Tonsillectomy
Tonsillectomy is a surgical procedure to remove the tonsils. The operation is performed under general anaesthetic by an ENT surgeon, and generally requires hospitalization for one day, or several days in the event of severe pain.
Find out more about tonsillectomy from ENT surgeon Dr. Delagranda.
Objectives of tonsil surgery
- Restore growth by improving swallowing and thus mealtimes
- Improve sleep quality, and thus daytime activities (schoolwork, sports) and behavior (social interactions and relationships)
- Eliminate angina-related pain and thus reduce school absenteeism
- Reduce bad breath (factors other than tonsils may be to blame)
- Facilitate the work of orthodontists and speech therapists
- In exceptional cases, diagnose cancerous pathologies
Tonsils
The palatine tonsils are located behind the mouth, on either side of the tongue, in the oropharynx. Round masses measuring 2 cm in diameter, made up of lymphoid tissue, they have an irregular surface dotted with crypts of varying depths. The tonsils play a role in the immune system, helping the body to mount a defense against bacterial and viral infections by triggering the production of antibodies and lymphocytes after trapping these micro-organisms. This mechanism is particularly useful in early childhood.
On the other hand, they can become a source of discomfort as a result of excessive volume acquired through chronic inflammation following repeated or persistent infections. Removing them poses no subsequent immune problems. In France, 10 to 12 million cases of acute tonsillitis are diagnosed each year, more than a third of them in children.
Most cases (60% to 80%) are viral.
Diagnosis of group A streptococcal infection by streptotest justifies antibiotic therapy (to reduce the risk of post-streptococcal complications).
Obstruction of the oropharynx by hypertrophic tonsils, leading to eating and breathing difficulties (OSA), is the second reason for tonsillectomy.
Who is concerned by tonsil removal ?
Children from the age of 2-3 and all adults can be concerned.
The main cause of tonsillectomy in adults is recurrent infection (tonsillitis or angina) or at least 2 peritonsillar abscess.
In children, the main causes of tonsil removal are tonsillar hypertrophy associated with OSAS (obstructive sleep apnea syndrome), chronic tonsillar infections (local tonsillar signs or satellite adenopathies persisting for 3 months) and/or recurrent tonsillitis (5 tonsillitis/year for 2 consecutive years). The prevalence-frequency of OSA in children is highest between the ages of 3 and 6 (1-3%), with obstructive pathologies being the most frequent causes (tonsils and vegetations). It can reach 13% in obese children.
The long-term consequences of OSAS are numerous and deleterious (cardiovascular, neurocognitive development, growth disorders).
Evaluate your own sleep and risk of sleep apnea syndrome
For yourself: Epworth sleepiness questionnaire (there will be a link to make): if the score is ≥ 9, a consultation is necessary.
For your child: Spruyt Gozal questionnaire (there will be a link to make): if the score is ≥ 2 ,75, a consultation is necessary.
The different stages of the intervention
The surgery
Tonsil surgery is performed under general anaesthetic with tracheal intubation in 20-30 minutes, using a variety of techniques depending on the indication (laser, radiofrequency, dissection-diathermy-electrocoagulation), in full hospitalization or on an outpatient basis (depending on certain criteria and only for children). Ablation is usually total, although some teams recommend partial ablation, particularly in cases of OSAS.
Hospitalization is brief in 99% of cases. The average length of stay is 1.4 days.
Tonsil removal is associated with removal of the vegetations in 82% of cases (source ATIH). 35,000 tonsillectomies were performed in France on patients under 18 in 2010.
Post-operative recovery period
The patient usually returns home the day after the operation, or the same day in the case of outpatient hospitalization.
After hospitalization, you should rest at home for 10 days, and check for bleeding (bloody sputum, marks on the pillow, etc.).
The surgeon will give you 10 to 15 days off work.
Sport is not recommended for the first 15 days, and resumption should be gradual.
Pain is considerable, except when radiofrequency is used, and corresponds to that of severe angina. Class II analgesics are used to control pain. Strong breath may be present during the healing period.
Food should be cold and blended for 10 days, to limit the risk of secondary bleeding from a falling eschar and reduce pain.
Post-operative care at home: mouthwash, analgesics.
Scarring: no visible scarring, but the back of the throat may appear whitish due to fibrin, which gradually disappears.
Complications of tonsil surgery
In addition to the risks inherent in any surgery involving general anesthesia, tonsillectomy presents rare risks of complications:
- Bleeding during the operation: less than 1% of operations.
- Haemorrhage when a pressure sore falls 1 to 3 weeks after the operation: 1 to 3% of cases.
- Voice changes: due to air leakage into the nose, these are exceptional and are improved by speech therapy.
- Tooth dislocation
- Small mouth injuries
Please refer to the ENT College’s explanatory sheet on tonsillectomy for further details.
➔ Amygdalectomie chez l’enfant
➔ Amygdalectomie chez l’adulte
When to have your tonsils removed?
Tonsillectomy is indicated in cases of :
- Enlarged tonsils leading to difficulty swallowing and delayed weight gain (short stature, low weight, very slow mealtimes): stage 3 or 4 of Brodsky’s classification.
- Enlarged tonsils causing respiratory problems when lying down, with repercussions during the day (snoring, sleep apnea or pauses in breathing OSA in children, nocturnal calls from children, fatigue during the day, irritability, behavioral problems).
- Tonsils that are too large, causing teeth to shift by pressing on the tongue (orthodontist’s request) or speech difficulties (speech therapist’s request).
- Recurrent angina (5 or more episodes/year), phlegmon (abscess around the tonsil)
- Bad breath due to cryptic tonsils with caseum (malodorous white production)
- Chronic pharyngeal pain
- Rare cancers in adults (squamous cell carcinoma, lymphoma) and exceptional cancers in children (lymphoma, rhabdomyosarcoma)
Frequently asked questions about tonsillectomy
Here is a selection of questions frequently asked by Dr Delagranda’s patients during a tonsillectomy consultation in La Roche-sur-Yon.
How do you know when to have tonsil surgery?
Ask your ENT surgeon for advice.
At what age can tonsils be removed?
From age 2-3, with no age limit.
How does tonsil surgery work?
The tonsil surgery is performed under general anesthesia with tracheal intubation in 20-30 minutes.
What are the risks of tonsillectomy?
In addition to the risks inherent in any surgery involving general anesthesia, tonsillectomy presents rare risks of complications:
- Bleeding during surgery: less than 1% of operations.
- Haemorrhage due to pressure sores 1 to 3 weeks after the operation, which occurs in 1 to 3% of cases.
- Voice changes: due to air leakage into the nose, these are exceptional and are improved by speech therapy.
- Tooth dislocation
- Small mouth injuries
When to eat after tonsillectomy?
Feeding can be resumed from day one.
What should I eat after a tonsillectomy?
Food should be cold and blended for 10 days, to limit the risk of secondary bleeding and reduce pain. Ice cream is permitted and recommended.
How can I reduce pain after tonsil surgery?
Cold foods, class-two analgesics with codeine and tramadol.
Can tonsils grow back?
No, or only very moderately, in the case of residues at the base of the tongue, which must be left in place for safety reasons, or in cases of partial removal for OSA.
How do you get tonsillitis?
Direct contact: Someone comes into contact with the infected person’s saliva, nose or skin wound.
Indirect contact: The microbes in an infected person’s nose and throat are transmitted through the air, in droplets (Flügge) that escape when the person coughs or sneezes.
Is tonsillitis contagious?
Not very contagious, if you avoid receiving the droplets of Flügge emitted by the patient in the eyes, nose or mouth.
Fees and payment for the procedure
Tonsil surgery is covered by health insurance. Contact your mutual insurance company to find out whether any extra fees will be covered.
Do you have a question? Need more information?
Dr Antoine Delagranda will be happy to answer any questions you may have about tonsil surgery. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon in the Vendée.
ENT consultation for tonsillectomy in Vendée
Dr Antoine Delagranda will be happy to answer any questions you may have about tonsil surgery. Dr Delagranda is a specialist in ENT surgery Clinique Saint Charles à La Roche-sur-Yon en Vendée.