A tonsillectomy is the surgical removal of the tonsils, the two pads located at either side of the back of the throat. The tonsils serve as part of the immune system, the first line of defense for pathogens entering the mouth or nose. Because of their function, they may become infected or inflamed and, in some cases, may require surgical removal. Tonsillectomies are more commonly performed on children than adults. A tonsillectomy may be necessary when an individual has recurring episodes of tonsillitis or an ongoing infection that has not healed with other treatment. Surgery may also be required if enlarged tonsils block airways, leading to sleep apnea, swallowing problems or difficulty eating. Rarely, a tonsillectomy may be performed to treat a malignancy of the tonsils.
Who Is A Candidate To Have A Tonsillectomy?
Although tonsillectomies used to be commonplace, that’s not the situation any longer. This surgery to remove or dramatically reduce the tonsils is still necessary for some patients, however. There are two types of patients who may need to have a tonsillectomy with Dr. Daneshrad: those who suffer chronic tonsillitis and those who are having sleep apnea due to their enlarged tonsils.
- Chronic tonsillitis — Recurring, chronic tonsillitis is categorized as having at least seven episodes within a year. For longer timeframes, this would be measured as at least five episodes per year in a two-year span or at least three episodes a year over a three-year period.
- Enlarged tonsils— Some people are born with larger than normal tonsils. In others, their tonsils become enlarged after frequent or persistent infections. The size of the tonsils now inhibits airflow. This makes the person more of a mouth breather during the day, especially with exercise. But it usually has the most impact during night when the tissues in the back of the throat relax during sleep. This slackening of tissues combined with the overly large tonsils can block the airway. This is obstructive sleep apnea.
Is Age A Factor For A Person Requiring A Tonsillectomy?
Age itself isn’t the issue, it’s the number of times the child or adult has tonsillitis. If the numbers are chronic, as described above, that is the determinant of whether the person should have their tonsils removed.
The same is true with airway obstruction by the person having enlarged tonsils. This isn’t an age problem, it’s tissue size that matters. Again, the damage that occurs from sleep apnea outweighs the value of a person keeping his or her tonsils.
Tonsillectomy Procedures
Traditionally, tonsillectomies have been performed with a scalpel under general anesthesia during a procedure which usually takes approximately an hour. In recent decades, many types of surgical procedures have become available for use in tonsillectomies. General or local anesthetics may be used, depending upon the method employed. Most patients return home several hours after the operation and are expected to heal within about 2 weeks.
Types Of Tonsillectomies We Offer
Cold Knife Dissection
During a cold knife tonsillectomy, the doctor uses a snare, a knife curved like a circle, to remove the tonsils. This method requires general anesthesia, and approximately 2 weeks of recovery time.
Electrocautery
Using the electrocautery method, the surgeon burns the tonsillar tissue, stemming blood loss through cauterization. While this technique greatly reduces the risk of excessive bleeding, research has shown that the heat employed can damage surrounding tissue and may lead to a more painful recovery.
Coblation
During a coblation tonsillectomy, radio waves are used to ionize a saline solution, energizing the ions enough to enable them to cut through tissue and remove the tonsils. Because this procedure is performed without heat, less postsurgical pain and more efficient healing has been reported.
Microdebrider
This technique is used for a partial tonsillectomy. The microdebrider is a powered rotary shaving device with suction, eliminating the enlarged portion of the tonsil while preserving some tonsillar tissue. A natural biologic dressing is placed over the tonsil in order to prevent inflammation and infection. This procedure has been shown to result in less pain, dehydration and bleeding and a more rapid recovery. Because this procedure leaves part of the tonsil intact, however, it is recommended as a treatment for enlarged tonsils rather than infected ones.
Harmonic Scalpel
In this technique, ultrasonic vibrations are used to simultaneously cut tissue and cauterize the wound. An advantage of this technique is minimal damage to the surrounding tissue since sound waves, rather than heat, are responsible for excision.
Laser Ablation
During laser ablation, a handheld laser device uses carbon dioxide to cut and destroy the tonsillar tissue. This technique reduces tonsil volume and eliminates recesses that collect recurrent infectious bacteria. This procedure is recommended for chronic sufferers of tonsillitis, chronic sore throats, severe halitosis, or airway obstruction caused by enlarged tonsils. The laser tonsil ablation is performed in 15 to 20 minutes under local anesthesia. The patient may experience minimal discomfort and may return to school or work the next day.
Some types of tonsillectomy procedures result in shorter recovery times and less postsurgical soreness, but not all types of surgery are appropriate for all patients.
Risks Of A Tonsillectomy
Although a tonsillectomy is a safe procedure, there are risks involved in any surgery. While a painful sore throat and some bleeding are expected after a tonsillectomy, more serious complications, though rare, may occur. These include:
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medications
- Postsurgical infection
- Breathing problems
While a tonsillectomy will greatly reduce the number of throat infections, it is possible for throat infections to recur after surgery. Additionally, the tonsils may partially grow back after a tonsillectomy, especially if some tonsillar tissue is left at the site.
What Is Recovery Like After A Tonsillectomy?
Unfortunately, these can be relatively painful recoveries. That’s because the area of the tonsils is quite sensitive and has plenty of nerve coverage. It’s important to lay low and stay in bed for several days after your surgery with Dr. Daneshrad. Your throat will, of course, be sore. But you may also have soreness in your jaw, ears, or even your neck. The first two or three days are the hardest; that’s when you really need to lay in bed or on the couch. Dr. Daneshrad will prescribe prescription pain medication.
Staying hydrated is very important, but you don’t want to hurt your throat. If you don’t like the feeling of drinking immediately, slowly dissolving ice chips is a good way to both get some water and to keep your mouth and the surgical area cool. You can eat ice cream, pudding, and yogurt. As soon as you can eat other foods that are easy to chew and swallow, you should bring those back into your diet. Nothing acidic, spicy, crunchy, or hard should even be contemplated, as they can all cause pain and/or bleeding.
You may have swelling in your throat and with your tongue. You may have a feeling of having something stuck in your throat (that’s the swelling). If you swallowed any blood, you’ll likely have some vomiting. Your breath won’t be exactly minty fresh as the tissues heal in the back of your mouth.
What Should You Not Do After Your Tonsillectomy?
You will need to fully avoid strenuous activity for two weeks. This is no time to tough it out. You don’t want to elevate blood pressure to your facial area. You’ll need to avoid any strenuous activity or exercise for two full weeks. This isn’t something to trifle with, as you need to keep blood pressure down to your entire head and face. This helps the tissues begin healing.
Also, as you would assume, you cannot eat anything crunchy, with any sharp angles (pretzels or chips, for instance), and anything spicy. These can all cause bleeding. Most people can return to school or work within two weeks after a tonsillectomy.
Are There Alternatives To Having A Tonsillectomy?
In the 1950s and 60s it was almost standard for children to have their tonsils removed if they had tonsillitis, but today we try and avoid removing the tonsils because of their role in protecting the throat from bacteria and viruses. But with patients with chronic tonsillitis and sleep apnea, this surgery is still a good idea due to the downsides of the problems caused by the tonsils.
Really the only alternative to a tonsillectomy is a partial tonsillectomy, clinically known as an intracapsular tonsillotomy. Dr. Daneshrad also performs these procedures.
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To learn more about Tonsillectomies at the Daneshrad Clinic, call 310.453.6500. We proudly serve patients from Santa Monica, Torrance, Los Angeles and surrounding areas, including Brentwood, Malibu, Culver City, Marina Del Rey, Venice, Pacific Palisades, Manhattan Beach, Redondo Beach, and Palos Verdes.