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When Should Tonsils Be Removed in Adults?

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When Should Tonsils Be Removed in Adults?

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Tonsils are removed in cases of sleep apnea or recurrent episodes of tonsillitis. Learn about the indications, best methods, and complications of tonsillectomy.

Medically reviewed by

Dr. K. Shobana

Published At August 24, 2018
Reviewed AtJune 10, 2024

Introduction:

Tonsillectomy is one of the most popular operations in the otorhinolaryngology field. Tonsillitis is the inflammation of oval-shaped pads of tissue situated at the back of the throat called tonsils. There are two tonsils present in the throat, one on each side. Tonsillitis is generally caused by viral and bacterial infections. Prompt and accurate diagnosis is required for the appropriate treatment of tonsillitis. The indications for the removal of tonsils in adults are the same as in children. Still, tonsillitis is less known in the adult population because when children grow, their tonsils shrink, and infections become less common.

What Are the Signs and Symptoms of Tonsillitis?

The main symptom of tonsillitis is swollen and inflamed tonsils that make breathing from the mouth difficult. Other symptoms include:

  • Tenderness of the throat or throat pain.

  • Yellow or white coating on the tonsils.

  • Painful ulcers or blisters on the throat.

  • Loss of appetite.

  • Trouble swallowing.

  • Bad breath.

  • Swollen glands in the neck or jaw.

  • Fever and chills.

  • Stiff neck.

  • Ear pain.

What Is a Tonsillectomy?

A tonsillectomy is when doctors remove the tonsils, those oval-shaped tissues at the back of the throat, one on each side. It used to be common for treating tonsillitis, but now it is mostly done for sleep problems. Sometimes, if tonsillitis keeps happening or does not get better with other treatments, a tonsillectomy is still an option. It can also help with breathing issues caused by big tonsils or rare diseases. Recovery takes about 10 days to two weeks.

Why Is Tonsillectomy Done?

A tonsillectomy is done primarily for two reasons, tonsillitis and sleep-disordered breathing. In rare cases, a tonsillectomy may also be necessary to address other issues such as difficulty breathing or swallowing due to enlarged tonsils or to treat certain rare diseases affecting the tonsils. The following are the indications of tonsillectomy.

1. Chronic Tonsillitis - Tonsillectomy is indicated in certain cases of chronic tonsillitis. Chronic tonsillitis is characterized by inequality in the size of both tonsils, congested anterior pillars that cover tonsils anteriorly, the collection of pus inside the tonsillar crypts even in the absence of acute inflammation, recurrent attacks of acute follicular tonsillitis, and palpable neck lymph nodes. Chronic tonsillitis is said to occur if a person experiences seven infections in one year, five infections per year for two consecutive years, or three infections per year for three consecutive years.

2. Peritonsillar Abscess - Peritonsillar abscess is an important indication of tonsillectomy. Peritonsillar abscess is an acute infection presented by the collection of pus in the space between the tonsil capsule and anterior pillar, fever, dysphagia, and severe throbbing pharyngeal pain. Peritonsillar abscess is usually unilateral. Just one attack of peritonsillar abscess is an indication of tonsillectomy.

3. Impacted Foreign Body - Impacted foreign body inside the tonsils is another indication of tonsillectomy. Many different foreign bodies may be impacted into the tonsils, but the most common are fish and bird bones. These bones are impacted in the tonsils during eating. Tonsillectomy would be indicated if the foreign body cannot be extracted through the mouth.

4. Sleep Apnea - When the tonsils are enlarged, they can cause airway obstruction when the person lies down, making him temporarily stop breathing while sleeping (sleep apnea). If the cause of sleep apnea is suspected to be enlarged tonsils, the doctor may recommend a tonsillectomy.

Does Tonsillectomy Affect Immunity?

Tonsils are lymphoid tissues. Tonsils play an important role in human immunity, but their removal does not harm immunity because the body is full of other lymphoid tissues. The important point is the presence of an indication for tonsillectomy.

What Is the Best Method for Tonsillectomy?

Now, there are a lot of methods for tonsillectomy, such as diathermy, radiofrequency, laser surgery, cryosurgery, and cold surgery. Cold surgery means the use of surgical instruments away from any source of heat as diathermy and laser. The best method is the method that the surgeon prefers. The aim is to remove the tonsils completely without primary bleeding.

What Happens Right After a Tonsillectomy?

Immediately after tonsillectomy surgery, the medical team will monitor vital signs. Upon waking up, feelings of queasiness may occur as the anesthesia wears off. If all is well after a few hours, patients typically go home to recover. However, complications may require an overnight hospital stay. One may also experience symptoms like mild fever, nausea, bad breath, ear, neck, or jaw pain, tongue or throat swelling, sore throat, loss of taste temporarily, nasal sounding voice, drink or food coming out of the nose, and a feeling of something stuck in the throat. These may last for a few days or weeks and are temporary.

What Are Tonsillectomy Risks and Complications?

While a tonsillectomy is generally safe for adults, potential risks like infection (rare), pain, dehydration due to decreased fluid intake, side effects from anesthesia, and complications with throat healing may occur. Some of the complications of tonsillectomy are primary hemorrhage, secondary hemorrhage, and residual tonsil tissue.

  • Primary Hemorrhage - It is the hemorrhage that happens within the first twenty-four hours after the operation. Primary hemorrhage can occur because of slipped ligature, detached thrombus, which occludes a blood vessel, and elevated blood pressure after coming back from anesthesia effect. Primary hemorrhage is an emergency. The patient must go through surgical closure of the bleeding blood vessel. Sometimes, external carotid ligation is mandatory if direct closure of the bleeding vessel has failed.

  • Secondary Hemorrhage - It is the hemorrhage that happens after the first 24 hours have passed. It is mostly secondary to the bacterial infection at the site of surgery. So, antibiotics are important after tonsillectomy to prevent bacterial infection. Dealing with secondary hemorrhage is different from that of primary hemorrhage. In case of secondary hemorrhage, the patient's throat must be irrigated with hydrogen peroxide under general anesthesia to remove all the infected tissues. In many cases, just previous irrigation is enough to stop the bleeding, but in other cases, external carotid ligation is needed to stop bleeding.

  • Residual Tonsil - Residual tonsil tissue is a common complication. Residual tonsil tissue can be inflamed repeatedly. Residual tonsil tissue can increase in size because of repeated inflammation. This hypertrophied residual tonsil tissue may need another surgery to be removed.

Conclusion:

Tonsillectomy is indicated if tonsillitis keeps coming back or causes other problems. Adults suffering from chronic sore throats and associated sleep apnea benefit from tonsillectomy. Although, the recovery is longer when compared to that of a child, the potential benefits often outweigh the temporary discomfort associated with the recovery process.

Frequently Asked Questions

1.

Is Tonsillectomy a Major Surgery?

Yes, tonsillectomy is a major procedure that is commonly practiced. However, not all patients with tonsil issues are indicated for this surgery. In addition, the procedure may lead to several complications like pain, infection, bleeding, dehydration, etc. But, mostly, it is a safe procedure with good outcomes too.

2.

How Do Enlarged Tonsils in Adults Happen?

Enlarged or swollen tonsils are more common in children, but adults are not left out. It may result in pain, swallowing difficulties, bad breath, etc. It most commonly occurs due to viral infections and may resolve within a week with home remedies and over-the-counter (OTC) medications. However, in case of severe symptoms, one must have a consultation.

3.

Is Tonsil Removal Normal in Adults?

Surgical or laser-assisted removal of tonsils is a common procedure. In addition, the procedure is suggested for adults due to enlarged tonsils that cause breathing difficulties and mostly due to recurrent tonsil infection. In addition, it is a safe procedure with minimal complications. But, the procedure has its own contraindications also.

4.

Is Tonsil Removal a Painful Procedure?

Tonsillectomy is usually performed under general anesthesia; the entire procedure takes up to 30 minutes or more (rarely). The patient may not feel any pain or discomfort during the procedure. However, moderate to severe pain may be felt in the throat, jaw, ears, and neck after the procedure. It may last for a week or two.

5.

What Are the Alternatives to Tonsillectomy?

There are two alternate options to tonsillectomy, and it includes
  - Laser Tonsil Ablation - When general anesthesia is not possible or due to other preferences, the laser ablates or shrinks the tonsils.
- Tonsillotomy - This is another alternative to tonsillectomy, where the tonsils are partially removed.

6.

What Is the Approximate Time Taken for Tonsil Surgery?

Tonsillectomy is a safe procedure, and complications do occur rarely. The whole procedure may last for half an hour to one hour. The surgical procedure is carried out under general anesthesia, and it does not cause any pain. Before the surgery, the specialist may examine your blood and body systems for any bleeding and other systemic disorders.

7.

Does Removing Tonsils in Adults Cause Any Problems?

Tonsillectomy may result in side effects like vomiting, pain in the throat, infection, bleeding, and swelling for a week or two after the surgery. But complications due to tonsil removal are rare and do not affect or degrade the body’s immune system. After the surgery, it may take two weeks for complete recovery.

8.

Can I Remove My Tonsils at the Age of 40?

Tonsillectomy is widely carried out in children; however, it is also done in adults but is not as popular as in children. But in case of any frequent infection, cancer, and breathing difficulties, a doctor may suggest the removal of tonsils even at the age of 40. But apart from the age factor, tonsillectomy may not be advised if a person at the age of 40 has severe medical conditions.

9.

What Indicates That Tonsil Removal Is Necessary for Adults?

A tonsillectomy is suggested in the following cases:
- Frequent tonsil infections.
- Enlarged tonsils.
- Breathing difficulties.

10.

Can Tonsils Be Removed at Home?

No, tonsils cannot be removed at home, requiring a doctor’s attention for any procedures. In the case of tonsil stones, otherwise known as tonsillolith, you can try salt water gargling as a home remedy. The specialist may indicate the removal of the tonsil only if necessary. Therefore, it is vital to have a visit for any tonsillar infections.

11.

What Are the Contraindications of Tonsillectomy?

Not in all cases; a tonsillectomy is suggested. There are a few instances where tonsillectomy is contraindicated, such as:
- In case of acute infection of the tonsil.
- Severe anemia.
- Poorly controlled systemic conditions.

12.

Does the Absence of Tonsils Cause Any Side Effects?

After the removal of tonsils, pain in the throat, ears, and jaws, vomiting, anxiety, and halitosis (bad breath) are a few common side effects that may last for a week or two. But, rarely, in case of any temperature rise, bleeding, and difficulty breathing, it is important to have a medical consultation. Studies also show that an individual may face respiratory infections years after tonsillectomy.

13.

What Foods Can I Take After Tonsil Surgery?

Foods that can be taken after a tonsillectomy are:
- Smoothies.
- Ice cream with low-fat, cheese, and other dairy products.
- Boiled and mashed veggies.
- Fruit juices, except fruits that are acidic.
- Cooked and blended cereals and grains

14.

What Are the Benefits of Having Tonsils?

Tonsils are of three types and are located along the throat. They protect the body from harmful bacteria that enter the mouth. They are packed with white blood cells; hence they prevent infections. In addition, tonsils may avoid the aspiration of particular foreign objects.
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Dr. Mohammed Osama Aboborda
Dr. Mohammed Osama Aboborda

Otolaryngology (E.N.T)

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