Tonsillectomy: Pros and Cons

People do not always take time to understand the function of the tonsils.  Many will be surprised to learn that the tonsils and adenoids are the body’s first line of defense as part of the immune system.  Further, the Mayo Clinic states that tonsils produce disease-fighting white blood cells which make them vulnerable to infection and inflammation.  Interestingly, the mainstream perspective on tonsils has changed over the years.  Mayo Clinic tells that at one time it was a common procedure to treat infection and inflammation of tonsils whereas now the procedure is intended for sleep-disturbed breathing but may still be used as treatment when tonsillitis happens frequently or does not respond to other treatments.

The decision on whether or not to do a tonsillectomy comes down to weighing the risks versus the benefits.  According to the American Academy of Otolaryngology – Head and Neck Surgery, sometimes the tonsils become infected and can be more of a liability than asset since they can cause airway obstruction or repeated bacterial infections.  In cases where tonsils are enlarged, you can expect the doctor to talk about problems related to the ears nose and throat and examine your head and neck.  He may have a small mirror or flexible lighted instrument in hand to assist him in viewing those areas.  Other avenues to check the tonsils include taking a medical history, doing a physical examination, throat cultures or strep tests to see if there is an infection in the throat, x-rays to find out the size and shape of the adenoids, blood tests to determine if there are infections like mononucleosis or running a sleep study or polysomnogram to see if sleep disturbance is happening as a result of large tonsils.

Anyone with tonsillitis, or infection of the tonsils, should consider tonsillectomy.  If you have tonsillitis, you know it.  Symptoms are obvious and include redder than usual tonsils, white or yellow coating on the tonsils, a subtle voice change from swelling, sore throat sometimes in conjunction with ear pain, discomfort when swallowing, swelling of the lymph nodes or glands in the neck, fever or difficulty breathing through the nose.

While bacterial infections of the tonsils can be managed with antibiotics, removal of the tonsils is advised if infections are recurrent.  It would be wise to consult with an otolaryngologist who can answer any questions you have about the procedure.  Preparation is straightforward.  The American Academy of Otolaryngology – Head and Neck Surgery states that two weeks before surgery, you should refrain from taking aspirin or medications that contain aspirin as well as stop taking any medications that may interfere with clotting.  It would be beneficial to see your primary care doctor to be sure you are in good shape for the surgery.

Recovery time varies but you can count on an ENT specialist before, during and after the procedure for the best care.  People are susceptible to a few post-operative troubles like swallowing problems, fever, throat pain, ear pain, vomiting and occasional bleeding from the mouth or nose.  For the best prognosis, take care of yourself.  A key message is to drink liquids in order to avoid dehydration and take pain medications as prescribed.  Pain after surgery can range from mild to severe and kids often report referred pain in their ears, jaw or neck.

The discomfort does not last forever.  Breathing returns to normal when swelling goes down in 10 to 14 days.  You can gradually increase your activity level and once you have returned to your normal diet and hydration routine, pain medication is no longer needed and you can sleep through the night, you are safe to return to work or school.  If you have any concerns, address them with your doctor.  Some people are afraid to eat because of throat pain and may lose weight which they eventually gain back.

The procedure is different for everyone.  Cold knife or steel dissection is the most common method which involves a scalpel to remove the tonsils with minimal post-operative bleeding.  Monopolar cautery or electrocautery causes less bleeding and is preferred.  That method burns tonsillar tissue and aims to reduce blood loss, though heat can cause thermal injury to surrounding tissue and cause discomfort after the operation.  Carbon dioxide laser or laser tonsil ablation is another option which is recommended for chronic recurrent tonsillitis or airway obstruction from large tonsils.  It is completed in 15 to 20 minutes under local anesthesia and people can usually go back to work or school the next day.  Laser technology is a major advance which translates to less pain during recovery and therefore less sleep disturbance and less need for medications.  A final option is bipolar radiofrequency ablation or coblation in which an ionized saline layer that disrupts molecular bonds without using heat is applied.  The advantage is that it can remove all or part of the tonsil while invoking less pain, faster healing and less post-operative care.  Be sure to investigate all of your options before making a decision that can impact your health.


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Jamie is a staff writer for Health&Wellness magazine.

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