Tonsillectomy

A tonsillectomy is done to treat some of the following conditions:

• Enlarged tonsils
• Severe or chronic, and recurring tonsillitis.
• Other rare tonsil problems

Tonsillitis:

Tonsils are masses that produce a type of disease-fighting WBC (white blood cells). These tonsils are usually present to fight against foreign bodies entering through the mouth and are considered to be the first line of immunity.

Tonsillectomy is performed to treat the inflammation and infection due to bacteria and viruses in the throat, the condition also known as tonsillitis. The problem of tonsillitis is commonly observed in children as the tonsils are very active before puberty as compared to the adults. This is also because the children do not have much exposure to the viruses and bacteria and have yet to develop good immunity towards them.

A tonsillectomy is advised by the doctor, in order to prevent episodes of severe or chronic, and recurring tonsillitis. The frequency of these episodes can vary for different patients and are typically in the cycles as mentioned below.

• Seven or more episodes in a year
• Five or more episodes in a year and in every preceding two years
• Three or more episodes in a year and in every preceding three years

Few of the other reasons, for which a doctor may advise going for tonsillectomy are:

• Tonsillar abscess, which means a pus collection behind the tonsil, that does not get treated with either the drainage process or medications.
• A severe bacterial infection that does not get treated with antibiotics.

Sometimes, the tonsils get enlarged after repeated infections or may be enlarged naturally. So, the tonsillectomy may be advised in order to treat the problems associated with enlarged tonsils. Due to enlarged tonsils, the patients have to face multiple problems including

• Difficulty, pain, and discomfort in swallowing
• Interrupted sleep due to breathing problems
• Difficulty in breathing properly

The procedure may also be done to treat various problems related to breathing and enlarged tonsils, along with some rare tonsil diseases, as mentioned below:

• Cancerous growth in one or both the tonsils
• Repeated bleeding from the nearby blood vessels

Tonsillectomy is a surgical procedure to remove the tonsils present at the back of the throat. Since it is a surgical procedure, there are certain risks associated with it as mentioned below.

• Severe bleeding during the tonsillectomy procedure occurs in some rare cases which may lead to a longer stay in the hospital and additional follow up treatments.
• In some cases, there might be some problems, related to the anesthesia, such as nausea, headache, vomiting or soreness of the muscles.
• Sometimes, there is excessive bleeding during the process of healing especially if the crusty layer over the wound is displaced.
• Heavy bleeding during the procedure of tonsillectomy.
• In rare cases, the surgical procedure of tonsillectomy may lead to infections that may need additional treatment.
• After the procedure, some of the other problems observed in the patients include swelling of the soft palate or the tongue. This leads to difficulty in breathing as it restricts the airway.

The doctor or the nurse will provide all the details to the patient about the surgical procedure of tonsillectomy along with the risks and benefits. Some of the steps to be followed before the surgery are as mentioned.

The doctor would like to know the history of the patient and might ask about some of the details from the patient. These details might include family or personal history of any bleeding disorders, allergic reactions to any medicines e.g. antibiotics etc., family or personal history of any adverse reactions to the anesthesia, information about any medicines the patient is taking and any surgeries performed earlier on the patient.

Some of the steps, which are required for the preparation of the procedure include the following.

• Avoid taking blood-thinning medicines e.g. aspirin and ibuprofen, at least two weeks before the procedure. It delays the healing process or clotting of the blood.
• Avoid eating or drinking anything after midnight, one night before the surgery.
• The patient is often advised to get a companion along to take care of the patient after the surgery and to drive back home the same day.
• It is observed that adults take more time to recover as compared to children, after the surgery. The recovery time after the surgical procedure of tonsillectomy is usually, 10 to 14 days.

During the procedure:

The procedure of tonsillectomy is usually done in an outpatient facility. The patient is allowed to go home after the surgical process completes. In some cases of complications, the patient might be advised to stay for a night in the hospital.

The patient is given general anesthesia before the surgery starts. The patient becomes temporarily unconscious. The doctor uses an instrument to hold open the mouth of the patient, in order to easily access the area to be treated. The tonsil is then cut with the help of a scalpel or a blade. The procedure requires a very high energy sound wave or heat to destroy or remove the damaged tissues and the procedure usually does not require any sutures or stitches, however, the bleeding would need to be controlled in the patient.

Process of recovery/after the procedure:

The patients might experience pain after the procedure has been completed. The pain may be felt in the throat, jaws, neck, and ears. The doctor advises following some of the steps, to the patients, to decrease the pain:

• Painkillers – Doctors do advise some painkillers after the surgical procedures in order to provide relief to the patient.
• Food – As the surgery takes place in the throat, the patient might face some difficulty in swallowing the food initially. Hence, the doctors advise eating some soft foods that are easily chewed and swallowed e.g. puddings or ice-creams. Usually, cold foods are advised as these helps in healing the wounds properly and in lesser time.
• Fluids – The patient is always advised to drink a lot of water/fluids after surgery.
• Rest – To have a fast recovery, the patient is advised to take proper rest.
• Exercise – The patient is advised to avoid strenuous physical activities or exercises at least for two weeks after the surgical procedure. Performing such activities may delay the healing process or cause some serious complications.

The patient is allowed to go home after the surgical process completes. In some cases of complications, the patient might be advised to stay for a night in the hospital.

After the procedure, the patient can start going to work if there is no pain. However, the patient would need to get good sleep and follow a normal diet. And it is important to consult the physician before making a decision on joining back office.

The patient must inform the doctor immediately in the following scenarios:

• In case of heavy or uncontrolled bleeding after the surgery, the patient should consult the doctor immediately.
• If the patient develops a high-grade fever i.e. 102 F/ 38.9°C, physician should be called.
• In case of any breathing problems or difficulty while sleeping. Snoring is common in the initial days after the surgery. But if the breathing problem continues, then the doctor consultation is a must.
• If a patient faces a problem of dehydration, then the doctor consultation is recommended. Dehydration causes decreased thirst and urination, headaches, weakness, fainting, dizziness and lightheadedness. In the case of children, the problem of dehydration may lead to crying without tears or urinating only 2 to 3 times in a day.
• Even after 12 hours of the surgery, if the patient is having stomach upset or is experiencing uncontrolled vomiting, physician must be consulted

After the procedure of tonsillectomy, the person cannot get tonsillitis ever. Also, the frequency and ability to get any other throat infection is very much reduced.

It is generally observed that the adults take more time to recover as compared to children. The recovery time after the surgical procedure of tonsillectomy is usually, 10 to 14 days. The parents should ensure that the children stay away from an infected person as there are very high chances of getting sick and acquiring infections after the surgery. The patient is advised to avoid consuming spicy, hot, hard and crunchy foods after the surgery.