Tonsillectomy

What is a tonsillectomy?

A tonsillectomy is the surgical removal of the tonsils. The tonsils are visible glands located in the back of your throat. Tonsils fight infection but can get infected and enlarged themselves. Infection of the tonsils is called tonsillitis. Frequent bouts of tonsillitis can lead to difficulty breathing, sleep apnea (pauses in breathing during sleep), difficulty eating, and ear infections. Your doctor may recommend a tonsillectomy if you or your child suffer from any or all of these conditions.

Tonsillitis is most likely to occur in children, but it occurs in adults as well. A common cause of tonsillitis is a bacterial infection of Streptococcus pyogenes, commonly known as strep throat. Certain viral infections, such as cytomegalovirus and adenovirus infections can also lead to tonsillitis.

A tonsillectomy is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options and should consider getting a second opinion about all of your treatment choices before you or your child has a tonsillectomy.

Other procedures that may be performed

Your doctor may recommend removal of your adenoids along with a tonsillectomy. The adenoids are also infection-fighting glands located in the throat. Adenoids can get infected and enlarged along with the tonsils and cause similar problems.

Why is a tonsillectomy performed?

Tonsillectomy is a surgical procedure that your doctor may recommend to treat a child or adult with problems related to the tonsils. These include:

• Antibiotic treatment failure, in which antibiotics do not cure a bacterial tonsil infection
• Cancer of the tonsils
• Difficulty eating or swallowing due to enlarged tonsils
• Excessive and loud snoring due to enlarged tonsils that block the breathing passages
• Frequent bouts of tonsillitis, in particular more than four tonsil infections over a year or five to seven over a two year period
• Sleep apnea, or pauses in breathing during sleep caused by enlarged tonsils
• Tonsillar abscess that does not respond to drug treatment

Your doctor may only consider tonsillectomy if other treatment options that involve less risk of complications have been ineffective.Talk with your doctor about all of your treatment options and consider getting a second opinion.

How is an tonsillectomy performed?         

A general surgeon, a pediatric surgeon, or anotolaryngologist (an ear, nose, and throat specialist) will lead a surgical team to perform your tonsillectomy in a hospital or possibly an office or clinic setting. The surgery is generally an outpatient procedure, although some patients may need to stay overnight in the hospital for observation.

Surgical approaches to a tonsillectomy

Your surgeon will remove or reduce the size of your tonsils through your mouth. Your surgeon will most likely remove all of your tonsil tissue if you have repeated tonsillitis. Alternatively, your surgeon may only reduce the size of your tonsils if they are enlarged. Your surgeon will determine which type of surgery is best for you or your child.

The types of tonsillectomy approaches include:

• Electrocautery burns off tonsil tissue. It also helps reduce blood loss by cauterization, which seals the blood vessels.
• Harmonic scalpel uses hot ultrasonic energy to vibrate a special blade. The blade cuts tonsil tissues and stops bleeding.
• Laser tonsil ablation (LTA) uses a laser to destroy and remove tonsil tissue.
• Microdebrider reduces the size of the tonsil with a rotary shaving device hooked up to suction.
• Radiofrequency ablation (somnoplasty and coblation) procedures use radiofrequency energy to destroy tonsil tissue.
• Scalpel removal of the tonsils is the most traditional tonsillectomy procedure.

Types of anesthesia that may be used

Your doctor will perform a tonsillectomy using a nerve block or general anesthesia.

• General anesthesia is a combination of intravenous (IV) medications and gases that put you in a special type of sleep. During general anesthesia, you are unaware of the procedure and will not feel any pain.
• Nerve block anesthesia, also known as local anesthesia, numbs the tonsils and nearby area. For local anesthesia, your anesthesiologist, nurse anesthetist, or doctor will inject an anesthetic medication in tissues around the procedure area. You will be awake, but kept as comfortable as possible during this procedure. You will also probably receive a sedative to help you stay relaxed and comfortable.