Tonsillectomy

India
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Overview

The tonsils are part of the lymphatic system located at the back of the throat, one on either side. Tonsils being the part of immune system, they play a role in protecting the body against respiratory and gastrointestinal infections. Sometimes while doing their job they themselves get infected (they swell a bit and become red), this is when you get a sore throat. The inflammation of tonsils is termed as tonsillitis.

Minor inflammations in the tonsils can be well managed by administering certain drugs such as antibiotics. But tonsillectomy in adults is definitely recommended for conditions such as:

● Sleep apnea accompanied by heavy snoring due to enlarged tonsils

● Breathing difficulty (airway obstruction) or swallowing problems caused by enlarged tonsils

● An abscess around the tonsils (peritonsillar abscess)

● Any suspicious growth of cancerous cells (very rare) in the area

● High frequency and severity of throat infections (more than 5-6 sore throat infections per year)

Benefits of surgery

Adult patients who had a severe sore throat (disabling pharyngitis) involving the palatine tonsils more than three times per year benefited from a tonsillectomy

The research says, after five months, the patients who had a tonsillectomy never had a severe sore throat, compared with 3 percent of those who didnt undergo the surgery. Out of those who underwent surgery, 4 percent saw a doctor for a sore throat compared with 43 percent who didnt have surgery. Also, 80 percent of patients who didn't undergo tonsillectomy had an acute sore throat compared with 39 percent who underwent surgery, the researchers noted.

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Before the Treatment

The surgeon may recommend discontinuing certain medications such as aspirin, ibuprofen, and other blood thinners two weeks before the surgery as these medications may increase the risk of excessive bleeding during and after the procedure.

Tonsillectomy in adults is carried out under general anesthesia. Pre-operative surgical preparation for general anesthesia may include abstinence from eating and drinking from the night before the procedure. This reduces the risk of aspiration. Home-recovery should be planned before undergoing surgery. As most people stay home from work or school for about a week following adult tonsillectomy.

How it is Performed

Types of Tonsillectomy Procedures

The first reported tonsillectomy is described as cutting the person's tonsils and removing them out, or holding them up with a hook and excising them with a scalpel. The choice of type of surgery is based on the extent of excision of the tonsils (partial tonsillectomy, complete tonsillectomy), post- operative pain and bleeding.

Cold Knife Dissection

This type of procedure is most common and requires the person to undergo general anesthesia. Tonsil removal is then conducted using a scalpel. They experience a minimal post-operative bleeding.

Electrocautery

This procedure involves burning of the tonsillar tissue with the help of heat. This procedure enables minimum blood loss due to cauterization. The heat of electrocautery may cause thermal injury to the surrounding tissue leading to increased post-operative discomfort.

Harmonic Scalpel

This technique uses ultrasound energy to vibrate the scalpel which enables simultaneous cutting and coagulation of the tissues. A harmonic scalpel vibrates at a speed of 55,000 cycles each second. These vibrations are invisible to the eye. But, they transfer the energy to the surrounding tissue there by the temperature if the tissue reaches eighty degree Celsius. This technique results in precise cutting and minimal thermal damage to the tissue.

Monopolar Radiofrequency Ablation

This procedure is preferred for partial tonsillectomy recommended for enlarged tonsils rather than chronic tonsillitis. This procedure is performed under local anesthesia or light sedation. This procedure involves the transfer of radiofrequency energy into the probes inserted into the tonsillar tissue. This causes scarring of the tissue which leads to decrease in the size of the tonsils. The tonsillar tissue is remained after the procedure, although it’s less prominent. This procedure is easy to perform and can be performed many times with minimal discomfort the person returning the person to the office or school immediately.

Bipolar Radiofrequency Ablation or Coblation

This technique is used for partial and complete tonsillectomy. The coblation technique does not use heat instead uses ionic dissociation mechanism when energy is transferred to remove the tonsils. The bipolar radiofrequency ablation produces an ionized saline, which is capable of disrupting molecular bonds. This procedure is carried out under general anesthesia technique. This technique requires less need for post-operative care, enables fast healing with less pain.

Microdebrider

This technique is used to perform partial tonsillectomy mainly recommended in the people with enlarged tonsils rather than those with repeated infections. Microdebrider is a rotary shaving device with continuous suction. This procedure eliminates the portion of the person's tonsils that are causing an obstruction by shaving while preserving their tonsillar capsule. This procedure is carried out under general anesthesia and has less pain and a quicker recovery.

Carbon Dioxide Laser or Laser Tonsil Ablation (LTA)

This procedure is generally carried out by a specialist (otolaryngologist) in the office setting in a person under local anesthesia. This procedure requires the use of a hand-held CO2 or KTP laser to vaporize and remove a person's tonsil tissue. This procedure is recommended for conditions which are a result of enlarged tonsils such as airway obstruction, and recurrent tonsillitis, chronic sore throats. This procedure requires only fifteen to twenty minutes causing minimum discomfort returning the person to office or school the next day. Bleeding is noticed in very few people. Laser technology requires less use of medication and less pain during post-operative recovery.

Recovery

Risks Associated with a Tonsillectomy

• Bleeding and infection

• Risks associated with anesthesia and medications

• Injury to person’s soft palate (uvula)

Recovery after a Tonsillectomy

• Take plenty of rest for the first two to three days after surgery as you may feel pain in the jaw, ears, or neck.

• A sore throat and pain are common after tonsillectomy during recovery.

• Tonsillectomy recovery can be improved by staying hydrated by sipping water and eating ice pops without hurting your throat.

• The ideal food choices during early recovery would be warm, clear broth and apple sauce.

• Soft foods including ice-creams puddings oat meal are recommended for a couple of days.

• For several days after tonsillectomy, you should avoid hard, crunchy, or spicy foods should be avoided.

• Pain medications comfort you during recovery.

• Snoring is common for the first two weeks post surgery. Consult your doctor if you have breathing difficulty after two weeks.

• You can go back to your work or school after two weeks of surgery as tonsillectomy recovery is almost completed by then.

• You may experience very few throat infections in future.

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