| Mr. Ibrahem/Tonsillectomy | |
|---|---|
 Typical appearance of the back of the throat three days post tonsillectomy. | |
| Other names | Adenotonsillectomy, T&A |
| Specialty | ENT surgery |
| Complications | Bleeding, vomiting, dehydration, trouble eating, trouble talking[1] |
Tonsillectomy is a surgical procedure in which both palatine tonsils are fully removed from the back of the throat.[1] The procedure is mainly performed for recurrent throat infections and obstructive sleep apnea (OSA).[1] For those with frequent throat infections, surgery results in fewer sore throats in the following one to two years, but unclear long term benefits.[1][2] In children with OSA it results in improved quality of life.[3]
While generally safe, complications may include bleeding, vomiting, dehydration, trouble eating, and trouble talking.[1] Throat pain typically lasts about one to two weeks after surgery.[1][4] Bleeding occurs in about 1% within the first day and another 2% after that.[1] Death occurs as a result in 1 out of between 2,360 and 1 in 56,000 procedures.[1] Tonsillectomy does not appear to affect long term immune function.[1][5]
Following the surgery ibuprofen and paracetamol (acetaminophen) may be used to treat pain.[1] The surgery is often done using metal instruments or electrocautery.[1][6] The adenoid may also be removed in which case it is known as an "adenotonsillectomy".[1] The partial removal of the tonsils is called a "tonsillotomy", which may be preferred in cases of OSA.[1][7][8][9]
The surgery has been described since at least as early as 50 AD by Celsus.[10] In the United States, as of 2010, tonsillectomy is performed less frequently than in the 1970s although it remains the second most common outpatient surgical procedure in children.[1] The typical cost when done as an inpatient in the United States is US$4,400 as of 2013.[11] There is some controversy as of 2019 as to when the surgery should be used.[1][2] There are variations in the rates of tonsillectomy between and within countries.[12][13]
References edit
- ^ a b c d e f g h i j k l m n o p Mitchell, Ron B.; Archer, Sanford M.; Ishman, Stacey L.; Rosenfeld, Richard M.; Coles, Sarah; Finestone, Sandra A.; Friedman, Norman R.; Giordano, Terri; Hildrew, Douglas M.; Kim, Tae W.; Lloyd, Robin M.; Parikh, Sanjay R.; Shulman, Stanford T.; Walner, David L.; Walsh, Sandra A.; Nnacheta, Lorraine C. (5 February 2019). "Clinical Practice Guideline: Tonsillectomy in Children (Update)". Otolaryngology–Head and Neck Surgery. 160 (1_suppl): S1–S42. doi:10.1177/0194599818801757. PMID 30798778.
- ^ a b Burton MJ, Glasziou PP, Chong LY, Venekamp RP (November 2014). "Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis" (PDF). The Cochrane Database of Systematic Reviews (11): CD001802. doi:10.1002/14651858.CD001802.pub3. PMC 7075105. PMID 25407135. Archived (PDF) from the original on 15 May 2021. Retrieved 6 December 2019.
Adeno-/tonsillectomy leads to a reduction in the number of episodes of sore throat and days with sore throat in children in the first year after surgery compared to (initial) non-surgical treatment.
- ^ Venekamp RP, Hearne BJ, Chandrasekharan D, Blackshaw H, Lim J, Schilder AG (October 2015). "Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children" (PDF). The Cochrane Database of Systematic Reviews (10): CD011165. doi:10.1002/14651858.CD011165.pub2. PMID 26465274. Archived from the original on 29 August 2021. Retrieved 8 July 2020.
- ^ Flint, Paul W.; Haughey, Bruce H.; Robbins, K. Thomas; Thomas, J. Regan; Niparko, John K.; Lund, Valerie J.; Lesperance, Marci M. (2014). Cummings Otolaryngology – Head and Neck Surgery E-Book. Elsevier Health Sciences. p. 2862. ISBN 9780323278201. Archived from the original on 13 May 2021. Retrieved 12 April 2019.
- ^ Bitar, MA; Dowli, A; Mourad, M (August 2015). "The effect of tonsillectomy on the immune system: A systematic review and meta-analysis". International Journal of Pediatric Otorhinolaryngology. 79 (8): 1184–91. doi:10.1016/j.ijporl.2015.05.016. PMID 26055199.
- ^ Damiani, F; Rada, G; Gana, JC; Brockmann, PE; Alberti, G (2 September 2016). "Long-term effects of adenotonsillectomy in children with obstructive sleep apnoea: protocol for a systematic review". BMJ Open. 6 (9): e010030. doi:10.1136/bmjopen-2015-010030. PMC 5020755. PMID 27591015.
- ^ Zhang, Lai-Ying; Zhong, Laurie; David, Michael; Cervin, Anders (December 2017). "Tonsillectomy or tonsillotomy? A systematic review for paediatric sleep-disordered breathing". International Journal of Pediatric Otorhinolaryngology. 103: 41–50. doi:10.1016/j.ijporl.2017.10.008. PMID 29224763.
- ^ Gorman, D.; Ogston, S.; Hussain, S. S. M. (2017). "Improvement in symptoms of obstructive sleep apnoea in children following tonsillectomy versus tonsillotomy: a systematic review and meta-analysis". Clinical Otolaryngology. 42 (2): 275–282. doi:10.1111/coa.12717. ISSN 1749-4486. PMID 27506317.
- ^ Stelter, Klaus (2014-12-01). "Tonsillitis and sore throat in children". GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery. 13: Doc07. doi:10.3205/cto000110. ISSN 1865-1011. PMC 4273168. PMID 25587367.
- ^ Lamprell, L; Ahluwalia, S (April 2015). "Who has been hiding in your tonsillectomy tray? Eponymous instruments in tonsillectomy surgery". The Journal of Laryngology and Otology. 129 (4): 307–13. doi:10.1017/S0022215114003016. PMID 25658777.
- ^ Sun, GH; Auger, KA; Aliu, O; Patrick, SW; DeMonner, S; Davis, MM (December 2013). "Variation in inpatient tonsillectomy costs within and between US hospitals attributable to postoperative complications". Medical Care. 51 (12): 1048–54. doi:10.1097/MLR.0b013e3182a50325. PMID 23969585.
- ^ "Surgical operations and procedures statistics - Statistics Explained". ec.europa.eu. Archived from the original on 3 December 2018. Retrieved 2019-10-08.
- ^ Suleman M, Clark MP, Goldacre M, Burton M (April 2010). "Exploring the variation in paediatric tonsillectomy rates between English regions: a 5-year NHS and independent sector data analysis". Clinical Otolaryngology. 35 (2): 111–7. doi:10.1111/j.1749-4486.2010.02086.x. PMID 20500580.