General Information about Tonsillectomy

	Tonsillectomy, in simple terms is the surgical removal of tonsils; two masses of tissue located one on either side, at the back of the throat.
Usually, only the tonsils are removed. However, in some cases, it might be necessary to remove the adenoids, which are located by the side of the tonsil.

What are tonsils and adenoid?

Tonsils (also called palatine tonsils) are two masses of lymph type of tissues located on both sides of the back of the throat.

Adenoids (also called pharyngeal tonsil) are also types of tissues lying by the side but extend sometimes higher up almost behind the nose.

Both these play an important role in fighting the infections in the body; they are believed to produce antibodies against the bacteria, which enter through the nose and the mouth. But if these become infected or enlarged, the normal breathing and drainage is affected, leading to serious health harm.

Anatomy and Physiology (Medical / dental students) 
Tonsils are two oval pads of tissues that are on either side of the throat and project out into it.

The uvula is what we see dangling down from the soft palate between the tonsils.

They are very vascular mainly to help them fight infections and are supplied by the External Carotid artery.

The nerve supply is from the 9th Cranial nerve. This nerve also supplies to certain parts of the ear, which would explain why patients complain of ear pain after tonsillectomy.

The adenoids are lymphoid tissue at the back of the nose in the area above the throat called the nasopharynx. We cannot see this when we look in the mirror because it sits above the soft palate, to be exact though there is only one adenoid.

Symptoms And Complications - Need for Surgery
Tonsillitis is seen when the tonsils are inflamed, the condition is diagnosed when the tonsils are red and enlarged. There is presence of pus, and is accompanied by fever, Sore throat, pain in swallowing, and swelling in the neck lymph nodes. Infected tonsils and adenoids block the normal breathing of a person and the drainage of the sinuses, thereby causing harm to other parts of the body. Like speaking, block the tube, which maintains the balance between the ears, leading to hearing loss. More common in children than adults, with the growth of the child the tonsil along with the adenoids tend to atrophy, that means to say they lose their usefulness and just exist as a nonentity.

Preparing the patient for anesthesia and surgery 
  Aspirin and Ibuprofen products should not be given for at least 2 weeks before operation.

It is important to notify the doctor if the child/patient has personal or family history of bleeding tendencies.

Blood testing is not routinely done in children before surgery unless there are special medical circumstances.

Generally, 8-10 hrs before to the operation, no food or liquids may be taken by mouth, including chewing gum, mouthwashes, throat lozenges, toothpaste, water. Anything in the stomach may be vomited when anesthesia is induced. However this is dangerous. Depending on the age of the child, a clear liquid such as water or fruit juice may be given until 4-5 hrs before.

  If it's a child it is important to reassure and also tell him off the possibilities of a sore throat even after surgery for a couple of days.

The surgery is usually done under either general or local anesthesia.

Give children a lot of support and assistance and be there for them emotionally and physically.

Tonsillectomy - Procedures
Operation is performed in the hospital by a specialist Ear Nose and Throat surgeon (Otolaryngologist). The operation is done through the patient's mouth, and the tongue is kept depressed with a surgical instrument called "Davis Gag" which keeps mouth open and the tongue depressed. During the procedure the surgeon removes the tonsils from the side of the throat by carefully scraping away using a special tweezers. Stitches during this procedure are very few to nil, as there are no cuts or incisions here. It usually lasts about 30-45 minutes. Tonsils are removed alone, though sometimes if found to be inflamed and infectious the adenoids are to be removed much in the same procedure using a using an instrument called "St Clair Thomson's Adenoid Curette". The operation then is called Adenotonsillectomy.

Post Operative Care & Complications

	First and foremost the patient is kept with their head low and lying to one side.
At no time would they be permitted to lie on their back or be left unattended till they regain consciousness.

Complications in this operation are very rare, usually seen in the form of bleeding almost immediately, or after several days. This is a very minor complication, which is easily corrected by the surgeon, but the patient is always advised to contact immediately after noticing the bleed.

No diet restrictions are imposed on the patient following surgery. The sooner the patients start eating solid food, the better for them. They should follow a simple diet of soft foods and liquids, for the first one to two days. There is no restriction in activity if the patient fells up to it. The patient might start to snore and tends to breathe through his mouth, due to pain, for a few days, which is normal.

In the week that follows the surgery, the patient will and might have some moderate to mild pain in the throat and ear, along with fever, nausea and vomiting. Sometimes especially in children there could be a slight change in the sound of the voice. Formation of thick white scabs over the place where the tonsil were removed can be seen. This is however normal, and might cause bad breath. There is no reason to worry, as it will fall off in about 10 days. In most cases, the patient swallows it unknowingly.

Follow-up is important after 7-10 days to 2 weeks, and it is advisable to definitely keep the appointment.

Tonsillectomy - Recovery
The maximum hospitals stay for this operation is about 8 to 10 hrs, or till the patients recover from anesthesia. Infact some patients even prefer to undergo the operation as an outpatient, but some might require an overnight stay, depending on their general well being. Regular pain relief formulation, including paracetamol and an anti inflammatory, such as ibuprofen ("Brufen") or diclofenac ("Voltaren") is prescribed for ten days, to make the post operative course as comfortable as possible. Ice cream and cold juices helps in soothing the child on way to recovery. Two weeks off work or school is usually necessary for full recovery.

Tonsillectomy - FAQs
1. What are tonsils? 
Tonsils are glands located on the right and left sides of the entrance to the throat.

2.What do tonsils do?
The role of the tonsils is to protect against infection.

3.What is tonsillitis? 
Tonsillitis is an infectious condition of the tonsils.

4.What are the symptoms of tonsillitis? 
Symptoms of tonsillitis include frequent throat, pain while swallowing, fever, swelling in the neck lymph nodes and ear infections or obstructed breathing.

5.Who gets tonsillitis?
Though tonsillitis can occur at any age, seventy percent of the patients who have tonsillectomies are under 18.

6.Can tonsillitis be treated with antibiotics?
  Antibiotics are quite often effective in treating tonsillitis, however the physician may suggest a tonsillectomy if antibiotics are no longer combating the illness.

7.Is tonsillitis contagious?
Yes. All forms, bacterial or viral, are contagious. It usually spreads from person to person by contact with the throat or nasal fluids of someone who is already infected.

8.How can I avoid getting tonsillitis? 
Wash hands frequently and keep the infected person's eating utensils and drinking glasses away from others.

9.How many times do you have to get tonsillitis before considering a tonsillectomy?
It is not possible to give an exact number of infections needed before a tonsillectomy should be considered because each person is different. However, generally people who have had five or more throat infections in one year could probably undergo a tonsillectomy and benefit.

10.What is a tonsillectomy? 
A tonsillectomy is the surgical removal of tonsils, most often due to chronic infection.

11.Whom do I take my child to, who performs the surgery?
You could initially consult your family doctor; he will refer you to a specialist Ear Nose and Throat surgeon (Otolaryngologist).

12. Is the surgery painful?
The patient is kept under a general anesthetic during the surgical procedure so pain is not felt. After surgery there might be mild to moderate pain.

13. How long does the patient have to stay in the hospital following a tonsillectomy?
Tonsillectomies are usually performed on an outpatient basis. The maximum hospital stay is usually 8-10 hours, sometimes an overnight stay. Usually discharged after the effects of anesthesia wear of.

14.Will a tonsillectomy eliminate sore throats?
Surgery will not eliminate throat infections, but will likely decrease the frequency of occurrence.

15.Are tonsillectomies rare?
  Surgical removal of the tonsils is one of the most frequently performed procedures of the throat.

16.When will my child be able to return to school?
Children usually return to school after about one week, and vigorous physical activity may be resumed at that time also. However, it depends on individuals and their doctors.