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Tonsillitis And Tonsillectomy

Surgery for Tonsils. Tonsillectomy

Last modified: 
16/08/2012 - 11:39

Contributing Author: Guy Slowik FRCS

tonsillectomy is the surgical removal of the tonsils.

These are the criteria doctors use to decide whether the tonsils should be removed:

  • Tonsillectomy is definitely required when the tonsils are so large they obstruct breathing, swallowing or both. Before surgery, however, antibiotics should be tried, perhaps for as long as a month, to see whether your child's condition can be improved. Children with obstructing tonsils commonly sleep restlessly and may have periods during sleep when breathing stops for seconds at a time because of blockage of the airway. In some children, voice quality is so sufficiently altered by large tonsils ("hot potato" voice) that tonsillectomy is justified.
  • Tonsillectomy also is justified if your child is having repeated bouts of infection, to the point that everyday activities are substantially disrupted despite adequate antibiotic treatment.
  • Currently, tonsillectomy is believed to provide enough benefit to justify doing the surgery in children who have developed at least 7 "significant" episodes of throat infection in 1 year, or at least 5 in each of 2 years, or at least 3 in each of 3 years. "Significant" episodes are defined as those associated with one or more of the following:
    • Fever of 101 degrees F (38.3 degrees C) or higher.
    • Enlarged or tender lymph nodes in the neck.
    • A pus-like coating, known as exudate, covering the tonsils or the surrounding throat area.
    • Evidence that the infection is streptococcal in origin.
  • Peritonsillar abscess, also called quinsy, is an abscess around the tonsil, usually following a tonsillitis attack. The infection causes a painful throat, high temperature, headache, impaired speech, drooling, and swollen tender lymph glands in the neck. Not all experts believe that surgery is called for following a single case of peritonsillar abscess. Often, no further difficulty develops once the condition is successfully treated. However, following a second peritonsillar abscess, tonsillectomy is definitely indicated.

Not every child who meets these minimum criteria should have a tonsillectomy. Many children will improve spontaneously without surgery sooner or later. The decision for or against surgery should take into account many factors including cost, convenience, and the preferences of the parents and the child.

Recent evidence indicates that children who are less severely affected by tonsillitis are usually not sufficiently helped by tonsillectomy to justify doing the surgery. Accordingly, it would seem prudent in most cases to limit tonsillectomy to children who meet the stringent criteria just specified.

 

 

Need To Know:

WHEN IS TONSIL OR ADENOID SURGERY DANGEROUS?

Certain circumstances increase the risk that your child will experience complications during or after tonsillectomy. In such cases, it is better to avoid or at least delay surgery.

  • Surgery should not be carried out while the tonsils are actively infected or immediately afterward, because of the increased risk of bleeding.
  • If your child or someone in your family has a history of unusual bleeding or bruising, this is always a danger signal, because certain rare bleeding disorders may not be detectable with the types of tests that are done routinely.
  • Anemia also constitutes a reason for avoiding or delaying surgery.
  • Any condition that results in abnormal function of the roof of the mouth, (ie. palate), particularly cleft palate, constitutes a reason to avoid adenoidectomy unless compellingly necessary.

 

PREPARING YOUR CHILD FOR SURGERY:

You should explain in advance to your child what is about to happen, in as much detail as possible, simply and reassuringly.

Children who are scheduled for a tonsillectomy should be warned that they will experience a sore throat and that swallowing will be painful after the operation, but that parents and medical personnel will do everything possible to minimize it.

  • Many hospitals have coloring books and storybooks for children. These will help your child cope with the experience.
  • It is important to not give your child anything to eat or drink-not even water- for at least 8 hours before surgery. If surgery will be done in the morning, this generally means no food or beverages starting at midnight the night before.

Need To Know:

Tell your surgeon:

  • about any medications your child is taking and ask whether these should be temporarily stopped.
  • about any family history of anemia, clotting disorders, unusual bleeding, or bruising.

Need To Know:

Once your child is admitted to the hospital:

The child should have unlimited access to parents or other adults who are important to them. You should be with your child immediately before the trip to the operating room and at the bedside when he or she returns from surgery. Direct explanation and language that the child can understand is always the best policy.

 
 

 

 

 

THE PROCEDURE (tonsil removal; tonsillectomy)

In children, removal of either the tonsils or the adenoids requires a general anesthetic. In adults the tonsils often may be removed under local anesthesia.

  • The mouth is held open to expose the tonsils.
  • The tonsils are grasped with clamps and pulled toward the middle of the mouth. The tonsils are removed by gentle dissection of the surrounding tissues.
  • Bleeding is controlled either by pressure, sutures, clamps or ties, or with use of electrocautery, a procedure in which heat is applied to blood vessels to seal the ends that have been cut during surgery.
  • If the adenoids are to be removed, this is done using a specially designed instrument that passes through the mouth and into the upper part of the throat behind the nose, where the adenoids lie.

 

How Long Is The Stay In Hospital

Increasingly, tonsil and adenoid surgery is being performed on an outpatient basis early in the day, with the patient leaving the hospital that evening. However, some surgeons prefer to have the patient remain in the hospital overnight, so they can deal with any immediate complications more promptly and effectively.

 

Possible Complications of Tonsillectomy

  • As with any operation, there is always a small risk associated with general anesthesia.
  • Bleeding from the operation site may occur immediately after surgery, or several days later when the crust that has formed at the operative site drops away. Bleeding usually can be readily controlled, but occasionally requires a return to the operating room for more intensive treatment. Rarely, blood transfusion may be required.
  • The risk of bleeding can be minimized by avoiding surgery during and immediately following episodes of infection and by avoiding the use of aspirin to control pain following surgery, as aspirin can reduce the blood's ability to clot.
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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.