Tonsillectomy

What do tonsil and adenoid do in the body?

In our body, we have lumps of tissue which are related to our immune system called lymph nodes. In our throat and back of the nose, these tissues form a ring called Waldeyer's ring. Tonsil and adenoid form part of this ring and have large clefts which increase the surface area of these tissues and help fight infections and forming our immune bank in the early years of our life. These soldiers or antibodies fight against infection. Tonsils can become enlarged from the age of two and can give symptoms of snoring and sleep apnea or tonsillitis if infected. Enlarged adenoids can give symptoms of nasal obstruction, sinusitis and mouth breathing as they are present at the back of the nose with glue ear and recurrent ear infections.

What is tonsillectomy and adenoidectomy?

Tonsillectomy is a procedure to remove tonsils if they are infected, cause sleep apnea or get frequent stones. It can be done by cold steel instruments, diathermy, coblation or LASER.

Adenoidectomy is the procedure to reduce the size of adenoids as adenoids are attached to neck muscles and skull base. Adenoids can be managed by curettage, suction diathermy or coblation.

In some cases, they can done together to be called adenotonsillectomy. In some cases, if indicated this can be combined with grommet insertion in ears.

Will tonsillectomy affect the singing voice?

Tonsillectomy is a procedure to remove tonsils if they are infected or have tonsil stones leading to bad breath or enlarged leading to sleep apnea or suspicion of cancer. If you are a professional singer, then it is crucial to understand how any procedure on your throat can affect your singing tone.

Tonsil sits on your pharyngeal muscles, and tonsillectomy can lead to scarring of these muscles. If you have large tonsils after tonsillectomy suddenly you will have more volume in your throat and can affect your vocal resonance. You may need support from a speech therapist and voice trainer to retrain. Anaesthetist and surgeon have to be aware of your profession. The surgeon can use low thermal damage techniques for tonsillectomy.

Will tonsillectomy help sleep apnea?

Sleep apnea or upper airway resistance can be due to multilevel obstruction. Enlarged tonsil can cause symptoms of snoring and high upper airway pressures. Sleep apnea treatment includes using CPAP. It is believed using CPAP in children can lead to facial deformity. A recent systemic review of the literature shows strong evidence that tonsillectomy for enlarged tonsils in children improves sleep apnea. Though tonsillectomy in adults on its own is not so effective. Tonsillectomy along with other palatal surgery tend to improve sleep apnea score.

Will tonsillectomy cure tonsil stones?

We all have tiny crevices on the tonsil surface. These crevices help increase the surface area of tonsil so that more bacteria can be caught. Sometimes these crevices catch food debris which can get infected with bacteria. All this can lead to bad smell (halitosis), stone formation (tonsillolith) and/ or frequent tonsillitis. First line treatment of frequent tonsil stone formation is maintaining good oral hygiene by gargling after every meal, brushing your teeth, manually removing or irrigating tonsil tone out. Make sure not to damage throat mucosa to bleed. If this does not work then discussing with ENT surgeon to have tonsils out or resurfaced are a treatment option. Use of coblation tonsillectomy helps to relieve symptoms, and it is a less painful and minimally invasive way.

What if I decide my child not to have a tonsillectomy?

Tonsillectomy is recommended if a child is having frequent tonsillitis and it is affecting the child's school and education. Rate of having tonsillitis will gradually go down over the next few years.
While the child is awaiting the rate of tonsillitis to go down the risk are

Febrile convulsions- this is a child can have fits due to high temperature.
Quinsy- this is abscess formation behind the tonsil which may need drainage and hospital admission for antibiotics.
Reto/ Para pharyngeal abscess- if the abscess and infection spread into the neck. This will need drainage, sometimes in neck and antibiotics.

What is involved in a tonsillectomy operation?

On the day of surgery, you will arrive at the ward. The nurse will show you the allocated room, check the paperwork ( name and operation they are having) and that the child is fasting for at least six hours. A child can have clear liquid for at least two hours before surgery.
The anaesthetist will check if the child has any medical illness, allergies and will discuss any possible anaesthetic complications.
The surgeon will check the consent form and answer any final questions you have before surgery.
You will be able to accompany the child to the anaesthetic room and once the child has full general anaesthesia you will come back to the waiting room.
The actual surgery takes 30mins to 45min excluding anaesthetic time. Once the tonsillectomy surgery is over your child will be transferred to the recovery room. After observation in the recovery, your child will be able to come back to the room. Your child should be able to go home the same day or the next day once they are eating properly. Follow up appointment and post-op instructions for eating and medications are given before you leave the hospital.

Mr Gaurav Kumar
Ear Nose Throat Consultant
To Book an appointment https://entsurgeonclinic.co.uk/
07494914140
Disclaimer: For general information only, always seek medical advice from your treating consultant.
https://www.entsurgeon-london.co.uk/

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ENT conditions (Mr Gaurav Kumar)

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