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Tonsillectomy

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Definition

The surgical removal of the tonsils, which are glands in the back of the throat.

The Tonsils

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Parts of the Body Involved

A tonsillectomy involves the throat and tonsils.

Reasons for Procedure

Tonsillectomy is most often performed for the following reasons:

  • To treat chronic or recurrent tonsillitis (four or more streptococcal infections of the tonsils per year) despite appropriate medication and other non-surgical treatments
  • To treat peritonsillar abscess when drainage along with non-surgical treatments are not effective
  • To remove enlarged tonsils that are causing severe problems with swallowing, breathing, or proper dental formation

Risk Factors for Complications During the Procedure

  • Obesity
  • Smoking
  • Poor nutrition
  • Recent chronic illness
  • Previous adverse reaction to anesthesia
  • Sickle cell anemia
  • Bleeding disorders
  • Pregnancy
  • Recent or current steroid use
  • Poorly controlled diabetes
  • Scarring because of severe frequent infections

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam of the tonsils, throat, and neck, at minimum
  • Blood test
  • Possibly a urine test
  • Review of medications; some may need to be stopped or adjusted for the procedure

In the days leading up to your procedure:

  • Do not take aspirin, aspirin-containing medications, or other nonsteroidal anti-inflammatory medications (NSAIDs).
  • The night before, eat a light meal and do not eat or drink anything after midnight, including mouthwash, toothpaste, lozenges, chewing gum, and water.

During Procedure

  • Anesthesia, and possibly sedation
  • Breathing tube
  • Retractor that holds your mouth open
  • Depressor that holds your tongue down

Anesthesia

General anesthesia is most common, but tonsillectomy can be performed with sedation and local anesthesia.

Description of the Procedure

One at a time, the surgeon will grasp each tonsil with tonsil forceps and cut it away from surrounding tissues. The tonsil is then removed with a snare or a tonsil guillotine clamp. Electrocauterization (scarring with an electrical current) or clamps and ties are used to stop bleeding from the blood vessels at the site where the tonsils were removed. Radiofrequency ablation can be used to reduce the volume and size of the tonsils.

After Procedure

The site where the tonsils were removed should heal within 7 to 10 days. Postoperative symptoms include, but are not limited to:

  • Swallowing problems
  • Throat pain
  • Ear pain
  • Vomiting
  • Fever
  • Bleeding from the site where the tonsils were removed

How Long Will It Take?

The procedure typically takes 20 to 60 minutes.

Will It Hurt?

Anesthesia prevents pain during the procedure, but pain after the procedure is common. Your doctor may prescribe pain medication or recommend over-the-counter pain drugs for you.

Possible Complications

  • Excessive bleeding from the site where the tonsils were removed
  • Adverse reaction to the anesthesia
  • Vomiting and dehydration

Average Hospital Stay

An otherwise healthy person can usually have this procedure done on an outpatient basis. Some patients may need to stay in the hospital for up to two days.

Postoperative Care

  • Drink plenty of fluids (avoid acidic drinks)
  • Take acetaminophen (Tylenol) or other pain medication prescribed by your physician to relieve pain
  • Apply ice to relieve pain
  • Take antibiotics, if they are prescribed, to treat or prevent infection
  • Avoid talking, coughing, and singing for one week
  • Avoid swallowing hard items such as crackers and hard cookies, as they may injure the back of the throat
  • Avoid vigorous exercise for 12 to 14 days
  • Avoid spicy, acidic, and hard-to-digest foods
  • Eat soft foods such as gelatin and pudding for 3 to 4 days after surgery, and gradually return to a normal diet
  • Bathe or shower as usual

Outcome

Outcomes vary depending on the reason for the tonsillectomy. They include:

  • Fewer throat infections
  • Improved breathing and swallowing

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the site where the tonsils were removed
  • Severe or worsening pain
  • New, unexplained symptoms

RESOURCES:

American Academy of Otolaryngology–Head and Neck Surgery
http://www.entnet.org

Kids Health
http://www.kidshealth.org/parent/medical/ears/tonsil.html

CANADIAN RESOURCES:

BC Healthguide
www.bchealthguide.org/kbase/topic/major/ut1026/cause

Canadian Family Physician
www.cfp.ca

References:

Alexander's Care of the Patient During Surgery . 11th ed. Mosby; 1999.

American Academy of Otolaryngology–Head and Neck Surgery website. Available at: http://www.entnet.org .



Last reviewed November 2007 by Elie Rebeiz, MD, FACS

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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