Tonsillectomy Procedures

Unfortunately, there may be a time when medical therapy (antibiotics) fails to resolve the chronic tonsillar infections that affect your child. In other cases, your child may have enlarged tonsils, causing loud snoring, upper airway obstruction, and other sleep disorders. The best recourse for both these conditions may be the removal or reduction of the tonsils and adenoids. The American Academy of Otolaryngology—Head and Neck Surgery recommends that children who have three or more tonsillar infections a year consider a tonsillectomy; the young patient with a sleep disorder should be a candidate for removal or reduction of the enlarged tonsils.

When Is a Tonsillectomy Performed?

A tonsillectomy may be recommended for recurrent tonsillitis, chronic tonsillitis, a recurrent throat infection, frequent infections, bad breath, or enlarged tonsils causing mouth breathing, obstructive sleep disordered breathing, or obstructive sleep apnea. The palatine tonsils contain lymphoid tissue that supports the immune system, but their removal generally does not significantly affect immune function. An otolaryngology head and neck specialist will review symptoms, examination findings, and family history according to the appropriate clinical practice guideline.

This outpatient procedure is a form of head and neck surgery. It is a surgical procedure performed under general anesthesia to complete the surgical removal of tonsils from the oral cavity. Available tonsil surgery options include electrocautery tonsillectomy, intracapsular tonsillectomy, and partial tonsillectomy. The surgeon will explain the recommended surgical technique, including hot versus cold tonsillectomy, management of the tonsillar capsule, and available anaesthetic techniques.

Patients undergoing tonsillectomy may feel pain in the throat, ears, jaw, or head/neck area afterward. Postoperative pain is managed with appropriate pain medication. Pain medicine will be tailored to your procedure and comfort. Recovery varies, but the surgeon will explain what to expect from the healing process and final tonsillectomy results.

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Everyone was friendly, professional and respectful. I was made to feel comfortable and confident in the Doctor and her assistant. I feel that I am in good hands with Dr. Rasband.

I had a severely obstructive scar tissue band removed from my right nasal cavity as well as a turbinate reduction. My surgery with Dr. Rasband was 1 month ago and I am LOVING the outcome! Just a few days after surgery, I was breathing 100% better. Dr. Rasband provided me with some cool pictures of the surgery. Recovery was quite easy, I was actually able to attend a work meeting the next day in office. I saw her a few times since then for post-op appointments. No re-adherence of the scar tissue band, and I am breathing 100% better. It’s amazing to have both sides of my nose open!

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Tonsillectomy Surgical Procedure

The first report of tonsillectomy was made by the Roman surgeon Celsus in 30 AD. He described scraping the tonsils and tearing them out or picking them up with a hook and excising them with a scalpel. There are now other procedures available – the choice may be dictated by the extent of the procedure and other considerations such as pain and post-operative bleeding. A quick review of each procedure follows:

• Cold knife (steel) dissection: The procedure requires the patient to undergo general anesthesia; the tonsils are completely removed with minimal post-operative bleeding.
• Electrocautery: Electrocautery burns the tonsillar tissue and assists in reducing blood loss through cauterization.
• Harmonic scalpel: This medical device uses ultrasonic energy to vibrate its blade at 55,000 cycles per second. Invisible to the naked eye, the vibration transfers energy to the tissue, providing simultaneous cutting and coagulation. Proponents of this procedure assert that the end result is precise cutting with minimal thermal damage.
• Bipolar Radiofrequency Ablation (Coblation): This procedure produces an ionized saline layer that disrupts molecular bonds without using heat. As the energy is transferred to the tissue, ionic dissociation occurs. This mechanism can be used to remove all or only part of the tonsil. It is done under general anesthesia in the operating room and can be used for enlarged tonsils and chronic or recurrent infections. The advantages of this technique are less pain, faster healing, and less post-operative care.

Consult with an otolaryngologist regarding the optimum procedure to remove or reduce your tonsils and adenoids.

Tonsillectomy and Adenoidectomy Surgery For Tonsils and Adenoids

Your child: Talk to your child about his/her feelings and provide strong reassurance and support throughout the process. Encourage the idea that the procedure will make him/her healthier. Be with your child as much as possible before and after the surgery. Tell him/her to expect a sore throat after surgery. Reassure your child that the operation does not remove any important parts of the body and that he/she will not look any different afterward. If your child has a friend who has had this surgery, it may be helpful to talk about it with that friend.

Adults and children: For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye’s syndrome).

• If the patient or patient’s family has had any problems with anesthesia, the surgeon should be informed. If the patient is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the surgeon should be informed.
• A blood test and possibly a urine test may be required before surgery.
• Generally, after midnight before the operation, nothing (chewing gum, mouthwashes, throat lozenges, toothpaste, water) may be taken by mouth. Anything in the stomach may be vomited when anesthesia is induced, and this is dangerous.

When the patient arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet with the patient and family to review the patient’s history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.

After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient until discharge. Every patient is special, and recovery times vary for each individual. Many patients are released after 2–10 hours. Others are kept overnight. Intensive care may be needed for select cases.

Your ENT specialist will provide you with the details of pre-operative and postoperative care and answer any questions you may have.

After Tonsillectomy Surgery

Several postoperative symptoms may arise. These include (but are not limited to) swallowing problems, vomiting, fever, throat pain, and ear pain. Occasionally, bleeding may occur after surgery. If the patient has any bleeding, your surgeon should be notified immediately.

Any questions or concerns you have should be discussed openly with your surgeon, who is there to assist you.

Frequently Asked Questions About Tonsillectomy

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