Rich John C.

Mercene BSN 36

DLS-UMC OR

TONSILLECTOMY
Introduction
A tonsillectomy is a surgical procedure in which the tonsils are removed from either side of the throat. The procedure is performed in response to cases of repeated occurrence of acute tonsillitis or adenoiditis, obstructive sleep apnea, nasal obstruction, snoring, or peritonsillar abscess. Sometimes the adenoids are removed at the same time, a procedure called adenoidectomy. Although tonsillectomy is being performed less frequently than in the 1950s, it remains one of the most common surgical procedures in children in the United States.

Anatomy and Physiology of Tonsils
The tonsils are 3 masses of tissue: the lingual tonsil, the pharyngeal (adenoid) tonsil, and the palatine or fascial tonsil. The tonsils are lymphoid tissue covered by respiratory epithelium, which is invaginated and which causes crypts. In addition to producing lymphocytes, the tonsils are active in the synthesis of immunoglobulins. Because they are the first lymphoid aggregates in the aerodigestive tract, the tonsils are thought to play a role in immunity. Although healthy tonsils offer immune protection, diseased tonsils are less effective at serving their immune functions. Diseased tonsils are associated with decreased antigen transport, decreased antibody production above baseline levels, and chronic bacterial infection.

Indications
Tonsillectomy may be indicated when the patient:  

Experiences recurrent infections of acute tonsillitis. The number requiring tonsillectomy varies with the severity of the episodes. One case, even severe, is generally not enough for most surgeons to decide tonsillectomy is necessary. Paradise in 1983 defined recurrent tonsillitis warranting surgery by the attack frequency standard as "Seven or more in a year, five or more per year for two years, or three or more per year for three years." However according to the current guidelines (2000) of the American Academy of Otolaryngology & Head and Neck Surgery (AAO-HNS), tonsillectomy is indicated if a patient contracts "Three or more attacks of sore throat per year despite adequate medical therapy." Has chronic tonsillitis, consisting of persistent, moderate-to-severe throat pain.

     Has multiple bouts of peritonsillar abscess. Has sleep 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) Produces tonsilloliths (tonsil stones) in the back of their mouth. During the surgery Because a tonsillectomy is performed under general anesthesia. than prolonged or repeated treatments for an infected throat. tonsillectomy may be a more effective treatment. Contraindications Contraindications for tonsillectomy include the following: y y y y Bleeding diathesis Poor anesthetic risk or uncontrolled medical illness Anemia Acute infection What you can expect Tonsillectomy is usually done as an outpatient procedure. That means unless serious complications arise. The surgeon may cut out the tonsils using a blade (scalpel) or a specialized surgical tool that uses heat or high-energy sound waves to remove or destroy tissues and stop bleeding. you or your child won't be aware of the procedure or experience pain during the surgery. you or your child will be able to go home the day of the surgery. and less costly. . Has abnormally large tonsils with crypts (Craters or impacts in the tonsils) Controversy over Indications The American Academy of Otolaryngology & Head and Neck Surgery (AAO-HNS) stated that "In many cases.

promote recovery and prevent complications include the following:  Medications. weakness. Snoring or noisy breathing is common during the first week or so of recovery. if you or your child is having difficulty breathing. Rest. Foods that are easy to chew and swallow should be added to the diet as soon as possible. Avoid milk for the first 24 hours after surgery. Food. You or your child should be able to return to work or school after resuming a normal diet. Fever. are the best choices immediately after surgery. Call your doctor if you observe signs of dehydration. Water and ice pops are good choices.com/health/tonsillectomy/MY00132/DSECTION=what-you-can-expect . dizziness or lightheadedness. hard or crunchy foods.mayoclinic. If the surgeon or your primary doctor prescribes antibiotics as a part of the post-surgical care. Fluids. sleeping normally through the night and not needing pain medication. Call your doctor if you or your child has a fever of 102 F (38. Take pain medications as directed by your surgeon or the hospital staff. such as reduced urination. get emergency care. Avoid spicy. headache. such as applesauce or broth.org/wiki/Tonsillectomy (2) http://www. take all of the pills as directed. jaw or neck. After 24 hours.9 C) or higher. Steps that you can take to reduce pain.wikipedia. thirst.During recovery Nearly everyone experiences pain following a tonsillectomy. foods such as ice cream and pudding can be added to the diet.    Sources: (1) http://en. Pain is most often in the throat. Bed rest is important for several days after surgery. but it may also be located in the ears. When to see the doctor or get emergency care Watch for the following complications that require prompt medical care:     Bleeding. It's important to get plenty of fluids after surgery. Breathing problems. Bland foods that are easy to swallow. Dehydration. Talk to your doctor about any activities that should be avoided. Common signs of dehydration in children include urinating fewer than two or three times a day or crying with no tears. Any bleeding requires a trip to the emergency room for a prompt evaluation and treatment. Surgery to stop bleeding may be necessary. and mild activities should be added gradually. However.

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