Tonsillectomy | Purpose, Contraindications, Procedure, Recovery and Complications

What is tonsillectomy?

Tonsillectomy is a quite common surgical procedure to remove the tonsils with or without adenoid glands. Every year, more than five hundred thousand patients enter the operation to remove their tonsils (tonsillectomy) or remove tonsils and adenoid glands (adenotonsillectomy). Although it is an extremely popular surgical procedure in pediatrics and young adults, but there are a continuous debates and discussion about the procedure specific indications to perform tonsillectomy surgery.

The tonsils are oval shaped lymphoepithelial tissue located at the back of throat. The tonsils consist of two palatine tonsils, adenoid gland, two tubal tonsils, and lingual tonsils. The term tonsillectomy here means removal of palatine tonsils.

Tonsils are part of the lymphatic system, with its specific location, it acts as the first line of defense mechanism against different pathogen that may enter the body. all tonsils and adenoid glands are part of Waldeyer’s ring, which play a key role in the body immune systems.

Indications of tonsillectomy

There are multiple indications for tonsillectomy, but the most common indications are:

    • Recurrent inflammation of the tonsils
    • Sleep breathing problems due to enlarged tonsils

According to the American academy of otolaryngology-head and neck surgery issue a clinical indicator for tonsillectomy as follows

1. Absolute indication

There are specific conditions that mandate surgical removal of tonsils such as an augmented tonsils which may results in

    • Marked airway obstruction
    • Difficulty of swallowing
    • The augmented tonsils can compromise breathing while sleeping
    • Cardio-pulmonary complications from repeated tonsilitis

In enlarged tonsils, tonsil’s size is not correlated with the severity of symptoms and signs of sleep disorders. The recurrence of airway obstruction during sleep may causes ventilation abnormalities and disturbance in sleep cycles. These abnormalities cause

    • affecting the child’s quality of life
    • delaying child’s growth
    • diminish in his learning ability.

Children with sleep disorders due to breathing difficulties have higher rates of using antibiotics, and more hospital visits than normal children. In a study by Bough et al. to provide an evidence-based guidance for clinicians to identify children candidate for tonsillectomy. They founded that certain associated conditions with sleep disorders breathing and enlarged tonsils such as delayed growth, behavioral changes, and learning difficulties would be improved after tonsillectomy.

One of the absolute indications of tonsillectomy is peritonsillar abscess, which is not responding to medical treatment and drainage. The drainage of peritonsillar abscess should be documented. Due to the recurrent nature of peritonsillar abscess; removal of the tonsils (tonsillectomy) is the optimum treatment of this condition.

Recurrent tonsilitis is an indication of tonsilitis especially if the repeated attacks accompanied with fever, also if the repeated attacks are associated with a febrile convulsion.

Another absolute indication of tonsillectomy is unilateral tonsil enlargement with the suspicion of malignancy. The enlarged tonsil require biopsy to identify the causative pathology.

2. Relative indications of tonsillectomy

There are some specific indications for tonsillectomy, but the indications here is not absolute, which may differ from case to case. The decision here is left to the surgeon’s decision for every specific case after explaining to the patients all pros and cons of his decision. Relative indications include:

– Recurrent tonsils infections many times in a specific year, with frequent antibiotic treatment for every infection time. Recurrent tonsilitis is common in children. Guidelines recommends close monitoring for children with a fewer tonsilitis attacks than seven times in the previous year, or less than five attacks of tonsilitis in the previous two years, or less than three attacks of tonsilitis every year for the previous three years. Tonsillectomy is recommended if the patient’s attacks of tonsillitis surpass the guidelines numbers.

– Chronic tonsilitis infections is more common in teenagers and adults. The repeated tonsils infections may respond at first to the antibiotic treatments, but later the tonsil infections do not resolve completely. Chronic tonsilitis symptoms include chronic throat pain, enlarged tonsils, and bad breath which may results in accumulation of food in the tonsils.

– Chronic tonsilitis due to repeated infection by group B streptococcal infections, with no response to the regular antibiotic treatment, or to the beta-lactamase resistant antibiotics.

– Hypertrophy of one or the two tonsils with malignancy is suspected.