Dr. Hazenfield -- Ear, Nose, and Throat Doctor in Hawaii

Tonsillectomy and Adenoidectomy

Hugh N. Hazenfield, M.D., F.A.C.S.

• Background:

   

  • Prior to the introduction of antibiotics, tonsillectomy and adenoidectomy was a commonly performed operation in many children

  • After the introduction of antibiotics, the frequency of tonsillectomy has become much less frequent because most tonsil infections can be cured with medication and not surgery

  • Many patients and parents ask if the tonsils and adenoids are necessary to fight off infections.  Many scientific studies have concluded that the answer is "No!"  There is enough other lymphatic tissue in the throat and neck to fight off infections.

• Indications for tonsillectomy and/or adenoidectomy:

   

  • Absolute indications (removal of tonsils and/or adenoids is definitely indicated):

    • Suspicion of a malignancy (cancer) in a tonsil or the adenoids

    

    Enlargement of Left Tonsil

    (Possible lymphoma)

     

    • Cor pulmonale, or heart failure due to obstruction of the airway by enlarged tonsils and adenoids in infants

     

  • Relative indications:

    • Tonsil infections:

       

      

      Acute Tonsillitis

       

       

      • Infections are associated with one or more of the following:

        • Positive throat culture for Streptococcus

        • Significant enlargement of lymph nodes in the neck

        • Dysphagia, or difficulty swallowing

        • Dyspnea, or difficulty breathing

        • Fever

      • Frequency:

        • Seven episodes in one year

        • Five episodes per year for two years

        • Three or more episodes per year for three years or more

    • Two or more episodes of peritonsillar abscess (pus pocket beside the tonsil).  Some otolaryngologists recommend tonsillectomy after one episode.

    

    Left Peritonsillar Abscess

     

    Click on the picture below to see a video of an incision and drainage of a peritonsillar abscess (Even with broadband, it takes a short length of time for the video to download):

     

    

     

     

    • Difficulty breathing, including loud snoring, gasping, and even sleep apnea resulting in fatigue due to enlarged tonsils and/or adenoids

     

    

    "Kissing" Tonsils

     

    • Infected food debris collecting in tonsils which cannot be treated medically and which may cause halitosis (bad breath)

     

    

    Debris in Right Tonsil

    (Keratosis pharyngis or Tonsillith)

   

   

• Tonsillectomy is NOT indicated for recurrent ear infections or chronic middle ear effusions

• Tonsillectomy is NOT indicated for infectious mononucleosis or Vincent's angina

Infectious Mononucleosis ("Kissing Disease")

• Another finding near the tonsil(s) that patients question whether surgery is indicated.  These are benign cysts, they may be on one side or both.  They are removed if they enlarge, become ulcerated, or if the patient is extremely concerned about them:

Cysts of the Tonsillar Fossae

• Indications for adenoidectomy alone:

  • If tubes through the ear drums are required more than once

  • Adenoidectomy or a biopsy of the nasopharynx (that part of the throat behind the nose) is indicated if there is a chronic effusion in the middle ear in an adult, especially on one side only, which does not resolve relatively rapidly (3-6 weeks) with proper medical treatment.  There may be a nasopharyngeal carcinoma (cancer of the top part of the throat).

  • Obstruction behind the nose causing snoring, airway obstruction, or poor sleep

• Risks of tonsillectomy and/or adenoidectomy:

  • Anesthetic risks

    • General anesthesia is used for most of these procedures.

    • It is extremely safe at present due to new anesthetic agents and meticulous monitoring during and after surgery.

     

  • Dehydration

    • Dehydration occurs in most patients due throat pain causing difficulty swallowing even liquids.

    • It is usually the cause of post-operative fevers in the first few days after surgery.

    • Patients simply must be forced to drink liquids.  Solid foods are not necessary.
       

  • Nasal regurgitation

    • Liquids and small particles such as rice may regurgitate out the nose temporarily after this surgery.

    • In the presence of a short palate or a submucous cleft palate (for which your surgeon will examine you before surgery) may cause permanent nasal regurgitation

     

  • Hemorrhage

    • Bleeding may occur during surgery, immediately after surgery, or 5-8 days after surgery.

    • It is estimated that 5 - 20% of tonsillectomy and/or adenoidectomy patients have post-operative bleeding, sometimes severe.

    • Delayed bleeding at 5 - 8 days post-operatively is usually due to the eschar (scab) falling off where the tonsils or adenoids were removed, and it sometimes requires returning to the operating room to control the bleeding under general anesthesia.

    • Report any signs of bleeding to your surgeon immediately!

     

  • Voice change

    • Essentially everyone undergoing this surgery has a mild voice change for up to 6 weeks after surgery, especially if the adenoids are removed.

    • Individuals who use their voice professionally, especially singers, may notice a permanent voice change or difficulty pronouncing some words while singing.  Discuss this fully with your surgeon!