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:
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Tenderness of the throat or throat pain.
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Yellow or white coating on the tonsils.
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Painful ulcers or blisters on the throat.
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Loss of appetite.
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Trouble swallowing.
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Bad breath.
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Swollen glands in the neck or jaw.
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Fever and chills.
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Stiff neck.
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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.
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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.
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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.
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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.
