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Tonsil removal (tonsillectomy)

What are tonsils?

Tonsils or palatinal tonsils
Tonsils or palatinal tonsils

Tonsils (or palatine tonsils) are a mass of lymphatic tissues inside your mouth at the back of your throat. The tonsils are parts of a lymphatic tissue ring (the so called Waldeyer ring), which can be found in the oral cavity and the pharynx. Being part of the immune system, this ring is the first immunological filtering station in providing protection against infections.

Why is a tonsil removal (tonsillectomy) needed?

Acute tonsillitis is an infection of the tonsils that can make your tonsils swell and cause sore throat, fever, troubles with swallowing, and also enlarge the glands around your neck. It is often caused by bacteria (streptococcus species). Frequent episodes of tonsillitis (reccurrent tonsillitis) might be a good reason for you to have a tonsillectomy.

A chronic tonsillitis may lead to a permanent sore throat, bad breath, and constantly enlarged lymph nodes on the neck. It can be the reason for patchy or diffuse hair loss, joint complaints, skin rashes of uncertain origin, fatigability, permanent rise in body temperature or fever, and chronic urogenital inflammations. In these cases, surgery is necessary.

The operation is also indicated in case of enlarged tonsils. Enlarged palatine tonsils may significantly narrow the throat, which may cause swallowing -, and/or respiratory difficulties, and may contribute to snoring and obstructive sleep apnoe syndrome (OSAS).

After this ENT surgery, your body will still be able to fight infections because sufficient amounts of lymphatic tissue can be found in the oral cavity and the pharynx (adenoid, lingual tonsils, etc.).

How does the procedure work?

Tonsillectomy is the surgical removal of the tonsils, and it is often performed in parallel  with adenoidectomy. The surgical procedure lasts about 40 minutes, and is performed under general anesthesia and usually in antibiotic prophylaxis.

There are several ways to remove the tonsils, the most common method is called “dissection and snare method.” In this case the tonsil is dissected along with its capsule and lifted out of its bed, and is ultimately removed using a tonsillar snare. In the meantime, bleeding tissues are cauterized. Other methods are also used in our hospital to perform tonsil removal (tonsillectomy), like laser- and coblation tonsillectomy. The major advantage of the coblation procedure is reduced bleeding and milder postoperative pain.

What are the benefits and risks of the surgery?

Risks

As with any surgery, there are certain risks associated with tonsil removal, including various infections and bleeding. The risk of bleeding is higher on Day 5 to 7 after surgery, when scabs fall off in small pieces from the tonsillar bed.

You will get a patient information sheet and informed consent form for detailed information about tonsillectomy, risks of the operation, and perioperative tasks. By all means, you will discuss with your doctor the possible risks of surgery before you make a treatment decision.

There are certain risks associated with general anesthesia, for which we will provide a separate information sheet and informed consent form. The tests that you will undergo before your surgery will ensure that these risks are reduced to minimum.

It is important to call your surgeon immediately in case of blood spitting or – vomiting, permanent nasal bleeding, fever or serious headache.

 

Benefits

Removal of the tonsils may reduce the frequency and severity of throat infections. It may also prevent the development of potentially serious kidney-, heart-, joint or brain conditions following streptococcal pharyngitis or tonsillitis (rheumatic fever). In case of enlarged palatine tonsils, tonsillectomy will improve swallowing- and/or respiratory difficulties.

In addition, you may reduce antibiotic intake related to infections due to reccurrent tonsillitis.

Am I a good candidate for tonsil surgery?

Tonsillitis and tonsillectomies are more typical in children than adults. However, when not removed, tonsils may cause problems at any age. Your ENT (ear, nose and throat) surgeon will advise surgery as necessary based on your symptoms, medical history and physical examination. You will be asked to undergo some tests (blood test, ECG), and to see your anesthesiologist and internist before your operation. This is to ensure that your overall health condition is good enough to safely allow a tonsil removal (tonsillectomy) under general anesthesia.

All of our patients are asked to complete a detailed medical history form. This is required by our surgeon and physicians so that they can decide if you are suitable for surgery.

If you are taking medications to prevent blood clotting than your tonsils should not be removed.

How should I prepare for the surgery?

  • Prepare a list of all of your symptoms and other medical conditions, past illnesses and allergies, even if they seem unrelated to your nose or sinuses. For this reason, you will receive a detailed questionnaire to complete, followed by a physical examination.
  • Be aware of any pre-appointment restrictions. Your ENT surgeon will provide you with all the necessary information so that you can prepare yourself for the diagnostic tests.
  • List all your medications and drugs, including vitamins and supplements
  • Ask a family member or friend to accompany you, someone who can help you recall all the information to be provided during your consultation.
  • Before the surgery, you will get a patient information sheet and an informed consent form with the necessary pre- and postoperative information to read and sign.

What shall I do after tonsil removal?

It takes about 14 days to recover from the surgery.

You can expect to have moderate to intense pain (sore throat, ear pain) for 7-10 days. This can be well controlled with oral pain killers.

You should only take medications approved at our clinic, and check with your ENT surgeon about any post-operative care you will need to perform to recover properly.

It is normal if you feel slowed down and deconcentrated for about a day after the surgery due to general anesthesia.

If there is no bleeding, you will be discharged on the first postoperative day. You will usually be advised to rest for around two weeks after surgery. Your surgeon will be able to give you more detailed information and advice.

For 2 weeks after tonsil removal you will be advised to avoid strenuous physical activities that may lead to bleeding of the operated area (blood spitting or –vomiting, nasal bleeding). In case of bleeding it is important to call your surgeon immediately, and go to the emergency.

It is important to note that you will have to drink plenty of fluids and keep a soft diet (eat only pulpy food) during the recovery period.

We recommend you do not travel far away from a medical facility or by air for two weeks following surgery.

Why is post-operative check-up important after the operation?

The first control examination is due after a week to check how well you recover, if there is any sign of infection or bleeding. Depending on your recovery, a second control might as well be needed.

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