not engage in any strenuous physical activities such as riding a bike or lifting heavy objects. Always be vigilant just in case you develop any complications post-surgery. Some of the warning signs to look for include:

• A high fever of 102 degrees Fahrenheit and above
• Any signs of bright red blood in your nose or saliva
• Feeling of light headedness or a headache which may be a sign of dehydration

Best option

You should always consider a healthcare provider who is willing to walk with you as you undergo a tonsillectomy. At goficure, we link you to some of the most qualified surgeons in performing tonsillectomy. We assist you to get consultation services with these surgeons at a discount.  We also help patients with post-operative care and recovery.

References