Why the tonsils are removed and how it’s done

Tonsillectomy is an operation to remove the tonsils, and is one the most common procedures Mr Julian Hamann, a top otolaryngologist and tonsil expert, performs. 

The tonsils are made up of lymphoid tissue and sit on each side at the back of the throat. The tonsils play a role in fighting infection, but are only important in the first two years or so of life. There are 100-200 lymph glands in the neck, and lymphoid tissue at the back of the tongue and nose, so there is plenty of surplus if the tonsils are removed.

Why are the tonsils removed?

• Infection is the most common reason as many people have recurrent problems with tonsillitis several times a year. Less commonly the tonsils can become chronically infected leading to a constant, sore throat. Tonsillitis causes a sore throat and often a fever. Occasionally an abscess can form around the tonsil. This is called a quinsy and usually requires drainage of the pus as an emergency. You can still have sore throats after having your tonsils removed, but they are usually much less frequent.
• Snoring and sleep apnoea - Large tonsils can cause the upper airway to become partially blocked when sleeping. This causes the soft tissues to vibrate, generating the sound of snoring. In extreme cases, the airway can become temporarily blocked, causing the person to stop breathing for a few seconds.
• Different sized tonsils - Most people have tonsils that are about equal in size. If one tonsil is obviously bigger than the other, it is usually advisable to remove the tonsils and send them for examination by a pathologist to identify why they are different in size. In the majority of cases there is no cause for concern.
• Swallowing difficulty – Large tonsils can cause swallowing problems.
• Other reasons - Occasionally tonsils can lead to bad breath (halitosis) due to food debris that becomes trapped in the tonsils. In some cases tonsil stones (tonsilloliths) can form. These are like white or cream pieces of grit in the tonsils that can be uncomfortable.

How are the tonsils removed?

The tonsils are removed surgically, under general anaesthetic. This procedure is called a tonsillectomy. There are different ways that the tonsils can be removed, but the most common way is with scissors and dissecting instruments. This method is referred to as the “cold steel” method. Cautery or ties (small pieces of thread) can be used to stop bleeding during the procedure. 

Coblation tonsillectomy is a newer technique that involves using a probe that dissolves the tonsil tissue at low temperatures (typically 40-60 degrees). All of the surgery is performed through the mouth. There are no cuts or scars to the skin. The operation usually takes about 15 minutes to perform.

Are there any alternatives to tonsillectomy?

Recurrent tonsillitis often improves with time, although this is difficult to predict and it can be a problem for many years. If you do not have your tonsils removed, there are other rare problems and complications that can occur such as:

• breathing difficulties
• abscesses around the tonsils or in the lungs
• rheumatic fever

What are the risks of tonsillectomy?

There are risks associated with any type of surgery. The risks of surgery need to be balanced against the risks of not doing surgery and the benefits of surgery. Tonsillectomy is a routine procedure, and it is unusual for problems to arise. More common and serious complications of tonsillectomy include:

• Bleeding - About one in twenty patients will have some minor bleeding after surgery. In about one in a hundred patients will need a second surgery to stop the bleeding. Bleeding can occur up to two weeks after the operation, and is usually caused by an infection.
• Infection - This can cause a worsening of the sore throat often with a fever.
• Injury to lips, tongue or teeth - This is unusual, but occasionally occurs as both the anaesthetist and surgeon need to put instruments into the patient’s mouth.
• General anaesthetic - Modern anaesthetics are usually very safe. If you have other health problems, this can increase the risk of anaesthesia. The anaesthetist will discuss the risks of anaesthesia before your operation.
   

If you would like to find out more about tonsillitis and tonsillectomy, make an appointment with a specialist.