Tonsils & Adenoids
TONSILLECTOMY & ADENOIDECTOMY
Tonsils are clumps of lymph tissue forming a ring around the back of the mouth. The two clumps we can see on the sides are called the palatine tonsils. Back behind and below the tongue are the lingual tonsils. Finally, hidden by the palate, directly behind the nose are the lumps we call adenoids. The lymphatic system is the backbone of the immune system. The lymph clumps in the back of the mouth are a small fraction of the body's supply. They can be safely removed without any known damage to the immune system.
There are only a few reasons currently recognized for removing tonsils. The most common is damage from repeated infections causing reinfection from within themselves. Damaged tonsils flare up painfully three or more times a year. They may or may not have 'white' material in them. The white material often visible is food residue and is normal in the tonsil.
Tonsils are sometimes removed when they cause obstruction. Obstructive symptoms can happen when the rapid growth of the lymphatic system during the first seven years occurs in children with a small throat and shallow sockets for the tonsils. Tonsils can appear to block the breathing and swallowing space. This is somewhat of an illusion because the act of opening the mouth widely pushes in the sidewalls of the throat to make it much narrower than it would be with the mouth closed. Still, there is a consensus among surgeons that children who snore loudly and who pause in their breathing at night for more than 5 seconds spell probably benefit from tonsillectomy. Adenoidectomy (removal of the adenoids) can be done at the same time if the adenoids block the back of the nose.
Finally, those who have suffered from a peritonsillar abscess... a dramatic and painful infection... are better off without their tonsils, since they have a high chance of having repeated abscesses. Frequent strep infections (meaning positive cultures), frequent colds, poor appetite, dental development problems are NOT reasons for surgery. They might have been considered necessary in the past, but the careful follow-up has NOT shown that tonsillectomy helps any of these conditions. The need for tubes in children who have frequent ear trouble is very little affected by adenoidectomy. Those who advocate adenoidectomy for these children STILL place the tubes at the same time!
While most tonsillectomies are performed on children, adults often need this procedure as well. There is a misconception that it is a worse procedure in adults than children. The fact is that children don't complain and adults do... bitterly! Adults take relatively the same amount of pain medicine as children. Tonsillectomy is safer in adults. There's no need to rush into the operation in childhood because it's worse later or avoid the operation in adult life because it's unusually dangerous. I perform tonsillectomy with or without adenoidectomy under general anesthesia. The patients usually go home the same day.
There are many ways to remove tonsils and adenoids. I have, in the past, relied on a classical wire loop technique. I tried lasers. The laser makes the operation more complicated and a hazard to the patient, operating room staff, and surgeon. Early claims that laser tonsillectomy would be 'bloodless', painless and faster healing haven't proven true. I currently use an ultra-precision microscopic technique developed in Europe. The typical patient we operate on parts with more blood having their pre-operative testing than during surgery.
Eighty percent of our adult patients tell us that the pain after surgery isn't worse than what they experienced during the infections which led up to the surgery. We provide pain medication to help with the initial painful period, usually five days.
When a tonsil is removed, a raw spot is left in the throat. Occasionally, the raw place oozes a little blood afterward. If nothing is done, the bleeding usually stops. I prefer, however, to take the patient back to the operating room and directly stop the bleeding. In this way, we avoid the anxiety of wondering whether this time the bleeding might not stop. I have the same or less post-surgical bleeding than other surgeons doing this procedure. The general incidence is about 3%. Mine has been lower. I am, however, more aggressive than is typical in bringing the patient back to the operating room for control of bleeding when it happens.