What are tonsils?
Tonsils are protrusions of tissue in the throat. They are part of your immune system and can be of variable size. Removing the tonsils is called a tonsillectomy. The tonsils are usually very active in programming your immune system during the first year or two of life; they can be removed without harm to the body because of the large amount of other immune or infection-fighting tissue scattered throughout the body.
The tonsils have pockets on their surface called crypts. These crypts help increase the surface area of the tonsil to make it more effective in its function. Sometimes these crypts can become large and deep; when they do, saliva, bacteria and food particles can collect in them. The crypts can become a home for bacteria. In times of stress, exertion, illness or other difficulty, the immune system may not be able to protect the tonsil from the bacteria living in these crypts, and infection results.
Strep throat.
Sometimes a bacteria named streptococcus lives in the crypts, and when this infects the tonsils, a patient is said to have a strep throat. Strep throat can be a serious condition if not treated promptly with antibiotics. Untreated, strep throat can lead to damage to the kidneys (glomerulonephritis, kidney failure, dialysis) or damage to the heart valves (rheumatic fever).
Sometimes a person may carry streptococcus bacteria living within the crypts of their tonsils, and, though they are unaffected by the the bacteria (their tonsils are uninfected), they can transmit the bacteria to others and give them strep throat. Called a strep carrier, such a person can cause others in a family or at school or day care to become ill. A test called a throat culture can determine if a person has strep throat or if they may be a carrier.
When to get your tonsils out.
The decision to get your tonsils out is an individual one that can only be made after consultation with your personal physician. There are many reasons to remove the tonsils. In the 1950's and 60's, the only reason to take out tonsils was if you still had them; then, in the 70's, the pendulum swung the other way as experts became more conservative: no one or only a very few got their tonsils out. Many physicians trained in the 60's and 70's still dogmatically practice this way today.
Soon most doctors and medical centers would learn that ignoring problem tonsils wasn't the right answer either. By the mid 80's most throat specialists and university medical centers agreed on several clear indications for the appropriate removal of tonsils. A balance was reached between indiscriminately removing all tonsils and not removing tonsils needed to be. The list of accepted reasons for tonsillectomy undergoes revision from time to time, but it should be clear that such a list should only be considered a guideline. Remember, the decision to remove your tonsils is a very individual and personal decision that should only be made after careful consultation with a medical expert.
Some of the more common reasons to get your tonsils out include:
- Frequent sore throats (3 or 4 in a year)
- Bad breath
- Large obstructing tonsils that disrupt sleep
- Large obstructing tonsils that cause choking or interfere with eating
- Large obstructing tonsils affect the development of teeth or dentition
- Peritonsillar abscess
- Strep carrier
How are tonsils removed?
Getting your tonsils out is outpatient surgery, meaning you come to the hospital in the morning, have your surgery done, and then you go home later that same day. The surgery is done by Dr. Bateman at the hospital; the procedure usually takes 30 to 45 minutes to perform. The tonsils are removed through the mouth, so there are no neck incisions made. A special device called a retractor is used to keep the tongue out of the way and allow access to the back of the throat. Sometimes this can cause some tongue soreness after surgery. Most patients are able to go home after an hour or two following surgery. A few patients are kept overnight for observation.
Anesthesia.
You are put completely to sleep to have your tonsils out. While Dr. Bateman performs the tonsillectomy, a second physician, an anesthesiologist, will administer medications to induce anesthesia and will monitor your heart and lungs during the operation. Most adults and older children have an IV placed in their arm (through which medicines and fluids are given during surgery) before they go to sleep. Smaller children are given anesthetic gas first, so that an IV can be placed after they are asleep. You will be able to meet with the anesthesiologist before surgery to discuss any questions you might have.
After surgery.
You'll get worse before you get better. Usually the day of surgery and the day following surgery aren't too bad. Each day, however, you'll find the pain and swelling gets worse. Don't be alarmed by this; its normal.
What to expect:
- Severe sore throat lasting 7 to 10 days after surgery.
- Ear pain, sometimes intense, usually beginning 1 to 5 days following surgery.
- Pain with talking, swallowing, chewing, yawning, and sneezing.
- Upset stomach and even vomiting in the initial days after surgery.
- Fever of 100° to 101.5°F orally; fever of 102.5°F (orally) should be reported.
- Sores and/or bruising of the mouth and tongue from retractors used in surgery.
- White/beige or grey/yellow-colored scabs (eschar) forming in the back of the throat, usually within 24 to 48 hours of surgery, and persisting for up to 4 weeks.
- Noticeable bad breath.
- Scant bleeding which may occur the day of surgery or 7 to 10 days after surgery when the scabs come off. This bleeding can be readily controlled with ice-water gargles. Persistent bleeding, more than a couple of tablespoons, coming from the mouth like a nosebleed, should be reported and the patient brought at once to the nearest Emergency Room.
Complications.
Dehydration. The most common complication is dehydration. Your fluid requirements increase as a result of the recent surgery and your body will require more fluids than usual to get better. The best way to keep hydrated is to keep a cup of something in your hand at all times. Take sips from it continually throughout the day to get a lot of fluids down without upsetting your stomach. If you rely on mealtimes to drink your fluids, your stomach may not cooperate and you may get very sick.
Bleeding. Bleeding is uncommon; about one in 50 people bleed following tonsillectomy. Usually the peak times to have problems bleeding are within the first 24 hours of surgery or 7 to 10 days following surgery, when the scabs start to fall off. Bleeding is possible anytime during the first 3 weeks following surgery. Flecks of blood or blood-tinged spit are usually not a problem; however, bright red blood, more than a couple of tablespoons, coming from your mouth like a nosebleed, is a problem. You would need to get into the emergency room right away. It's usually not a life-threatening problem as long as it's taken care of in a timely manner.
Nasal Escape. Sometimes air can escape through the nose during speech following tonsillectomy and/or adenoidectomy, resulting in a funny, nasal-sounding voice. In fewer cases, liquid can be regurgitated through the nose when drinking. Swelling of throat and palatal muscles after surgery make it difficult for the palate to elevate and close off the back of the nose effectively. Lasting only a few weeks, this is usually only a temporary condition.
