Tonsillectomy - OR

Rich John C.
Mercene DLS-UMC OR
BSN 36
TONSILLECTOMY
Introduction
A tonsillectomy is a surgical procedure in which the tonsils are removed from either
side of the throat. The procedure is performed in response to cases of repeated occurrence of
acute tonsillitis or adenoiditis, obstructive sleep apnea, nasal obstruction, snoring,
or peritonsillar abscess. Sometimes the adenoids are removed at the same time, a procedure
called adenoidectomy. Although tonsillectomy is being performed less frequently than in the
1950s, it remains one of the most common surgical procedures in children in the United States.
Anatomy and Physiology of Tonsils

The tonsils are 3 masses of tissue: the lingual tonsil, the pharyngeal (adenoid) tonsil,
and the palatine or fascial tonsil. The tonsils are lymphoid tissue covered by respiratory
epithelium, which is invaginated and which causes crypts.
In addition to producing lymphocytes, the tonsils are active in the synthesis of

immunoglobulins. Because they are the first lymphoid aggregates in the aerodigestive tract, the
tonsils are thought to play a role in immunity. Although healthy tonsils offer immune protection,
diseased tonsils are less effective at serving their immune functions. Diseased tonsils are
associated with decreased antigen transport, decreased antibody production above baseline
levels, and chronic bacterial infection.
Indications
Tonsillectomy may be indicated when the patient:
 Experiences recurrent infections of acute tonsillitis. The number requiring tonsillectomy

varies with the severity of the episodes. One case, even severe, is generally not enough for
most surgeons to decide tonsillectomy is necessary. Paradise in 1983 defined recurrent
tonsillitis warranting surgery by the attack frequency standard as "Seven or more in a year,
five or more per year for two years, or three or more per year for three
years." However according to the current guidelines (2000) of the American Academy of
Otolaryngology & Head and Neck Surgery (AAO-HNS), tonsillectomy is indicated if a patient
contracts "Three or more attacks of sore throat per year despite adequate medical
therapy."
 Has chronic tonsillitis, consisting of persistent, moderate-to-severe throat pain.
 Has multiple bouts of peritonsillar abscess.
 Has sleep apnea (stopping or obstructing breathing at night due to enlarged tonsils or
adenoids)
 Has difficulty eating or swallowing due to enlarged tonsils (very unusual reason for
tonsillectomy)
 Produces tonsilloliths (tonsil stones) in the back of their mouth.
 Has abnormally large tonsils with crypts (Craters or impacts in the tonsils)
Controversy over Indications

The American Academy of Otolaryngology & Head and Neck Surgery (AAO-HNS) stated
that "In many cases, tonsillectomy may be a more effective treatment, and less costly, than
prolonged or repeated treatments for an infected throat.
Contraindications
Contraindications for tonsillectomy include the following:
 Bleeding diathesis
 Poor anesthetic risk or uncontrolled medical illness
 Anemia
 Acute infection
What you can expect
Tonsillectomy is usually done as an outpatient procedure. That means unless serious

complications arise, you or your child will be able to go home the day of the surgery.
During the surgery

Because a tonsillectomy is performed under general anesthesia, you or your child won't be
aware of the procedure or experience pain during the surgery.
The surgeon may cut out the tonsils using a blade (scalpel) or a specialized surgical tool that
uses heat or high-energy sound waves to remove or destroy tissues and stop bleeding.
During recovery
Nearly everyone experiences pain following a tonsillectomy. Pain is most often in the throat, but
it may also be located in the ears, jaw or neck.
Steps that you can take to reduce pain, promote recovery and prevent complications include
the following:
 Medications. Take pain medications as directed by your surgeon or the hospital staff. If

the surgeon or your primary doctor prescribes antibiotics as a part of the post-surgical care, take
all of the pills as directed.
 Fluids. It's important to get plenty of fluids after surgery. Water and ice pops are good
choices. Avoid milk for the first 24 hours after surgery.
 Food. Bland foods that are easy to swallow, such as applesauce or broth, are the best
choices immediately after surgery. After 24 hours, foods such as ice cream and pudding can be
added to the diet. Foods that are easy to chew and swallow should be added to the diet as soon
as possible. Avoid spicy, hard or crunchy foods.
 Rest. Bed rest is important for several days after surgery, and mild activities should be
added gradually. You or your child should be able to return to work or school after resuming a
normal diet, sleeping normally through the night and not needing pain medication. Talk to your
doctor about any activities that should be avoided.
When to see the doctor or get emergency care

Watch for the following complications that require prompt medical care:
 Bleeding. Any bleeding requires a trip to the emergency room for a prompt evaluation
and treatment. Surgery to stop bleeding may be necessary.
 Fever. Call your doctor if you or your child has a fever of 102 F (38.9 C) or higher.
 Dehydration. Call your doctor if you observe signs of dehydration, such as reduced

urination, thirst, weakness, headache, dizziness or lightheadedness. Common signs of
dehydration in children include urinating fewer than two or three times a day or crying with no
tears.
 Breathing problems. Snoring or noisy breathing is common during the first week or so

of recovery. However, if you or your child is having difficulty breathing, get emergency care.
Sources:
(1) http://en.wikipedia.org/wiki/Tonsillectomy
(2) http://www.mayoclinic.com/health/tonsillectomy/MY00132/DSECTION=what-you-can-expect

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Rich John C.

Anatomy and Physiology of Tonsils

In addition to producing lymphocytes, the tonsils are active in the synthesis of

 Experiences recurrent infections of acute tonsillitis. The number requiring tonsillectomy

Controversy over Indications

What you can expect

Tonsillectomy is usually done as an outpatient procedure. That means unless serious

During the surgery

 Medications. Take pain medications as directed by your surgeon or the hospital staff. If

When to see the doctor or get emergency care

 Dehydration. Call your doctor if you observe signs of dehydration, such as reduced

 Breathing problems. Snoring or noisy breathing is common during the first week or so

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