12 April 2011

Tonsils and Tonsillectomy

What are tonsils and adenoids?

The tonsils are two clumps of tissue, on either side of the throat, embedded in a pocket at the side of the palate (roof of the mouth). The lower edge of each tonsil is beside the tongue...way in the back of the throat. The adenoids are a single clump of tissue in the back of the nose (nasopharynx). They are located (in the adult) on the back wall of the throat (pharynx)...about one inch above the uvula (the little teardrop shaped piece of tissue that hangs down in the middle of the soft palate).
What function do they serve? Aren't they important?
The tonsils and the adenoids are mostly composed of lymphoid tissue, which is found thoughout the gastointestinal tract and on the base of the tongue. Lymphoid tissue is composed of lymphocytes...which are mostly involved in antibody production. Since we generally consider antibody production to be a good thing, many studies have been performed to try to clarify the importance of the tonsils. There seems to be no adverse effect on the immune status or health of patients who have had them removed.

Q. What is tonsillitis?
A. Tonsillitis is an infectious condition of the tonsils.
Q. What are the symptoms of tonsillitis?
A. Symptoms of tonsillitis include frequent throat and ear infections or obstructed breathing.
Q. Who gets tonsillitis?
A. Though tonsillitis can occur at any age, seventy percent of the patients who have tonsillectomies are under 18.
Q. Can tonsillitis be treated with antibiotics?
A. Antibiotics are frequently effective in treating tonsillitis; however, your physician may suggest a tonsillectomy if antibiotics are no longer combating the illness.
Q. Is tonsillitis contagious?
A. Yes. All forms, bacterial or viral, are contagious. It usually spreads from person to person by contact with the throat or nasal fluids of someone who is already infected.
Q. How can I avoid getting tonsillitis?
A. Wash your hands frequently and keep the infected person's eating utensils and drinking glasses away from yours.
Q. How many times do you have to get tonsillitis before considering a tonsillectomy?
A. It is not possible to give an exact number of infections needed before a tonsillectomy should be considered because each person is different. However, general guidelines suggest that individuals who have five or more throat infections in one year would probably benefit from a tonsillectomy.
Q. What is a tonsillectomy?
A. A tonsillectomy is the surgical removal of tonsils, most often due to chronic infection.
Q. Is the surgery painful?
A. The patient is under a general anesthetic during the surgical procedure.
Q. How long does the patient have to stay in the hospital following a tonsillectomy?
A. Tonsillectomies are usually performed on an outpatient basis (does not require an overnight hospital stay).
Q. Will a tonsillectomy eliminate sore throats?
A. Surgery will not eliminate throat infections, but will likely decrease the frequency of occurrence.
Q. Are tonsillectomies rare?
A.surgical removal of the tonsils is one of the most frequently performed procedures of the throat.
Q. When will my child be able to return to school?
A. Patients usually return to school after about one week, and vigorous physical activity may be resumed at that time also. However, you and your doctor should determine when your child is ready for normal activity.

Indications for tonsillectomy
  • Absolute indications
  • # Enlarged tonsils that cause upper airway obstruction, severe dysphagia, sleep disorders, or cardiopulmonary complications
    # Peritonsillar abscess that is unresponsive to medical management and drainage documented by surgeon, unless surgery is performed during acute stage
    # Tonsillitis resulting in febrile convulsions
    # Tonsils requiring biopsy to define tissue pathology

  • Relative indications
    # Three or more tonsil infections per year despite adequate medical therapy
    # Persistent foul taste or breath due to chronic tonsillitis that is not responsive to medical therapy
    # Chronic or recurrent tonsillitis in a streptococcal carrier not responding to beta-lactamase-resistant antibiotics.
Contraindications: Contraindications for tonsillectomy include the following:
  • # Bleeding diathesis
    # Poor anesthetic risk or uncontrolled medical illness
    # Anemia
    # Acute infection

How is tonsillectomy done?

While the patient is under general anesthesia, the ear-nose-throat (ENT) surgeon holds the mouth open to expose the tonsils. The tonsils are then cut away with an instrument or a cautery (burning instrument). Bleeding is controlled, and the cut heals naturally without stitches.
Tonsillectomy: Expectations after Surgery
In most cases, the surgery clears problems immediately. After surgery, the number of throat infections is reduced, but not completely eliminated.
Tonsillectomy: Convalescence & Recovery
Tonsillectomy is usually done on an outpatient basis, with the patient returning home the same day as the surgery. Rarely, patients are observed overnight in the hospital and return home the day after the surgery. Complete recovery can take 2 weeks.
Expect some throat and ear pain in the first days following surgery. The use of ice packs to relieve pain may be helpful, and sucking on an ice cube or eating ice cream may provide adequate comfort. In addition, pain-relief medication may be prescribed. During recovery, it is recommended to eat soft, easy-to-swallow food and to drink a lot of cold fluids.
The use of humidifier at home can also bring some comfort. Your child may experience alternating "good and bad" days for 2 weeks after surgery. It is a good idea to keep your child away from crowds or ill people for 7 days, since the throat is highly susceptible to infections during this period
Tonsillectomy: Risks
  • Risks for any anesthesia include the following:
  • - Reactions to medications
    - Breathing problems
  • Risks for any surgery include the following:
    - Bleeding
    - Infection
In rare instances, post-surgical bleeding can go unnoticed and can cause serious consequences. Frequent swallowing may be a sign of bleeding from tonsils.
New techniques
Various newer techniques for tonsillectomy have been described and are in use, including ultrasonic dissection, cold ablation, laser tonsillectomy, and diathermy tonsillectomy. These are currently being assessed, and possible benefits and harms have not yet been fully evaluated.

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