What Is Tonsillectomy 

Tonsils are small lumps of tissue which are located in the back of your throat. There are two tonsils present, one of each side of your throat, and they help your immune system to fight against infections. 

Tonsillectomy is the surgical removal of these tonsils and it is a common and relatively simple procedure. In the past, tonsillectomies were performed more frequently than they are now. The reasons for needing a tonsillectomy, details about the procedure and its after effects will be discussed in this article below. 

Anatomy and function of tonsils 

As described above, tonsils are located at the back of your throat on either side. They are small and pinkish in colour and if you hold up a mirror to your mouth and open wide, you will be able to see them yourself. They may appear red, inflamed or white if you are currently suffering from a disorder involving the tonsils. 

Tonsils are part of our immune system and they help to protect us against germs and infections. As they are located at the back of the mouth, they can help to stop germs that may enter our bodies through the mouth and nose. This makes them one of the first lines of defence of your body. They are of particular importance during childhood, which is when they are at their largest size. They help children build up a strong immunity, particularly between the ages of 3 and 10.¹

Indications for tonsillectomy 

Your tonsils might need to be surgically removed if they are doing more harm than good to your body. Some reasons for needing this surgery are:

• Tonsils which are large and cause breathing problems in your child especially whilst sleeping. They may partially block the airway and cause snoring and periods of paused breathing which is called obstructive sleep apnea.
• Repeated episodes of infected tonsils, known as tonsillitis. There have been certain guidelines set out by the NHS in order to define how many repeated episodes of tonsillitis will require a tonsillectomy, which can be found here. 
• Any cancer located in the tonsils. If your doctor suspects tonsillar cancer, your tonsils will be removed right away without adhering to the guidelines listed for tonsillitis. 

Preoperative preparation 

Your doctor will instruct you on how to prepare for the surgery and also ask you some questions. These questions might involve asking about any medications you are taking, any known allergies or any family history of allergies (including any allergies to anaesthetic) or bleeding disorders. They might also need to take some blood tests. 

Your doctor might also advise you to change or stop taking any of your usual medications a few days prior to surgery. You will also be advised to not eat or drink anything a few hours prior to your surgery. Tonsillectomies are usually outpatient procedures which means that you wont need to stay in the hospital overnight (unless any complications arise). However, you should expect a recovery time of at least 10-14 days after the surgery. ²

If you are ill, have a bad cough or a high fever on the day of the surgery you should inform your doctor so that they can reschedule. 

Tonsillectomy procedure

This procedure is done under general anaesthesia, which means that you will be asleep. The tonsils are removed through the mouth, so the surgeon will not have to put any incisions (surgical cuts) into your skin. 

There are several ways that tonsils can be removed:

• Traditional Scalpel: This is the widely used surgical steel knife and it can be used to remove the tonsils. After removal, the bleeding will be stopped by sutures (stitches) or electrocautery. 
• Electrocautery: Sometimes, electrocautery itself will be used to both remove the tonsils and stop the bleeding.
• Snare Tonsillectomy: in this method, an instrument known as a snare is used to extract the tonsils. This instrument has a wire loop at the end, which is used to control the bleeding after removing the tonsils.³
• Harmonic Scalpel: this instrument makes use of ultrasonic vibrations in order to remove the tonsils as well as stop the bleeding. 
• Some other methods can also be used such as microdebrider (which involves cutting and suction to stop the bleeding), carbon-dioxide lasers and radiofrequency ablation (a procedure which uses heat to remove the tonsils). 

Tonsillectomies can generally take about 30 minutes to one hour. There are two types of tonsillectomies; the traditional method involves complete removal of both tonsils (total tonsillectomy) and the second one is known as intracapsular tonsillectomy.⁴ This procedure is also known as partial tonsillectomy. In this method, the surgeon will remove most of the affected tonsil tissue but will leave a thin layer of tissue behind in order to prevent the exposure of underlying blood vessels and muscle. The advantages of this surgery include: 

• Shorter healing time
• Lesser pain 
• Able to consume food and drink sooner after the operation
• Less risk of bleeding

With the intracapsular tonsillectomy, there is a chance that the tissue left behind might regrow or contract an infection but this is a very slim chance.⁴

Recovery and postoperative care

After the operation, you will be transferred to the recovery area, where your heart rate, oxygen saturation and blood pressure are carefully monitored. Your doctor will provide you with pain medications which need to be taken regularly in the beginning.  It is important to consume lots of fluid and stay hydrated, but remember to start off with small sips and then larger quantities of fluid. You can start off with soft and bland food such as yoghurt, ice cream and mashed potatoes and then slowly start to build up to solid food once your pain levels decrease. Strenuous activity should be avoided the first few days after surgery.

You might experience a little pain in your throat, voice hoarseness, bad breath, swelling or a low grade fever immediately after your operation. These symptoms are considered normal and should go away within a few days. At times, you may experience vomiting or even vomit up some dark brown blood which is the blood swallowed during surgery. This is not a very common occurrence but it is still normal. 

Complications and risks 

Tonsillectomy surgeries are relatively straightforward procedures but, as with any surgery, there are some risks involved which can include:⁵

• There is a risk of infections but postoperative infections are rare
• Excessive bleeding during surgery which might increase your stay at the hospital. Bleeding after the surgery is also a risk. 
• Excessive swelling in the tongue and back of the mouth causing breathing problems
• People might experience drowsiness, nausea and headaches due to the anaesthesia but these symptoms are minor and will go away. Rarely, a person might have a poor reaction to anaesthesia and become very ill. 
• Excessive nausea and vomiting
• The surgeon might accidentally chip your teeth during the procedure, but this is also a very rare occurrence 

It is advised that you seek immediate medical attention if you experience any bright red bleeding from your mouth or nose after surgery, have very high fever, have problems with your breathing or start to show signs of dehydration. You should also call your doctor if your pain does not subside after a couple of weeks or if it starts to get worse.

Comparisons with other treatments 

Although tonsillectomies are not considered to be very complicated procedures, at times the risks involved in the surgeries can outweigh the benefits. Young age, advanced age, and later stages of pregnancy are some examples of the conditions in which your doctor might advise you against surgery or ask you to consider delaying it to a later date. 

If your tonsils are not causing too many disruptions to your life, and there are no breathing difficulties, you and your doctor might agree to simply “wait and watch”. At times, a course of antibiotics might be prescribed for any infection in the tonsils. Tonsils decrease in size with age, so simply waiting might help to resolve any minor tonsil problems.⁶

As discussed above, partial tonsillectomy might be preferred over total tonsillectomy.⁴ This has shown to provide several advantages over more traditional methods and should also be explored as an alternate option. 

Summary

Tonsils are an important tissue located at the back of your throat which play an important role in protecting us against germs and infections. They also help children to build up their immunity. 

At times, tonsils might get infected too many times or become enlarged and cause disruption to your sleep. If this happens, your doctor might opt to remove them altogether. There are many different methods to remove tonsils and your doctor will aim to choose which method is safest for you. You and your doctor can discuss if total tonsillectomy is needed or if partial tonsillectomy can be done instead, as this method has better postoperative results.

The risks of this surgery are minimum but there are some complications which can arise. Bleeding and infection are the most common complications and your doctor will take care to minimise these risks during and after the surgery.

After your surgery, your throat might feel sore for a week or so and you might experience other minor symptoms. It is important to recognise any danger signs which may occur after surgery and immediately seek medical attention. 

Overall, tonsillectomies are very common and simple procedures that are widely practised by doctors all over the world. They are relatively safe with minimum risks and few long term side effects.