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Tonsillectomy
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/tonsillectomy/MY00132
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Definition
Tonsillectomy (ton-sih-LEK-tuh-mee) is the surgical removal of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side.
A tonsillectomy was once a common procedure to treat infection and inflammation of the tonsils (tonsillitis). Today, a tonsillectomy is usually performed when tonsillitis occurs frequently or doesn't respond to other treatments.
A tonsillectomy may also be necessary to treat breathing and other problems related to enlarged tonsils and to treat rare diseases of the tonsils.
Recovery time for a tonsillectomy is usually at least a week.
Why it's done
A tonsillectomy is used to treat:
- Recurring, chronic or severe tonsillitis
- Complications of enlarged tonsils
- Other rare diseases of the tonsils
Tonsillitis
Tonsils produce certain types of disease-fighting white blood cells. Therefore, the tonsils are believed to act as the immune system's first line of defense against bacteria and viruses that enter your mouth.
This function may make them particularly vulnerable to infection and inflammation. The problem is more common in children because the immune system function of tonsils is most active before puberty.
A tonsillectomy may be recommended to prevent frequent, recurring episodes of tonsillitis. Frequent is generally defined as:
- More than five to seven episodes in one year
- More than four episodes a year over two years
- More than three episodes a year over three years
The procedure may also be recommended if:
- A bacterial infection causing tonsillitis doesn't improve with antibiotic treatment
- An infection that results in a collection of pus behind a tonsil (tonsillar abscess) doesn't improve with drug treatment
Complications of enlarged tonsils
Tonsils may become enlarged after frequent or persistent infections, or they may be naturally large. A tonsillectomy may be used to treat the following problems caused or complicated by enlarged tonsils:
- Difficulty breathing
- Disrupted breathing during sleep
- Difficulty swallowing
Other diseases of the tonsils
A tonsillectomy may also be used to treat other rare diseases or conditions of the tonsils, such as:
- Cancerous tissue in one or both tonsils
- Recurrent bleeding from blood vessels near the surface of the tonsils
Risks
Tonsillectomy, like other surgeries, has certain risks:
- Reactions to anesthetics. Medication to make you sleep during surgery (general anesthesia) often causes minor, short-term problems, such as headache, nausea, vomiting or muscle soreness. Serious, long-term problems are rare.
- Swelling. Swelling of the tongue and soft roof of the mouth (soft palate) can cause breathing problems, particularly during the first few hours after the procedure.
- Bleeding during surgery. In rare cases, severe bleeding occurs during surgery and requires additional treatment and a longer hospital stay.
- Bleeding during healing. Bleeding can occur during the healing process, particularly if the scab from the wound is dislodged too soon. Emergency surgery to stop the bleeding is riskier than scheduled surgeries that allow for appropriate pre-surgical safeguards, such as fasting.
- Infection. Rarely, surgery can lead to an infection that requires further treatment.
How you prepare
You'll receive instructions from the hospital on how to prepare yourself or your child for a tonsillectomy.
Information you'll likely be asked to provide includes:
- All medications, including over-the-counter drugs and dietary supplements, taken regularly
- Personal or family history of adverse reactions to anesthetics
- Known allergy or other negative reactions to medications, such as antibiotics
Instructions for preparing will include the following:
- Don't take aspirin or other over-the-counter nonsteroidal anti-inflammatory drugs for at least two weeks prior to surgery.
- Don't eat or drink anything after midnight before the scheduled surgery.
- Make arrangements for a ride home.
- Plan for a week or more of recovery time. Adults may need more time than children.
Questions to ask your doctor or the hospital staff for yourself or on behalf of your child include:
- When should I arrive at the hospital?
- Where do I need to check in?
- Can I take other prescription medications in the days before surgery? When can I take the last dose?
- What is the expected recovery time?
- What restrictions to activities or diet should I expect during recovery?
What you can expect
Tonsillectomy is usually done as an outpatient procedure. That means unless serious complications arise, you or your child will be able to go home the day of the surgery.
During the surgery
Because a tonsillectomy is performed under general anesthesia, you or your child won't be aware of the procedure or experience pain during the surgery.
The surgeon may cut out the tonsils using a blade (scalpel) or a specialized surgical tool that uses heat or high-energy sound waves to remove or destroy tissues and stop bleeding.
During recovery
Nearly everyone experiences pain following a tonsillectomy. Pain is most often in the throat, but it may also be located in the ears, jaw or neck.
Steps that you can take to reduce pain, promote recovery and prevent complications include the following:
- Medications. Take pain medications as directed by your surgeon or the hospital staff. If the surgeon or your primary doctor prescribes antibiotics as a part of the post-surgical care, take all of the pills as directed.
- Fluids. It's important to get plenty of fluids after surgery. Water and ice pops are good choices. Avoid milk for the first 24 hours after surgery.
- Food. Bland foods that are easy to swallow, such as applesauce or broth, are the best choices immediately after surgery. After 24 hours, foods such as ice cream and pudding can be added to the diet. Foods that are easy to chew and swallow should be added to the diet as soon as possible. Avoid spicy, hard or crunchy foods.
- Rest. Bed rest is important for several days after surgery, and mild activities should be added gradually. You or your child should be able to return to work or school after resuming a normal diet, sleeping normally through the night and not needing pain medication. Talk to your doctor about any activities that should be avoided.
When to see the doctor or get emergency care
Watch for the following complications that require prompt medical care:
- Bleeding. Any bleeding requires a trip to the emergency room for a prompt evaluation and treatment. Surgery to stop bleeding may be necessary.
- Fever. Call your doctor if you or your child has a fever of 102 F (38.9 C) or higher.
- Dehydration. Call your doctor if you observe signs of dehydration, such as reduced urination, thirst, weakness, headache, dizziness or lightheadedness. Common signs of dehydration in children include urinating fewer than two or three times a day or crying with no tears.
- Breathing problems. Snoring or noisy breathing is common during the first week or so of recovery. However, if you or your child is having difficulty breathing, get emergency care.
- Fact sheet: Tonsils and adenoids. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/HealthInformation/tonsilsAdenoids.cfm. Accessed March 21, 2010.
- Wetmore R. Tonsils and adenoids. In: Kliegman R, et al., eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/193178650-2/0/1608/0.html. Accessed April 5, 2010.
- Tonsillopharyngitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec08/ch090/ch090i.html. Accessed March 21, 2010.
- Tonsillar cellulitis and abscess. The Merck Manuals: The Merck Manual of Healthcare Professionals. http://www.merck.com/mmhe/sec19/ch222/ch222b.html. Accessed April 5, 2010.
- Fact sheet: Tonsils and adenoids post-op. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/HealthInformation/tonsilsAdenoidsPostop.cfm. Accessed March 21, 2010.
- How safe is anesthesia? What are the risks? American Society of Anesthesiologists. http://www.asahq.org/patientEducation/resource.htm. Accessed May 12, 2010.
- Fact sheet: Tonsillectomy procedures. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/HealthInformation/tonsillectomyProcedures.cfm. Accessed March 21, 2010.
- Orvidas LJ (expert opinion). Mayo Clinic, Rochester, Minn. May 19, 2010.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. May 13, 2010.
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