What are Tonsils?
Tonsils are groups of lymphoid tissue located at the back of the throat on both sides. There are three pairs: lingual tonsils at the base of the tongue, adenoid tonsils (adenoid or pharyngeal tonsil) located behind the nasal cavity, and palatine tonsils on the sides of the throat. They are part of the body’s immune system, responsible for trapping and eliminating pathogens entering through the mouth and nose, as well as helping produce white blood cells and antibodies, especially in children whose immune systems are not fully developed.
However, as one grows into adulthood, the role of the tonsils decreases, and they shrink or atrophy with age. In some cases, they may become sites of frequent inflammation because they easily accumulate pathogens. Treatment for tonsillitis mostly refers to the palatine tonsils.
Important and Common Tonsil-Related Diseases
- Acute Tonsillitis often results from viral or bacterial infections such as Streptococcus. Patients experience sudden sore throat, difficulty swallowing, high fever, chills, swollen and tender lymph nodes in the neck, and may have pus from a peritonsillar abscess with bad breath. If symptoms are mild, rest, frequent hydration, pain relievers, and fever reducers can improve the condition. If caused by bacterial infection, antibiotics help improve symptoms within 3-7 days.
- Chronic Tonsillitis has symptoms similar to acute tonsillitis but lasts longer or recurs multiple times within a year. Common symptoms include chronic sore throat, bad breath, voice changes, and persistent swollen lymph nodes. If medication is ineffective or frequent recurrences disrupt daily life, surgery may be considered.
- Tonsil Stones (Tonsil Stone or Tonsillolith) form from food debris, dead cells, and bacteria trapped in tonsil crevices, forming white or yellow lumps. Patients often have bad breath, feel a lump in the throat, difficulty swallowing, and throat irritation. Initial treatment includes frequent gargling and oral hygiene or removal by a doctor. Tonsillectomy is considered only in severe or chronic cases that significantly affect quality of life.
When Should Tonsillectomy Be Performed?
Surgery is considered when other treatments fail, including the following medical indications:
- Chronic or recurrent tonsillitis, such as inflammation occurring 5 times per year for 2 consecutive years or 3 times per year for 3 years, with symptoms of fever, sore throat, and difficulty swallowing.
- Enlarged tonsils causing upper airway obstruction, leading to severe snoring or obstructive sleep apnea (OSA), which affects sleep quality and overall health, such as daytime sleepiness, attention deficit in children, or high blood pressure in adults.
- Enlarged tonsils affecting swallowing or breathing, such as difficulty swallowing, breathing difficulties, or noisy breathing.
- Complications from inflammation, such as peritonsillar abscess or throat pus not responding to medication.
- Suspected tumors or cancer of the tonsils, such as abnormal unilateral tonsil enlargement, irregular surface, or bleeding from the tonsils accompanied by other symptoms like weight loss, loss of appetite, or abnormal lymph node enlargement. A biopsy may be performed to diagnose tumors or cancer.
Tonsillectomy Techniques and Methods
There are several tonsillectomy techniques currently available. The choice depends on the severity of symptoms, overall patient health, and patient preferences. Each method has its advantages, disadvantages, and specific characteristics as follows:
- Cold Steel Tonsillectomy is the traditional method using a scalpel to completely remove the tonsils. It is the standard method without heat. Hemostasis is achieved by suturing or electrocautery (ligation or diathermy). Although it takes longer and involves more blood loss than other methods, it remains a standard technique favored for its precision and good outcomes.
- Electrocautery Tonsillectomy uses an electrocautery device to cut tissue and stop bleeding simultaneously by applying heat from electric current (monopolar or bipolar diathermy). It reduces bleeding effectively and takes less time but may cause a burning sensation at the wound and sore throat after surgery due to surrounding tissue injury, though less than with scalpel surgery.
- Radiofrequency Ablation uses high-frequency radio waves to generate heat around 40 degrees Celsius to destroy tonsil tissue and stop bleeding without a scalpel. Patients experience less blood loss, less pain, and faster recovery compared to electrocautery or scalpel methods.
- Laser Tonsillectomy uses laser light to cut tissue and stop bleeding simultaneously. It results in less bleeding and pain but is more expensive than other methods, so it is usually reserved for select cases.
- Ultrasonic Scalpel (Harmonic Scalpel) uses ultrasound waves causing vibration and low heat to cut and coagulate tonsil tissue simultaneously. This reduces injury to surrounding tissues, minimizes blood loss, causes less postoperative pain, and allows faster recovery. It is suitable for patients wanting to reduce complication risks but has limitations in some cases and may be costly.
Tonsillectomy Procedure
Generally, before tonsillectomy, the doctor prepares the patient by performing necessary health checks such as blood and urine tests and instructs fasting for at least 6 hours before surgery to prevent aspiration. Each surgical technique has similar steps as follows:
- An anesthesiologist administers general anesthesia to prevent pain and body movement during surgery that could interfere with the procedure.
- The surgeon inserts a mouth gag to open the mouth wide and clearly view the tonsils, enhancing safety and precision during surgery.
- The tonsils are removed using the planned technique, such as scalpel, electrocautery, radiofrequency, laser, or ultrasonic scalpel, removing the tonsils completely without external wounds.
- The surgical site is checked, bleeding is controlled by electrocautery and pressure, then instruments are removed from the mouth.
Post-Tonsillectomy Self-Care
The surgery takes about 30 minutes to 2 hours depending on the technique and complexity of each case. After surgery, patients stay in the hospital for 1-2 nights for close monitoring and care. The patient will have only a wound in the throat, usually seen as a white patch where the tonsils were removed, which gradually heals within 7-14 days. After returning home, self-care should continue as follows:
- Consume cold liquid or semi-liquid foods such as cold milk, yogurt, and ice cream during the first 1-3 days to reduce irritation and relieve sore throat. Once the wound improves, switch to soft foods like porridge or soft cooked rice. Avoid hard, spicy, hot, or acidic foods and alcoholic beverages as they may irritate the wound and cause bleeding.
- Avoid coughing, sneezing forcefully, or clearing phlegm vigorously as these may cause bleeding.
- Do not pick at the throat or remove the white fibrin patches on the wound as this can cause bleeding and delay healing.
- Sleep with the head elevated and apply cold compresses to the neck frequently to reduce swelling and pain.
- Maintain oral hygiene by gently gargling and brushing teeth carefully.
If there is heavy or continuous bleeding from the throat wound, difficulty breathing, severe discomfort, or high fever, consult a doctor immediately.
Q&A: Frequently Asked Questions About Tonsillectomy
Q: Does tonsillectomy hurt?
A: Tonsillectomy causes sore throat and wounds in the throat, making swallowing food and water difficult. However, pain can be relieved with painkillers and care as advised by the doctor, such as sucking on cold lozenges. Pain gradually decreases after the first 3-7 days and usually resolves within 1-2 weeks.
Q: Will my voice change after tonsillectomy?
A: After tonsillectomy, the voice may temporarily change due to swelling of the wound and throat walls, causing hoarseness or altered voice. It improves and returns to normal within 1 week after surgery.
Q: Can tonsillitis recur after tonsillectomy?
A: The chance of recurrence is greatly reduced because the tonsils are removed. However, in rare cases, some tonsil tissue may remain.
Q: Does tonsillectomy affect the immune system?
A: It does not reduce the body’s immune system because tonsils are only part of the lymphatic system in the throat and head. The body has many other lymphoid tissues that function to eliminate pathogens.
If you or someone close to you frequently has a sore throat, voice changes, bad breath, or snoring that affects daily life, closely monitor symptoms and consult an ENT specialist for evaluation and consideration of treatment, including modern tonsillectomy techniques in various forms. At Phyathai Phaholyothin Hospital, we have a team of ENT specialists ready to provide advice, diagnosis, and personalized treatment planning based on Value Healthcare principles for cost-effectiveness and quality, helping you regain a good quality of life for a long time.
Dr. Siripen Mukbanditpong
ENT Specialist
Phyathai Phaholyothin Hospital
