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Reasons for Tonsillectomy

Reasons for Tonsillectomy

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Reasons for tonsillectomy
Reasons for tonsillectomy

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Published by: Rasdumi on Aug 12, 2008
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Reasons for tonsillectomy
Tonsillectomy may be performed when the patient:
Experiences frequent bouts of acutetonsillitis. The number requiring tonsillectomy varieswith the severity of the episodes. One case, even severe, is generally not enough for mostsurgeons to decide tonsillectomy is necessary.
Haschronic tonsillitis,consisting of persistent, moderate-to-severe throat pain.
Has multiple bouts of  peritonsillar abscess.
Hassleep apnea (stopping or obstructing breathing at night due to enlarged tonsils or  adenoids)
Has difficulty eating or swallowing due to enlarged tonsils (very unusual reason for tonsillectomy)
Producestonsillolithsin the back of their mouth.
Has abnormally largetonsilswith crypts (Craters or impacts in the tonsils)
[edit] Common causes and demographics
Infections requiring tonsillectomy are often a result of  
("strep throat"), but somemay be due to other  bacteria,such as
, or viruses. However, theetiologyof the condition is largely irrelevant in determining whether tonsillectomy is required
.Most tonsillectomies are performed on children, although many are also performed on teenagersand adults. The number of tonsillectomies in the United States has dropped significantly fromseveral million in the 1970s to approximately 600,000 in the late 1990s
[
 
]
. This has beendue in part to more stringent guidelines for tonsillectomy and adenoidectomy (seetonsillitisandadenoid). Still, debate about the usefulness of tonsillectomies continues. Not surprisingly, theotolaryngologyliterature is usually pro-tonsillectomy, whereas the pediatricliterature has the opposing view
[
 
]
. Enlarged tonsils are removed more often among adults and children for sleep apnea (airway obstruction while sleeping), snoring, and upper airway obstruction. Childrenwho have sleep apnea can do poorly in school, are tired during the day, and have some links toADHD 
 
.Tonsillectomy in adults is more painful
[
 
]
than in children, although each patient willhave a different experience. Post-operative recovery can take from 10 up to 20 days, duringwhich narcotic analgesics are typically prescribed. Most surgeons advise eating soft foods after  having your tonsils removed. Patients in the United States and Canada are usually advised not toeat "crunchy" or "rough" food (toast, biscuits, cookies & crackers) as these will scrape the back of the throat, increasing the risk of bleeding or infection after the operation, whereas patients inthe United Kingdom are often encouraged to eat rough foods to keep the tonsillar beds clean.Some believe that dairy products tend to coat the throat causing an increase in possible infectionand therefore discourage their use. Spicy and acidic foods are irritating and should be avoided.Proper hydration is also very important during this time, sincedehydration can increase throat  pain, leading to avicious cycleof poor fluid intake. At some point, most commonly 7-11 daysafter the surgery (but occasionally as long as two weeks (14 days) after), bleeding can occur 
 
whenscabsbegin sloughing off from the surgical sites. The overall risk of bleeding isapproximately 1-2% higher in adults
. Approximately 3% of adult patients develop significant bleeding at this time. The bleeding might naturally stop quickly, or else mild intervention (e.g.,gargling cold water) could be needed (but ask the doctor before gargling because it might bruisethe area of the skin that has been cauterized). Otherwise, a surgeon must repair the bleedingimmediately bycauterization, which presents all the risks associated with emergency surgery(most having to do with the administration of anesthesiaon a patient whose stomach is notempty). Various procedures are available to remove tonsils, each with different advantages anddisadvantages. Children and teenagers sometimes exhibit a noticeable change in voice 
after theoperation
.
[edit] Methods of tonsil removal
The first report of tonsillectomy was made by the Roman encyclopedistCelsusin 30 AD. Hedescribed scraping the tonsils and tearing them out or picking them up with a hook and excisingthem with a scalpel. Today, the scalpelis still the preferred surgical instrument of manyear, nose, and throat specialists. However, there are other procedures available – the choice may be dictated by the extent of the procedure (complete tonsil removal versus partial tonsillectomy) and other considerations such as painand post-operative bleeding.A quick review of each procedure follows:
Dissection and snare method
: Removal of the tonsils by use of a forceps and scissorswith a wire loop called a 'snare' is the most common method practiced byotolaryngologiststoday. The procedure requires the patientto undergogeneral anesthesia; the tonsils are completely removed and the skin is cauterized. The patient will leave with minimal post-operative bleeding.
: Electrocautery burnsthe tonsillar tissue and assists in reducing blood  loss throughcauterization. Research has shown that the heat of electrocautery (400°C
 
)results in thermal injury to surroundingtissue. This may result in more discomfort duringthe postoperative period.
Harmonic scalpel
: This medical device usesultrasonicenergy tovibrateits blade at 55kHz. Invisible to the nakedeye,the vibration transfers energy to the tissue, providing simultaneous cutting andcoagulation. The temperature of the surrounding tissue reaches80°C. Proponents of this procedure assert that the end result is precise cutting withminimal thermal damage.
Radiofrequency ablation
: Monopolar  radiofrequencythermal ablation transfers radiofrequency energy to the tonsil tissue through probes inserted in the tonsil. The procedure can be performed in an office (outpatient) setting under light sedation or localanesthesia. After the treatment is performed,scarringoccurs within the tonsil causing it todecrease in size over a period of several weeks. The treatment can be performed severaltimes. The advantages of this technique are minimal discomfort, ease of operations, andimmediate return to work or school. Tonsillar tissue remains after the procedure but isless prominent. This procedure is recommended for treating enlarged tonsils and notchronic or recurrenttonsillitis.
Thermal Welding
: A new technology which uses pure thermal energy to seal and dividethe tissue. The absence of thermal spread means that the temperature of surrounding
 
tissue is only 2-3 °C higher than normal body temperature. Clinical papers show patientswith minimal post-operative pain (no requirement for narcotic pain-killers), zero edema(swelling) plus almost no incidence of bleeding. Hospitals in the US are advertising this procedure as "Painless Tonsillectomy". Also known as Tissue Welding.
Carbon dioxide laser
:Laser  tonsil ablation (LTA) finds the otolaryngologist employing a hand-heldCO2or KTP laser to vaporize and remove tonsil tissue. This techniquereduces tonsil volume and eliminates recesses in the tonsils that collect chronic andrecurrentinfections. This procedure is recommended for chronic recurrent tonsillitis,chronic sore throats, severehalitosis,or airway obstruction caused by enlarged tonsils. The LTA is performed in 15 to 20minutesin an office setting under local anesthesia. The patientleaves the office with minimal discomfort and returns toschoolor work the next day. Post-tonsillectomy bleeding may occur in 2-5% of patients. Previous research studies state that laser technology provides significantly less pain during the post-operative recovery of children,  resulting in lesssleepdisturbance, decreased morbidity, and less need for medications. On the other hand, some believe that children are adverse to outpatient procedures without sedation.
Microdebrider
: The microdebrider is a powered rotary shaving device with continuoussuction often used duringsinus surgery. It is made up of a cannula or tube, connected to a hand piece, which in turn is connected to a motor with foot control and a suction device.The endoscopic microdebrider is used in performing a partial tonsillectomy, by partially shavingthe tonsils. This procedure entails eliminating the obstructive portion of the tonsil while preserving the tonsillar capsule. A natural biologic dressing is left in place over the pharyngealmuscles, preventing injury, inflammation, and infection. The procedure results in less post-operative pain, a more rapid recovery, and perhaps fewer delayed complications. However, the partial tonsillectomy is suggested for enlarged tonsils – not those that incur repeated infections.
Bipolar Radiofrequency Ablation (see Coblation tonsillectomy)
: This procedure produces anionized salinelayer that disruptsmolecular bondswithout using heat. As the energy is transferred to the tissue, ionic dissociation occurs. This mechanism can be usedto remove all or only part of the tonsil. It is done under general anesthesia in theoperating room and can be used for enlarged tonsils and chronic or recurrent infections.This causes removal of tissue with a thermal effect of 45-85 °C. It has been claimed thatthis technique results in less pain, faster healing, and less post operative care
.However,review of 21 studies gives conflicting results about levels of pain, and its comparativesafety has yet to be confirmed
.
Adenoidectomy
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