With the end of the cold and flu season in sight, there are many patients coming to ear, nose and throat clinic to seek a remedy for multiple recurrences of severe sore throat, strep throat episodes or just chronic low grade tonsil infections over course of fall and winter seasons. Frequent or chronic throat infections may affect productivity at work or school and lower overall quality of life. Remedies such as oral antibiotics may be only partially or temporarily effective and may harbor significant side effects over several courses. Surgery to remove tonsils is often a last resort option indicated in cases with severe or highly frequent infections. Here are some answers to commonly asked questions about tonsils and tonsil surgery.
What are tonsils?
Tonsils are clumps of tissue in the throat (one on each side of the throat) that contain a collection of immune cells (lymphatic tissue). The typically enlarge during upper respiratory infections and may at times become painful. Enlarged tonsils without any symptoms are common among kids. Left alone, enlarged tonsils may eventually shrink on their own over the course of several years. While enlarged, tonsils may obstruct breathing, particularly at nights.
What is tonsil surgery?
Surgical removal of the tonsils is one of the most common operations performed on children and adults in the U.S. This is an operation performed under general anesthesia (completely asleep in an operating room) and can take about 20 minutes to perform. It is done through the mouth without any external incisions. Recovery times vary but they can last about 7 days in younger children and 10-14 days or longer in teenagers and adults.
What are the risks of surgery?
Tonsil procedures are not without risk. Bleeding is the most important risk of surgery. This can happen up to 2 weeks after surgery in up to 3% of children/adults. It is extremely rare that patients may need a blood transfusion or additional surgery. All children/adults experience throat discomfort/pain for several days, up to 3 weeks for adults.
When is surgery necessary?
Sometimes the tonsils should come out. But the benefits must outweigh the risks. All of the following are valid reasons for evaluation.
1. Severe snoring and obstructive sleep apnea (most common reason in children)
2. Recurrent/chronic infections or tonsil stones (most common reason in adults)
3. Difficulty eating meat or chewy foods
4. Recurrent abscess (deep infection) of the tonsil
5. Suspected tumor of the tonsil
What about when tonsils are not painful or infected but are very large?
This is a scenario that is most common in young children and is an important reason to consider tonsillectomy. Obstruction of the throat can lead to sleep apnea which may have repercussions on children’s behavior, growth and development.