Tonsil Removal (Tonsillectomy): All You Need to Know!

Are you thinking of having your tonsils removed? Having your tonsils removed with a surgical procedure is called a tonsillectomy, one of the most common procedures which ENT surgeons perform in both children and adults in Singapore. Everything you need to know about having a tonsillectomy is explained here, so read on!

A) WHY DO YOU NEED A TONSILLECTOMY?

There a few reasons to consider having your tonsils removed surgically and the most common reason is because of your tonsils keep getting infected i.e. tonsillitis. Tonsillitis usually causes a bad sore throat with difficulty swallowing and fever. Sometimes, tonsillitis can become so severe that it prevents you from swallowing your oral medications, so it may required admission into hospital to have intravenous IV antibiotics, painkillers and fluids. We would normally consider a tonsillectomy in patients who have been suffering recurrent episodes of tonsil infections, e.g. 3-4 times a year, or if the bad sore throat due to tonsillitis just doesn’t seem to fully recover, even with antibiotics. Removing your tonsils means removing the tonsils as the main source of throat infections and good news, tonsils don’t regrow!

Other reasons to consider having a tonsillectomy include snoring and breathing difficulties because large tonsils block off the back of your throat, making it difficult for airflow to enter your airway. Such patients may also suffer obstructive sleep apnea (OSA) and go on to suffer disrupted poor sleep, repeated nocturnal waking, mouth-breathing and just feeling generally tired all the time. So removing your tonsils can improve your breathing significantly if large tonsils overcrowd your throat and airway.

Of course, if one tonsil grows bigger than the other, then there may be cause for concern because sometimes, lymphoma or squamous cell cancer can invade the tonsil tissue to form a tumour. A tonsillectomy is then urgently needed to obtain tissue to send off to Pathology for a diagnosis because lymphoma and squamous cell cancers of the tonsil need further treatment with chemotherapy drugs and/or radiation treatment.

B) WHAT ARE THE RISKS OF HAVING A TONSILLECTOMY?

Although generally, having your tonsils is a pretty straightforward uncomplicated procedure in most patients, be aware that there is a slight risk of bleeding after surgery due to secondary infection. If this occurs, this tends to present within the first 2 weeks after surgery. Sometimes, such patients are readmitted to hospital for closer monitoring e.g. children, and rarely, return to the operating theatre to have the bleeding blood vessel closed off with diathermy (a safe electric current).

After tonsil surgery, expect a sore throat but this is usually well-controlled with oral painkillers, gargles and throat sprays. The key to ensuring a smooth recovery is to take your painkillers regularly for the first 1-2 weeks so that the pain is controlled enough for you to eat and drink adequately.Sometimes the throat pain may temporarily increase around Day 5-7 but hang on in there, push through this tricky phase and you will make a good recovery. You can eat really anything you feel like but it is wise to avoid spicy foods for the first 2 weeks or so. Popular stuff to eat after having your tonsils removed include ice cream, porridge, mashed potato, scrambled egg, beancurd or tofu, noodle soups.

Rarely, some patients notice some altered taste or reduced taste but this usually recovers after a few weeks or months. This sometimes happens because of the metal gag instruments which have to be used to open your mouth wide enough to be able to access the back of your throat where your tonsils are located. The metal instruments press on your tongue for the duration of surgery but usually for less than 30 minutes. The nerve endings in the tastebuds may temporarily go into “shock” for a while but usually recover.

C) HOW ARE YOUR TONSILS REMOVED?

There are many techniques to remove your tonsils and it pretty much depends on your ENT surgeon’s preference and experience. Having your tonsils removed is done with you asleep under general anaesthesia. It can be done as a day case in the morning with some patients going home later on in the day. Some patients are kept in overnight to monitor their oxygen levels and their breathing, if the tonsillectomy was performed to help improve the breathing, rather than infection. Studies have shown that the post-tonsillectomy bleeding rate increases significantly if the chosen technique uses a lot of heat to remove the tissue, due to the resulting burnt and charred throat muscle which makes it more painful after surgery. The burnt tissue may then become infected, leading to an increased risk of bleeding postop from this area. So the safest way is to carefully dissect out the tonsil tissue with minimal heat applied to the tissue! Acceptable postop bleeding rates after tonsillectomy should usually be 1-2 % and not much higher than this, so it is helpful to check with your ENT surgeon what his personal bleeding rate after tonsillectomy is before you proceed.

Whatever the technique chosen, a metal gag instrument (shown in the above picture) is needed to press the tongue flat to be able to get a good view of the back of the throat to reach the tonsils. Tonsil removal usually takes less than 30 minutes, sometimes even less than 15 minutes for both tonsils to be removed. It is much easier to perform a tonsillectomy in children as their tonsils tend to be well-defined and clear of fibrotic scarred tissue. Adults who have had many tonsil infections often have very scarred tonsils which are “stuck” down to the underlying muscle bed, which may make it a bit trickier to find the right tissue plane.

SO WHEN IS IT TIME TO CONSIDER HAVING YOUR TONSILS REMOVED?

1. When you keep on suffering bad sore throats or need multiple courses of antibiotics
2. When you find it difficult to breathe, especially when asleep
3. When you snore loudly and/or sleep poorly, especially if you gasp or choke for air
4. When one tonsil looks much larger than the other
5. When you keep on getting bad breath and white cheesy spots: Tonsil stones!

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