Tonsillectomy and adenoid removal
Tonsillectomy and adenoid removal are surgical procedures aimed at treating chronic infections and complications associated with the tonsils and adenoids. The tonsils, located at the back of the mouth, and adenoids, situated near the nasal passages, are part of the body's lymphatic system, playing a role in immune defense. Conditions such as chronic tonsillitis, characterized by recurrent infections, and adenoid hypertrophy, which can lead to nasal congestion and ear issues, may necessitate these surgeries.
Tonsillectomy involves the removal of the palatine tonsils, while adenotonsillectomy refers to the simultaneous removal of both the tonsils and adenoids. These procedures are generally considered when infections occur frequently—defined as several episodes within a year or over two consecutive years. Although surgery is less common today due to advances in antibiotic treatments, it remains a viable option for persistent cases.
Recovery typically involves a few weeks of discomfort, particularly throat pain, which can be managed with a soft diet and pain relief. While the surgeries do not eliminate the possibility of future throat infections, they often result in fewer and less severe episodes. It's also important to note that the risks of these surgeries are generally low, making them relatively safe options for those suffering from significant tonsil or adenoid-related issues.
Tonsillectomy and adenoid removal
Anatomy or system affected: Lymphatic system, respiratory system, throat
Definition: The removal of the palatine tonsils (tonsillectomy) or the palatine tonsils and the adenoids (pharyngeal tonsils), in adenotonsillectomy.
Indications and Procedures
In common use, the term “tonsils” indicates two pinkish palatine tonsils, almond-shaped masses of soft lymphatic tissue located on either side of the back of the mouth. There are two other tonsil types: the lingual tonsils, positioned at the back of the tongue, and the pharyngeal tonsils (adenoids), found in the pharynx and near the nasal passages. Together, the three types of tonsils constitute an irregular band of lymphatic tissue that roughly encircles the throat at the back of the mouth. This tissue band is called Waldeyer’s ring. The surface of each tonsil is composed of many deep crypts that, in the case of the palatine tonsils, often become the sites where food debris lodges or sites of bacterial and viral infections. The resulting inflammation of the tonsils is called tonsillitis.
In many cases, acute tonsillitis causes severe throat pain that is easily cured by antibiotic treatment, without recurrence. In others, it returns repeatedly, leading to chronically infected palatine tonsils. Infection of the pharyngeal tonsils (adenoids) causes nasal congestion, and it sometimes produces hearing loss as a result of the obstruction of the Eustachian tubes, which lead from the ear to the throat. This obstruction of the Eustachian tubes may also predispose a person to ear infections.
Severe, chronic tonsillitis is most often treated by surgery to remove the palatine tonsils. Chronic in this context is defined by seven infection diagnoses in a single year or five diagnoses of infection in two consecutive years. When such surgery is required, physicians often elect to remove the infected adenoids as well. This double surgery is called adenotonsillectomy. The lingual tonsils are rarely removed because they do not often become infected. While the exact function of the components of Waldeyer’s ring is not clear, they are seen as important to the production of bacteria-killing lymphocytes and antibodies, which protect the throat and digestive system from infection. For this reason, unlike in the past, the tonsils are removed only when absolutely necessary, and tonsillitis (or adenoid infection) is most often treated with antibiotics; penicillins and cephalosporins are the drugs of choice.
Usually, the onset of acute tonsillitis is signaled by sudden and severe throat pain, high fever, headache, chills, and diffuse pain in the lymphglands of the neck. These symptoms will normally clear up in five to seven days. The most dangerous form of tonsillitis is caused by streptococcal bacteria, usually the Streptococcus pyogenes species. Associated complications increase with the severity of the infection.
Especially severe cases of tonsillitis may lead to a deep infection of the throat involving peritonsillar abscess (quinsy). Many cases of quinsy must be treated by lancing the infected region, causing it to drain. The most severe complications of inappropriately or incompletely treated streptococcal tonsillitis are acute nephritis (kidney disease) and rheumatic fever, which may lead to serious heart problems. Both glomerulonephritis and rheumatic fever are due to autoimmune processes triggered by the infection.
When tonsillectomy is carried out, the adenoids are not removed unless they too cause frequently recurring health problems. The removal of the adenoids alone (adenoidectomy) is sometimes deemed necessary in children when repeated blockages of the nasal passages have caused excessive breathing through the mouth. Prolonged mouth breathing in children can lead to facial deformities because of stress on the developing facial bones.
The tonsils of children are removed under general anesthesia. With adults, local anesthesia is used whenever possible. Tonsillitis in children is much more severe and frequent than in adults because the tonsils decrease in size as one gets older. Similarly, the surgery is more difficult and severe in children because of the larger tonsil size.
Uses and Complications
In most cases, tonsillectomy, adenotonsillectomy, and adenoidectomy are simple surgeries with few complications. The entire recovery period from such a procedure is usually several weeks. Most patients experience severe throat pain during the first few days of the recovery period, but this pain diminishes rapidly with time. It is important for the patient to eat soft food during recovery in order to prevent bleeding, which can become dangerous in some cases. Palatine tonsils do not grow back after surgery, although adenoids may sometimes reappear. The secondary adenoids, however, rarely become troublesome. Tonsillectomy, adenotonsillectomy, and adenoidectomy do not lead to freedom from sore throats. They do usually result, however, in a decreased frequency and severity of throat infections.
Bibliography
Beers, Mark H., et al., eds. The Merck Manual of Diagnosis and Therapy. 20th ed. Merck Research Laboratories, 2018.
Ferrari, Mario. PDxMD Ear, Nose, and Throat Disorders. PDxMD, 2003.
Icon Health. Tonsillectomy: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. Author, 2004.
Tierney, Lawrence M., Stephen J. McPhee, and Maxine A. Papadakis, eds. Current Medical Diagnosis and Treatment. McGraw-Hill Medical, 2022.
"Tonsil and Adenoid Removal – Discharge." MedlinePlus, 29 Nov. 2022, medlineplus.gov/ency/patientinstructions/000155.htm. Accessed 20 July 2023.
"Tonsillectomy." MedlinePlus, medlineplus.gov/ency/article/003013.htm. Accessed 20 July 2023.
Townsend, Courtney M., Jr., et al., eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st ed. Saunders/Elsevier, 2022.