In Which Situations Is Tonsil Surgery (Tonsillectomy) Performed?

Exact indications;

• The tonsils are large enough to obstruct the upper airway, causing severe swallowing difficulties or causing heart-lung complications
• Cause sleep apnea
• Recurrent peritonsillar abscess (abscess formation around the tonsils)
• Tonsillitis that causes febrile convulsions
• Suspicion of tonsil-derived tumor
• Tonsil bleeding

Relative indications;

• Recurrent tonsillitis; 7 or more in the last 1 year, 5 or more every year for the last 2 years, 3 or more inflammations per year for the last 3 years or more, it is considered that the tonsils cannot protect the body and are itself a source of infection, and it is recommended to be taken. The important thing here is that the infection attacks are caused by bacteria. It should be well differentiated from viral upper respiratory tract infections. The statement “he has a throat infection or his throat is red” by physicians other than ENT specialists is not sufficient for an indication for surgery for bacterial tonsil infection. Infection attacks should include a few of the following criteria; Sore throat, fever higher than 38 degrees, large and sensitive lymph nodes in the neck, accumulation of inflammation on the tonsils
• Bad taste and bad breath that does not go away despite drug treatment
• Carriage of beta (beta hemolytic streptococcus) and diphtheria that persist despite drug therapy
• Unilateral tonsil enlargement (tumor suspected)
• Growth retardation unexplained by other causes
• Causes permanent enlargement of lymph nodes in the neck (lasting longer than 6 months)
• Speech disorder caused by enlarged tonsils
• Snoring from enlarged tonsils
• Tonsil stones
• Eagle’s syndrome

In the indications of tonsillectomy (tonsil surgery), apart from those listed above; The distress of the parents in this regard and the loss of work days, the loss of the child’s school days and the economic dimension of the infections and treatment are also social criteria that should be evaluated.

What are the Contraindications of Tonsil Surgery ( Tonsillectomy )?

• Bleeding diathesis (blood clotting disorders)
• Uncontrollable chronic diseases (such as diabetes, high blood pressure) and risks in terms of anesthesia
• Anemia
• Active infection period

Tonsil surgery cannot be performed without correcting these conditions.

Tonsil and adenoid surgery is the most common childhood surgery in our country, many European countries and in the USA. The frequency of surgery may vary between countries and different regions of the same country. Allergy is more common in children with chronic tonsil and adenoid disease. The reverse is also true, that is, chronic tonsil and adenoids disease is more common in allergic children.

How Is Tonsil Surgery Performed?

Tonsillectomy (Tonsillectomy) is performed under general anesthesia. Before the operation, routine blood tests and the evaluation of the anesthesiologist are checked to see if there is any obstacle to the operation. The surgery itself takes about 20-30 minutes. The total time, with the patient sleeping and waking up, is approximately 1 hour. Different instruments or methods can be used in surgery. These; It can be counted as classical dissection method (cold knife method), Electrocautery (monopolar, bipolar), Radiofrequency, Harmonic scalpel, Microdebrider, Laser. Except for the classical method, there is less bleeding during the operation and shorter operation time, while there is no difference in terms of the possibility of bleeding after the operation. However, if bleeding occurs except the classical method, it is more difficult to stop. In addition, the cost of surgery increases, except for the classical method.

What is Tonsil (Tonsil) Reduction?

In recent years, reduction surgery has been performed in tonsil growths that are not accompanied by recurrent tonsillitis. For this purpose, instruments such as coblation, harmonic scalpel, radiofrequency, and microdebrider are used. In these methods, not all tonsil tissue is removed. Advantages; the remaining functioning tonsil tissue, less post-operative pain and faster recovery. Disadvantages are more frequent post-operative bleeding, recurrent tonsil infections, and the possibility of regrowth of the remaining tonsil tissue.

Post Tonsil Surgery Process and Nutrition

After 5-6 hours of follow-up after the surgery, the patient is checked and usually discharged. However; Patients under the age of 3, who are thought to be at risk of bleeding, who do not have adequate oral nutrition, who live far from the hospital, who have undergone surgery for sleep apnea or peritonsillar abscess, are hospitalized for at least 1 night.

After the operation, a white cover begins to form in the area where the tonsils are removed. This cover is actually healing tissue, it should not be mistaken for inflammation. As the tissue under this white cover heals, the whiteness disappears and returns to the normal color inside the mouth. This process takes an average of 10 days. During this period, there may be sore throat, sometimes pain in the ear, especially when swallowing. They are mostly relieved with pain relief syrups.

After the surgery, a diet is applied starting from cold and soft foods and switching to warm and solid foods. Juicy foods such as cold milk, ice cream, pudding, seedless soup and fruit juice are recommended for the first 3 days. After the surgery, a diet list is given by the service nurses. You should definitely take plenty of fluids.

Mild fever may occur after surgery. It usually returns to normal with adequate fluid intake and antipyretic.

Children with very large tonsils may experience temporary thinning of the voice after surgery.

For children who go to school, rest for 1 week or 10 days is recommended.

What are the Complications of the Surgery?

• Bleeding: It is seen at a rate of 2-3% after tonsil surgery. Most of them are seen in the first 24 hours. Rarely (0.4%) It may been 7-10 days. Re-operation may be required for bleeding that cannot be stopped with local interventions.
• Pain
• Dehydration (fluid loss), Weight loss
• Fever
• Airway edema
• Local trauma to oral tissues
• Tongue edema
• Infection
• Incomplete removal of tonsil tissue or enlargement of the root of the tongue
• Sound changes
• Jaw joint problems
• Psychological trauma
• Anesthesia-related complications