Friday, July 7, 2023

Tonsillectomy in adults. What are the indications?

 Tonsillectomy is a surgical procedure to remove the tonsils, which are two small masses of tissue at the back of the throat that are part of the body's immune system. In some people, the tonsils become infected or enlarged, causing severe sore throats, snoring, or other problems. Tonsillectomy may be advised if you have obstruction causing sleep apnea, or you may need surgery if you have recurring, chronic, or severe infections

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Indications

Some common indications for tonsillectomy in adults include:
  • Chronic throat infection, which is the most common reason. Adults who have the surgery usually have had several sore throats over 1 to 3 years or have had a peritonsillar abscess
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  • Sleep-related breathing disorders, such as sleep apnea
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  • Enlarged tonsils that cause difficulty swallowing or obstruct the airway
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Procedure

Tonsillectomy is usually done as an outpatient procedure under general anesthesia, which means patients can go home the day of the surgery. During the surgery, a tube will be placed in your throat to keep your airway open, and a special device is used to keep the mouth open. Other tools are used to take out the tonsils or part of the tonsils from the back of the throat. The tissue is taken out through the mouth
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Recovery

Recovery time varies from person to person, but it usually takes about 10 days to two weeks for a full recovery. Children tend to bounce back faster than adults, with some seeming back to normal within a few days. Teens and adults can expect to recover for about two weeks. Throat pain and/or ear pain is common after tonsillectomy and it can take up to 2 weeks for you to feel better. Ear pain frequently occurs between the 3rd and 7th days and results from special nerve connections. Pain medication should be administered regularly for the first week, and anti-inflammatory medications such as Motrin, Advil, Ibuprofen, Aleve, and Naproxen Sodium are also frequently used and help reduce pain and inflammation
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Complications

Complications from tonsillectomy are rare, but they can occur. Some common complications include:
  • Postoperative infection
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  • Bleeding
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  • Edema of the tongue
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  • Glossopharyngeal nerve injury
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  • Carotid artery injury
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  • Dehydration
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  • ENT pain
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According to a retrospective analysis of a large insurance database, of adult patients who undergo a tonsillectomy, 20% will have a complication, 10% will visit an ED, and approximately 1.5% will be admitted to a hospital within 14 days of the tonsillectomy. Six percent were treated for postoperative hemorrhage, 2% for dehydration, and 11% for ENT pain within 14 days of surgery
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Recommendations

Here are some recommendations for aftercare following tonsillectomy:
  • Drink at least 4 to 6 eight-ounce glasses of liquid daily to prevent dehydration
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  • Within 1-2 days, add cold and soothing foods (ices, ice-cream, frozen yogurt, Jell-O). As you feel better, add soft bland items that are easy to chew and swallow (pasta, puddings, mashed potatoes, tuna or chicken salad, macaroni and cheese). Avoid foods that are sharp, hot, or spicy. Lollipops and hard candies may be sucked, not chewed
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  • There are no strict rules for activity after surgery other than to avoid contact sports or heavy exertion for about 2 weeks. Work can be resumed after one week for nearly all patients. You should get out of bed frequently and return to normal activity as soon as possible
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  • Keep the mouth and teeth clean after a tonsil operation. The teeth should be brushed gently two or three times a day. If you have a humidifier, it should be used
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  • Many patients complain of earache after a tonsil operation. This is normal and frequently the ear pain is worse than the throat pain. This pain is coming from nerve fibers in the throat. This is not an ear infection. Usually, the pain is most intense on the third to sixth postoperative day
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  • Some fever is expected. If it is over 102 degrees F, call your healthcare provider
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  • Call your healthcare provider or pediatrician right away if you see bright red blood or have a fever or severe pain
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Contraindications

There are no absolute contraindications to tonsillectomy. However, the procedure may not be recommended if you have:
  • A bleeding disorder
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  • A history of severe bleeding after dental work or surgery
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  • A weakened immune system
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It's important to discuss any concerns or questions with your healthcare provider before undergoing tonsillectomy.

References

  1. Saint Luke's Health System. Adult Tonsillectomy. Retrieved from https://www.saintlukeskc.org/health-library/adult-tonsillectomy
  2. University of Mississippi Medical Center. Home Care after Tonsillectomy - Adult. Retrieved from https://www.umc.edu/Healthcare/ENT/Patient-Handouts/Adult/Adenoids_tonsils/Tonsillectomy_Adult.xml
  3. PubMed. Prevalence of complications from adult tonsillectomy and impact on health care expenditures. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24691645/
  4. UpToDate. Tonsillectomy in adults: Indications. Retrieved from https://www.uptodate.com/contents/tonsillectomy-in-adults-indications
  5. Verywell Health. How Long Does It Take to Recover From a Tonsillectomy? Retrieved from https://www.verywellhealth.com/how-long-does-it-take-to-recover-from-a-tonsillectomy-1192159
  6. Cleveland Clinic. Tonsillectomy: Procedure Details and Recovery. Retrieved from https://my.clevelandclinic.org/health/treatments/15605-tonsillectomy
  7. ENT Specialty Care. Postoperative Care of Adult Tonsillectomy/UPPP. Retrieved from https://www.entspecialtycare.com/provider-physician/instructions-postoperative_care_of_adult_tonsillectomy_uppp
  8. PubMed Central. Rare and fatal complications of tonsillectomy: sudden pneumothorax and extensive subcutaneous emphysema. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9340339/
  9. Mayo Clinic. Tonsillectomy. Retrieved from https://www.mayoclinic.org/tests-procedures/tonsillectomy/about/pac-20395141
  10. Glacier Ear, Nose & Throat. Adult Tonsillectomy. Retrieved from https://glacierentclinic.com/adult-tonsillectomy/
  11. WebMD. Can an Adult Need a Tonsillect

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