Tonsillectomy
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
|
WikiDoc Resources for Tonsillectomy | |
|
Articles | |
|---|---|
|
Most recent articles on Tonsillectomy Most cited articles on Tonsillectomy | |
|
Media | |
|
Powerpoint slides on Tonsillectomy | |
|
Evidence Based Medicine | |
|
Clinical Trials | |
|
Ongoing Trials on Tonsillectomy at Clinical Trials.gov Trial results on Tonsillectomy Clinical Trials on Tonsillectomy at Google
| |
|
Guidelines / Policies / Govt | |
|
US National Guidelines Clearinghouse on Tonsillectomy NICE Guidance on Tonsillectomy
| |
|
Books | |
|
News | |
|
Commentary | |
|
Definitions | |
|
Patient Resources / Community | |
|
Patient resources on Tonsillectomy Discussion groups on Tonsillectomy Patient Handouts on Tonsillectomy Directions to Hospitals Treating Tonsillectomy Risk calculators and risk factors for Tonsillectomy
| |
|
Healthcare Provider Resources | |
|
Causes & Risk Factors for Tonsillectomy | |
|
Continuing Medical Education (CME) | |
|
International | |
|
| |
|
Businness | |
|
Experimental / Informatics | |
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [1] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Overview
A tonsillectomy is a surgical procedure in which the tonsils are removed. Sometimes the adenoids are removed at the same time.
Reasons for tonsillectomy
Tonsillectomy may be performed when the patient:
- Experiences frequent bouts of acute tonsillitis. The number requiring tonsillectomy varies with the severity of the episodes. One case, even severe, is generally not enough for most surgeons to decide tonsillectomy is necessary.
- Has chronic tonsillitis, consisting of persistent, moderate-to-severe throat pain.
- Has multiple bouts of peritonsillar abscess.
- Has sleep apnea (stopping or obstructing breathing at night due to enlarged tonsils or adenoids)
- Difficulty eating or swallowing due to enlarged tonsils
Common Causes and Demographics
Infections requiring tonsillectomy are often a result of Streptococcus ("strep throat"), but some may be due to other bacteria, such as Staphylococcus, or viruses. However, the etiology of the condition is largely irrelevant in determining whether tonsillectomy is required [1].
Most tonsillectomies are performed on children, although many are also performed on teenagers and adults. The number of tonsillectomies in the United States has dropped significantly from several million in the 1970s to approximately 600,000 in the late 1990s. This has been due in part to more stringent guidelines for tonsillectomy and adenoidectomy (see tonsillitis and adenoid). Still, debate about the usefulness of tonsillectomies continues. Not surprisingly, the otolaryngology literature is usually pro-tonsillectomy, whereas the pediatric literature has the opposing view. Enlarged tonsils are being removed more often among adults and children for sleep apnea (airway obstruction while sleeping), snoring, and upper airway obstruction. Children who have sleep apnea can do poorly in school, are tired and fatigued during the day, and have some links to ADHD [1] [1].
Tonsillectomy in adults is more painful than in children, although each patient will have a different experience. In adults it can be extremely painful often referred to as more painful than child birth. Post-operative recovery can take from 10 up to 20 days, during which narcotic analgesics are typically prescribed. Most surgeons advise eating soft foods after having your tonsils removed. Some believe that dairy products tend to coat the throat and therefore discourage their use. Spicy and acidic foods are irritating, and should be avoided. Proper hydration is also very important during this time, since dehydration can increase throat pain, leading to a vicious cycle of poor fluid intake. At some point, most commonly 7-11 days after the surgery (but occasionally as long as two weeks (14 days) after), bleeding can occur when scabs begin sloughing off from the surgical sites. The overall risk of bleeding is approximately 1-2% higher in adults [1]. Approximately 3% of adult patients develop significant bleeding at this time. The bleeding might naturally stop quickly, or else mild intervention (e.g., gargling cold water) could be needed. Otherwise, a surgeon must repair the bleeding immediately by cauterization, which presents all the risks associated with emergency surgery (most having to do with the administration of anesthesia on a patient whose stomach is not empty). Various procedures are available to remove tonsils, each with different advantages and disadvantages. Children and teenagers sometimes exhibit a noticeable change in voice [1] after the operation [1] [1].
Methods of tonsil removal
The first report of tonsillectomy was made by the Roman encyclopedist 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. Today, the scalpel is still the preferred surgical instrument of many ear, nose, and throat specialists. However, there are other procedures available – the choice may be dictated by the extent of the procedure (complete tonsil removal versus partial tonsillectomy) and other considerations such as pain and post-operative bleeding. A quick review of each procedure follows:
- Dissection and snare method: Removal of the tonsils by use of a forceps and scissors with wire loop called 'snare' is the most common method practiced by otolaryngologists today. 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. Research has shown that the heat of electrocautery (400 C) results in thermal injury to surrounding tissue. This may result in more discomfort during the postoperative period.
- 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. The temperature of the surrounding tissue reaches 80 C. Proponents of this procedure assert that the end result is precise cutting with minimal thermal damage.
- Radiofrequency ablation: Monopolar radiofrequency thermal ablation transfers radiofrequency energy to the tonsil tissue through probes inserted in the tonsil. The procedure can be performed in an office setting under light sedation or local anesthesia. After the treatment is performed, scarring occurs within the tonsil causing it to decrease in size over a period of several weeks. The treatment can be performed several times. The advantages of this technique are minimal discomfort, ease of operations, and immediate return to work or school. Tonsillar tissue remains after the procedure but is less prominent. This procedure is recommended for treating enlarged tonsils and not chronic or recurrent tonsillitis.
- Thermal Welding: A new technology which uses pure thermal energy to seal and divide the tissue. The resulting absence of thermal spread means that the temperature of surrounding tissue is only 2-3 degrees C higher than normal body temperature. Clinical papers show patients with minimal post-operative pain (no requirement for narcotic pain-killers), zero edema (swelling) plus almost no incidence of bleeding. Hospitals in the US are advertising this procedure as "Painless Tonsillectomy". Also known as Tissue Welding.
- Carbon dioxide laser: Laser tonsil ablation (LTA) finds the otolaryngologist employing a hand-held CO2 or KTP laser to vaporize and remove tonsil tissue. This technique reduces tonsil volume and eliminates recesses in the tonsils that collect chronic and recurrent infections. This procedure is recommended for chronic recurrent tonsillitis, chronic sore throats, severe halitosis, or airway obstruction caused by enlarged tonsils.
The LTA is performed in 15 to 20 minutes in an office setting under local anesthesia. The patient leaves the office with minimal discomfort and returns to school or work the next day. Post-tonsillectomy bleeding may occur in two to five percent of patients. Previous research studies state that laser technology provides significantly less pain during the post-operative recovery of children, resulting in less sleep disturbance, decreased morbidity, and less need for medications. On the other hand, some believe that children are adverse to outpatient procedures without sedation.
- Microdebrider: The microdebrider is a powered rotary shaving device with continuous suction often used during sinus surgery. It is made up of a cannula or tube, connected to a hand piece, which in turn is connected to a motor with foot control and a suction device.
The endoscopic microdebrider is used in performing a partial tonsillectomy, by partially shaving the tonsils. This procedure entails eliminating the obstructive portion of the tonsil while preserving the tonsillar capsule. A natural biologic dressing is left in place over the pharyngeal muscles, preventing injury, inflammation, and infection. The procedure results in less post-operative pain, a more rapid recovery, and perhaps fewer delayed complications. However, the partial tonsillectomy is suggested for enlarged tonsils – not those that incur repeated infections.
- 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. This causes removal of tissue with a thermal effect of 45-85 C. It has been claimed that this technique results in less pain, faster healing, and less post operative care [1]. However, review of 21 studies gives conflicting results about levels of pain, and its comparative safety has yet to be confirmed [1].
See also
External links
- Insight Into Tonsillectomy and Adenoidectomy
- Tonsillectomy Procedures
- drtbalu otolaryngology on line
References
de:Tonsillektomie
fr:Tonsillectomie
id:Tonsilektomi
it:Tonsillectomia
nl:Tonsillectomie
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
