Many people ask what are the functions of tonsils. Tonsils are lymphoid tissues. Lymphoid tissues are centres which produces infection-fighting cells. However after the first year of life, the tonsils do not serve any great function as we have different areas of the body to serve that purpose. Tonsillectomy is the operation to remove our tonsils from the back of the mouth.
Why have the operation
The 2 commonest reason for the operation is recurrent tonsillitis, and sleep disordered breathing (where the size of the tonsils is so big that it blocks off our airway when we fall asleep). Both conditions can occur in children and adult. Other reasons could include a history of quinsy (collection of pus with the tonsil capsule) and growth on the tonsil where the removed tonsil will be sent for histology analysis. Occasionally, some people can be bothered by tonsil stones – tiny white particles that arises within the crypts of the tonsils which pops out regularly, bringing with them a slightly offensive odour.
How is the operation done
The operation requires a general anaesthetic (putting patient to sleep). There are several ways to perform tonsillectomy. Traditionally the tonsils are being ‘peeled off’ from the side of the throat, using either scissors to cut and dissect, or a diathermy to burn and cauterise. Tonsils removed this way have their capsules (covering) removed as well, and is termed extracapsular tonsillectomy. One of the latest trend is a change of the way we perform the operation. It has been shown that if the capsule can be retained during the operation, post-operative pain reduces significantly. Intracapsular tonsillectomy (removing tonsils within the capsule) is carried out by a method called coblation, where a chemical reaction within the plasma serves to vaporise the tonsil.
Does it hurt
Having your tonsils removed can be very painful. The pain is similar to an attack of tonsillitis, and normally worsens during day 3-4 after the operation before it improves gradually over the next 10 days. The newer coblation method does have a better pain outcome, with patients feeling back to their normal self within a week.
After the operation
Normally you will be observed on the ward over a period of 4 to 6 hours. You should be able to eat and drink as when comfortable to do so. Painkillers will be given on discharge, and you should take them regularly in the first week.
How long do I have to be off work
It is advisable to have a period of convalescence of 2 weeks (1 week if coblation method) after the operation. Physical exercise or strenuous activities should be refrained. Likewise social gatherings and activities should be kept to a minimum to reduce the risk of acquiring infection.
The main complication for tonsillectomy is post-operative haemorrhage. This normally happens to 2-3% of patient if performed using the traditional method, and slightly lower with the coblation method. Other possible complications include infection, minor lip and dental injury (bruising or cutting to lip or gum area). Very uncommonly there could be taste disturbance. With the intracapsular method, there could also be some regrowth of tonsil tissue requiring a second operation. This risk is less than 1%.
Is there any alternative treatment
For tonsillitis, the only alternative treatment is antibiotics during the infective episode. For other reasons requiring tonsillectomy, there are no real alternative to taking the tonsils away.