Synopsis

There are a number of reasons why a tonsillectomy is performed. In this article, Mr Wale Olarinde outlines the different conditions that may require a patient’s tonsils being removed.

What is a tonsillectomy?

A tonsillectomy is an operation where the tonsils (usually both) are removed. The tonsils are lymph glands that can be seen by looking at the sides of the throat right at the back. There are several other groups of lymph glands in the mouth, on the tongue and in the throat, so removing the tonsils does not affect your immunity in any way.

The reasons tonsils are removed

Tonsils are usually removed for many reasons although the most common reasons to remove them include recurrent tonsillitis, very large tonsils causing obstructive sleep apnoea (OSA) , and cancer (or suspicion of cancer) of the tonsil.

Recurrent tonsillitis

Recurrent tonsillitis is by far the most common reason to have a tonsillectomy. Recurrent tonsillitis is having five separate attacks of tonsillitis per year for two years in a row. Less stringent criteria may sometimes be used to define recurrent tonsillitis in adults.

Tonsillitis is usually a viral infection lasting for about five to seven days where the affected person finds it very painful to swallow, may feel feverish and quite ill, has a sore throat and may not be able to carry out their usual activity e.g. school, work or whatever their usual activity is. Recurrent tonsillitis ‘burns out’ in many people but can be very disruptive for the sufferer. Children are more commonly affected by recurrent tonsillitis because they get frequent infections of the upper respiratory tract. The tonsils are part of the respiratory tract.

Obstructive sleep apnoea and tonsillectomy

Obstructive sleep apnoea can be caused by enlarged tonsils (and sometimes adenoids too), blocking the airway when the affected person is asleep. This condition can usually be diagnosed by an ENT surgeon although investigations may be required to confirm it. A tonsillectomy (usually with removal of the adenoids in this case) usually resolves obstructive sleep apnoea, particularly in children.

Cancer of the tonsils

Cancer of the tonsil is not common although its incidence has over the past ten years been increasing. Removing the tonsil is usually done to diagnose or confirm a suspicion of cancer. Further investigations (scans) and treatment are usually required.

Tonsillectomy treatment

Most patients having a tonsillectomy will be discharged on the same day the operation. The operation is done through the mouth and usually takes about 30 minutes. There is usually pain after the operation and this gets worse between days four and five after the operation. Patients are prescribed two or three different types of pain killers to get through this painful period. It takes about two weeks to return to usual activity after surgery.

Risks associated with tonsillectomy

The main risk of a tonsillectomy is bleeding, which could happen anytime in the first ten days after the operation. The risk of a bleed is about three to five per cent. Most bleeds will cease with bed rest and mouth gargles, although most people with a bleed need to be admitted back to hospital for a 24 hour observation period. Less than a quarter of patients who bleed need to have another operation to stop the bleeding.