Tonsillectomy

About Tonsillectomy

Tonsillectomy is the surgical removal of the palatine tonsils and is one of the most common operations in children. It is often combined with removal of the adenoids, an adenotonsillectomy. The main indications have shifted over time from recurrent throat infections to sleep disordered breathing and obstructive sleep apnea caused by enlarged tonsils and adenoids. For recurrent infection, guidelines use criteria such as the Paradise criteria, which consider how frequent and well documented episodes of tonsillitis have been. In adults, indications include recurrent tonsillitis, peritonsillar abscess, also called quinsy, tonsil enlargement contributing to sleep apnea, persistent tonsil stones with bad breath, and asymmetric enlargement raising suspicion of cancer. The operation is performed through the mouth under general anesthesia. Techniques include cold steel dissection, electrocautery, coblation, which uses radiofrequency energy in saline, and the harmonic scalpel, and each balances bleeding during surgery against postoperative pain and later bleeding. Intracapsular or partial tonsillectomy, which leaves a thin rim of tissue, is used particularly in children with sleep apnea and may cause less pain, though regrowth can occur. Recovery involves throat pain that is often more severe and prolonged in adults than in children, along with ear pain referred from the throat. The most serious complication is bleeding, either within the first day or later when the healing scabs separate, which can be life threatening and is treated as an emergency. Other complications include dehydration from reduced drinking and, rarely, changes in voice quality.