Tonsillectomy

Alternate Names
palatine tonsillectomy
lingual tonsillectomy



Definition of Tonsillectomy

Tonsillectomy is the removal of the palatine or lingual tonsils at the back of the throat. The tonsils, along with the adenoids, are part of the system that captures germs entering the body and triggers an immune response to an infection.

Who is a candidate for the procedure?

The palatine tonsils are easily seen on either side of the throat at the level of the soft palate. Removal of the palatine tonsils is an appropriate treatment in the following situations:

• if there have been 3 to 5 bacterial infections of the tonsils within 3 to 5 years
• if there have been more than 6 episodes of tonsillitis in a year
• if chronic tonsillitis, or infection of the tonsils, does not respond to antibiotics

The lingual tonsils are areas of tonsil tissue at the back of the tongue. They may be removed for one of several reasons, including:

• recurrent or chronic tonsillitis
• enlargement of the tonsils that causes sleep apnea, a breathing disorder that occurs during sleep
• enlargement of the tonsils that causes difficulty swallowing, especially in children
• diagnosed or suspected cancer

How is the procedure performed?

A tonsillectomy to remove the palatine tonsils is usually done under general anesthesia, which means that the person is put to sleep for the procedure, feels no pain, and has no awareness of the operation. A device holds the mouth open, and a clamp is applied to the tonsil. An incision is then made in the lining over the tonsil.

This incision can be made with scissors, knife, laser, or electrocautery, in which a pencil-like device connected to an electric current gently burns through tissue, avoiding the use of a knife. The incision exposes a loose tissue layer between the tonsil and the muscles of the palate. The tonsil is then "shelled" out.

General anesthesia is also used when the lingual tonsils are removed. The mouth is held open by an instrument called a laryngoscope, a lighted tube through which the lingual tonsils can be seen and removed. The lingual tonsils are at the back of the tongue and are rather firmly attached to the muscles of the tongue. The tonsils are separated from the muscle using either laser or electrocautery.

Because the tonsils have such a good blood supply, there is often quite a bit of bleeding from numerous tiny vessels. This bleeding can usually be stopped by touching the tip of the electrocautery device to the vessel. Commonly, the adenoid is also infected and is removed as well.

Recently, the Food and Drug Administration (FDA), approved a radiofrequency procedure to shrink tonsils in adults, rather than removing them. This procedure is done in a healthcare professional's office using only local anesthesia, which numbs the area around the tonsils. The person sits and opens his or her mouth while the healthcare professional applies bursts of radiofrequency heat with a needle-like device or wand.

What happens right after the procedure?

Following removal of the palatine or lingual tonsils, the throat usually feels quite painful. A tonsillectomy is usually done in a same-day surgery setting, which means that the person can go home after a brief stay in the surgery recovery room. In some cases, an overnight stay in the hospital might be needed.

When a radiofrequency procedure is used to shrink the tonsils, the person can go home soon after the procedure. Some individuals report a sore throat after this procedure, but many return to work within a day or two.

What happens later at home?

After a tonsillectomy, a person should drink enough liquid to avoid dehydration and to keep the throat moist. While a few people can eat a fairly normal diet right away, most people are comfortable with a limited variety of beverages and soft foods. Some foods should be avoided, including:

• acidic or sour beverages, such as tomato or citrus juices, which may cause more pain to the throat
• very hot or spicy foods, which can also cause pain
• rough or scratchy foods, which should be avoided for at least 10 days. These foods may knock the scabs off in the back part of the throat and cause severe bleeding.

Pain medications should be limited to those prescribed or recommended by the surgeon. Aspirin products must be avoided after tonsillectomy because of the possibility of bleeding.

What are the potential complications after the procedure?

Most cases of hemorrhage, or bleeding, after tonsillectomy occur in the first 5 to 7 days after surgery. This bleeding should be reported immediately to the surgeon, who may use electrocautery to stop it.

The pain from a tonsillectomy is usually most intense in the first 48 hours after surgery. It starts to ease off but may worsen again 4 to 6 days after surgery. The second peak of pain is often accompanied by severe ear pain. Usually there is nothing wrong with the ears. The pain just happens to radiate at this point in the recovery. The scabs in the back of the throat often lead to a foul taste in the mouth accompanied by very bad breath. Antibiotics may help with this problem.

After the surgery, strep throat infections are quite rare. Removal of the tonsils in children cures about 95% of sleep apnea cases. Someone who has had difficulty swallowing because of enlarged tonsils can usually swallow normally after recovery. A person with cancer may need other surgery, chemotherapy, or radiation therapy.