Enlarged tonsils: remove or not,indications, methods, recovery after removal

Update: October 2018

Tonsils (glands) are accumulations of ovoid lymphoid tissue
forms located in the oral mucosa, included
in the composition of the lymphoid pharyngeal ring. Allocate steam rooms (pipe and
palatine) and unpaired (pharyngeal and lingual) tonsils. Glands have
porous structure. Palatine riddled with lacunae that are
a kind of trap for infectious agents, and also have
composition of follicles that produce protective cells.

Tonsil functions:

  • barrier: the retention of microorganisms trapped in the oral cavity
    with air;
  • immunogenic: in the gaps of the tonsils ripen B – and
    T lymphocytes;

Causes of chronic tonsillitis (constantly increased
tonsils) in children and adults

  • Frequent acute inflammatory processes in lymphoid formations
    (sore throats, ARVI) lead to:

    • Tonsil tissues – transformation of lymphoid tissue into
      connective; – loss of self-cleaning ability;
    • narrowing and deformation of lacunae;
    • formation of stagnation of lacunae content and formation of purulent
      traffic jams;
    • scarring that completely cover some
      lacunae, and the infectious contents are inside them.
  • Hereditary predisposition with a very high percentage
    transfer.
  • Related factors that inhibit immunity: stress,
    poor nutrition, unfavorable environmental situation and
    others

The immune system is undergoing significant changes, therefore
chronic tonsillitis refers to autoimmune diseases.
Modified tonsils stop performing their function and
become a chronic source of infection. Slightest infectious
external attack causes clinically severe acute respiratory viral infections, tonsillitis, and constant
the presence of pathological microflora leads to the development
resistance to antibiotics and antiviral drugs, with
each time complicating the treatment of ENT diseases.

Features of tonsils in children

Lymphoid pharyngeal formations reach a maximum size to
5-7 years old. In childhood, the tonsils have their own characteristics –
besides the fact that it is still growing formations, the lacunae have narrow
form, which contributes to the stagnation of the contents inside them.

But the normal growth of the tonsils is disturbed and pathological
irregular growth due to natural (disease) and
artificial (vaccination) bacterial and viral infections.

Thus, the imperfection of the immune system, part of which
are tonsils, infectious attack, hereditary
predisposition and pathological growth of tonsils lead to
the development of chronic tonsillitis.

What is the risk of chronic tonsillitis?

Chronic focus of infection that resides in
tonsil is a source of toxins that poison
the body, further inhibit immunity. Toxic products
are carried with blood to the internal organs and affect them
(bacterial damage to heart valves, kidney tissue,
joints), but most of all “gets” near the underlying structures, and
A person / child is constantly harassed by otitis, rhinitis and
conjunctivitis.

Hypertrophic altered lymphoid tissue impairs breathing,
normal sleep and even speech. Therefore, the problem of tonsillectomy is often
only occurs in childhood, sometimes with life
indications.

Indications for tonsil removal

There are so-called unconditional indications for surgery in
adults and children for whom tonsillectomy is a vital
necessary:

  • Thrombosis of the jugular vein or sepsis, which complicated sore throat;
  • Complications on the kidneys, heart, joints and nervous system on
    background infection with beta-hemolytic streptococcus A in a patient
    or his immediate family (very high risk);
  • Constantly severe course of sore throats (high temperature, strong
    pain, massive suppuration);
  • Severe sore throats + are allergic to major groups
    antibiotics used to treat;
  • Formation of peritonsillar abscess against a background of sore throat;
  • Acute rheumatic heart disease;
  • Hyperplasia of the lymphoid tissue that interferes with breathing or
    swallowing;
  • The absence of remission of chronic disease on the background
    antibacterial, physiotherapeutic, sanatorium
    treatment for 1 year.

Also tonsillectomy is considered justified in the following
cases:

  • more than 7 cases of angina during the year;
  • more than 5 cases of angina per year for 2 consecutive years;
  • more than 3 cases of angina per year for 3 consecutive years.

Plus accompanying each case of angina next
symptoms:

  • T more than 38.8 C;
  • purulent plaque on the glands;
  • significant increase in cervical l / w;
  • seeding hemolytic streptococcus group A.

And:

  • PFAPA syndrome – frequent repetitions of angina after 3-6 weeks;
  • autoimmune neuropsychiatric disorders in children in the background
    streptococcal infection.

In other cases, it is recommended to take a waiting position with
constant supervision by a doctor.

Tonsil removal methods

All methods of tonsil removal are carried out in a hospital and
relate to surgery, require a certain
training and surveys. Anesthesia method in each case
is chosen individually – it is possible to use local and general
anesthesia.

There are “cold” and “hot” tonsillectomy, but this
the classification is not entirely correct since the series
Modern methods are based on the effects of cold.

Methods

�”Cold”

�”Hot” (some modern methods)

The essence Removal with a surgical instrument (scalpel, wire
loop surgical scissors)
Removal with heat generating special tools
destructive and cauterizing tissue;
pros
  • low probability of postoperative bleeding
  • spent over the years technology.
  • the operation is fast;
  • practically not accompanied by bleeding.
Minuses
  • accompanied by bleeding;
  • longer operation;
  • long recovery period (up to a month) may be a relapse
    growth of tonsils.
  • the healing process is slower;
  • damage to nearby connective tissue;
  • a higher increase in postoperative bleeding.
Price of tonsil removal 15 thousand 20-50 thousand

Preparation for tonsillectomy

Minimum examination of the patient includes:

  • general and biochemical blood test
  • research on coagulability and blood type
  • ECG
  • other tests and studies are assigned individually
  • on the day of the operation can not eat and drink.

Let’s take a closer look at modern methods of tonsillectomy.

Laser removal

Apply both radical removal of tonsils by laser, and
laser ablation resulting in destruction of the upper layers of tissue
(partial removal). Use sintering and destructive effects.
laser beam to remove lymphoid tissue, prevent
bleeding and avoid the formation of an open wound.

Equipment: A local anesthetic is sprayed onto the mucosa. Amygdala
grasped by forceps and gradually exfoliate from the tissue by laser
by the beam.
Contraindications:
  • Acute infectious processes, including respiratory
    character;
  • Exacerbation of chronic diseases;
  • Oncopathology;
  • Diabetes mellitus 1 ton and decompensation of diabetes mellitus 2 ton;
  • Respiratory and cardiovascular diseases in the stage
    decompensation;
  • Blood disorders with coagulation disorders
    blood;
  • Children’s age up to 10 years;
  • Pregnancy.
pros:
  • Outpatient care;
  • No bleeding and risks associated with it;
  • There is no need for electrocoagulation of vessels;
  • Local anesthesia may be used;
  • The duration of the intervention is 15-30 minutes;
  • Short recovery period without loss
    working capacity;
  • There is no open wound and associated risk of infection;
  • Efficiency is estimated at 80%.
Minuses:
  • Perhaps the formation of burn nearby tissue;
  • Soreness after cessation of anesthesia;
  • The loss of an important lymphoid barrier organ and the risk of more
    serious diseases – pharyngitis, bronchitis, etc .;
  • Relapse may occur with laser ablation;
  • High price.

Cauterization with liquid nitrogen (cryodestruction)

The pathological tissue is deep-frozen with liquid nitrogen
at T – 196 C.

Equipment: After local anesthesia, gas is supplied to the tonsils at
help special nozzles. Each tonsil is affected by about
2 minutes. After the procedure, the dead tissue gradually (within 2
weeks) rejected.
Contraindications: same as laser burns, except for children
age
pros:
  • Outpatient care;
  • No age limit;
  • Preservation of deep, intact areas of the tonsils, i.e.
    preservation of their barrier function;
  • No pain during surgery;
  • Bloodless method – at low T the vessels are frozen;
  • Short lengthy procedure 15-20 minutes;
  • The depth of the lacunae of the remaining tissue decreases, which simplifies their
    reorganization.
Minuses:
  • Pathologically altered tissue areas may remain;
  • Rejection of anesthetized tissue is accompanied by unpleasant
    odor from the mouth and a certain discomfort;
  • After the procedure, there is some pain in the ears and
    throat.

Removal of tonsils by coblator

A coblator is a special device that converts electrical
energy into the plasma stream. Plasma energy breaks bonds in
organic compounds, leading to cold tissue destruction,
that break down water, nitrogen compounds and carbon dioxide
gas.

Equipment: After local anesthesia of the mucous membrane of the amygdala
grab the tongs and act on her coblator, resulting in
tonsil is separated from surrounding tissues.
Contraindications: same as laser burns, except for children
age
pros:
  • Lack of severe pain requiring a common
    anesthesia;
  • No bleeding and burn tissue;
  • Low risk of postoperative bleeding;
  • An open wound surface does not form;
  • The dosed influence which is not damaging surrounding
    fabrics;
  • Flexible device that allows you to work in hard to reach
    places;
  • Быстрое восстановление без потери working capacity;
  • There is no postoperative tissue necrosis;
  • There is no age limit.
Minuses:
  • High price;
  • Requires high qualifications doctor;
  • Имеются противоindications.

 Radio wave tonsillectomy

Denaturation of tonsil tissue using apparatus radio wave
surgery.

Equipment: after anesthesia into the altered lymphoid tissue is immersed
active conductor. Radio waves heat the tissue that occurs
denaturing tissues without destruction and with minimal risk
damage to adjacent tissues. The heating temperature destroys and
pathogenic flora. When a certain tissue resistance is reached
the device turns off automatically.
Contraindications: the same as laser burns.
pros:
  • Minimally invasive intervention that does not require hospitalization;
  • Quick procedure (20-30 minutes);
  • Bloodless method;
  • Low risk of intra- and postoperative complications;
  • Lack of pain;
  • Lack of tissue necrosis and burns;
  • Fast recovery without disability.
Minuses:
  • Expensive method;
  • Requires high qualifications doctor;
  • Relapse is possible.

Ultrasound tonsillectomy

Using high frequency vibrations with
ultrasound scalpel. Ultrasonic vibrations energy
cuts tissue and immediately coagulates them, eliminating bleeding.
The maximum temperature of the surrounding tissue reaches 80 C.

The procedure, advantages and disadvantages are similar.
radio wave тонзилэктомии.

Possible complications of tonsillectomy

Although the operation does not fall into the category of complex and
almost always without complications, their probability is not
excluded.

During surgery:

  • laryngeal edema with a risk of choking;
  • аллергическая реакция на препарат anesthesia;
  • heavy bleeding;
  • aspiration of gastric juice with the development of pneumonia;
  • jugular vein thrombosis;
  • tooth damage;
  • fracture of the lower jaw;
  • burns of lips, cheeks, eyes;
  • soft tissue injuries of the oral cavity;
  • heart failure.

After operation:

  • remote bleeding;
  • sepsis (possible with low immunity,
    HIV-infected);
  • taste disturbance;
  • neck pain.

Postoperative period after tonsil removal

Feelings in the first hours

  • After the anesthesia stops, it can be felt
    �”Lump or foreign body in the throat” due to swelling of soft tissues.
  • Pain that builds up as you move away from anesthesia
    (it is stopped by injections of anesthetics).
  • Hoarseness and nasal voices, also associated with swelling.
  • Nausea associated with receptor irritation.
  • It is possible to raise T to 38 ° C (normal variant).

Behavior

  • Bed rest – the patient is laid on his side and spits
    evolved blood and ichor.
  • A few hours after the operation, you can get up.

Throat view

  • Bright red wound surface that quickly inflames
    (variant of the norm).

Nutrition

After surgery, you also can not drink and eat for a certain time (from 4
h up to 1 day). When the doctor allows you to eat, you can
after the pain reliever will work to reduce
the discomfort. Products – cold or slightly warm, soft, not
sour.

Next 2-3 days

Gradually, the symptoms disappear, there is an unpleasant smell from the mouth
and minor pain in the neck. Places where the tonsils were, become
dirty gray. Sore throat still remains, especially when swallowing,
therefore it is worth continuing to use painkillers.

Food should be liquid and not hot.

Recovery period

Complete wound healing occurs within 2-3 weeks:
dirty gray is replaced by white and yellow, then a new
mucosa. Slowness gradually passes. In early
the recovery period excluded travel, stress, because
possible development or manifestation of complications. Repeat required
visit to the doctor after wound healing.

Popular questions related to tonsillectomy

Is it possible to get angina after tonsil removal?

Angina is of different types and affects not only the tonsils,
therefore, the likelihood of relapse remains. But in the course of observing
children undergoing recurrent tonsillitis have become much less common, and
completely stopped. Adult patients are also noted.
improvements, not so obvious, but there are.

Does the frequency of sore throat decrease?

Yes, such unpleasant symptoms, which previously manifested in
the slightest supercooling will bother much less often.

When you can take a wait and wait
child surgery?

Waiting is justified in the following cases (with observation of
child for 12 months):

  • less than 7 cases of angina in the last year;
  • less than 5 cases of angina every year for the last 2 years;
  • less than 3 cases of angina every year for the last 3 years.

Does the risk of internal complications after surgery disappear?
organs associated with strep throat infections?

No, the problem remains relevant for the operated
patients.

Does bad breath disappear after tonsillectomy?

If smell is associated with the activity of pathogenic microorganisms,
located in the gaps of the lymphoid tissue, it will disappear. but
There are other reasons for bad breath.

Is it necessary to remove the tonsils only with their hypertrophy?

If enlarged tonsils interfere with swallowing and breathing, their
It is recommended to remove or trim.

Does tonsillectomy help with hemolytic pharyngeal seeding
streptococcus group A?

The microorganism lives not only on the tonsils, therefore operation
can not solve the problem completely.

How much increases the risk of serious organ diseases
breathing after tonsillectomy?

It is impossible to assess this risk – it all depends on the state.
immunity and body adaptability to new conditions
existence without tonsils.

What are the remote consequences of the removal of the tonsils?

Since the tonsils are part of the immune system, it is possible
development of a decline in cellular and humoral immunity and related
with this disease of the respiratory system, as well as increased allergic
reactions to various stimuli.

Is it necessary to remove tonsils in chronic
tonsillitis?

Not. It is much more important to strengthen the body’s defenses (healthy
lifestyle, sports, balanced diet, hardening). With
positive dynamics during the year expediency in operations
not.

Автор: врач-гигиенист, эпидемиолог

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