Tonsillectomies are among the most commonly performed surgical procedures in the United States, but their popularity seems to wax and wane. At times, the medical community has generally viewed the surgery as a minor, rite of passage for children. At other times, it has been more critical.
As more research reveals the risks of leaving swollen, infected tonsils alone - in addition to the risks of removing them - it is ever more important than ever for patients to be informed. This article will attempt, as accurately as possible, to outline the risks versus benefits of having your tonsils removed.
Common Reasons a Surgeon Might Suggest a Tonsillectomy
Probably the two most common reasons a surgeon might suggest removing tonsils are: sleep apnea and the presence of numerous strep infections. Among adults, chronic infection is the main reason for the procedure; among children, sleep apnea is the No. 1 reason.
Sleep apnea is a condition where a person stops breathing for brief periods of time during their sleep. Recent research has shown that over time, this lack of oxygen to the brain and heart can result in severe illnesses, including heart disease, depression, mood swings, aggression, daytime sleepiness and numerous other health problems. Swollen tonsils can can cause apnea by directly blocking the airway while a person is lying down.
New information about the dangers of sleep apnea has certainly increased the number of tonsillectomies in the United States. In fact, surgeons are more likely to recommend removing the tonsils if you have sleep apnea than if you have chronic tonsillitis alone. Removing swollen tonsils has been found to be very effective in treating and curing this form of sleep apnea. However, surgery should only be considered when other, less invasive forms of medical treatment are not tolerated or are ineffective.
For more information on sleep apnea read:
- What Is Sleep Apnea
- Can My Child Have Sleep Apnea?
- How Sleep Apnea Can Diminish the Quality of Your Child's Life
- The Effects of Sleep Apnea on Diabetes
Most professional guidelines do not recommend a tonsillectomy for infections unless you have had five to seven of them in one year. In addition, a surgeon will consider the severity of those infections and how responsive they are to treatment.
While removing the tonsils is usually helpful for treating chronic infections it is not always 100% effective. It is still possible to get strep throat or a similar infection after having your tonsils removed. Nevertheless, the majority of people either stop having infections or don't have as many. If you do get an infection after a tonsillectomy the infection is usually not as severe as it would have been before the surgery. For more information read:
- What Causes Swollen Tonsils?
- What Are Complications of Strep Throat I Should Know About?
- What to Do About Recurring Strep Throat
Other reasons your doctor may recommend removing your tonsils include peritonsilar abscesses, tonsil cancer and enlarged tonsils that are causing teeth problems. Enlarged tonsils that are causing difficulty with swallowing or breathing and have not responded to other treatments should be removed as soon as possible.
The RisksExpected or Common Problems After Tonsillectomy
Aside from some life-threatening complications tonsillectomies come with some expected, unpleasant side effects. Many people experience nausea and vomiting, throat pain, difficulty swallowing, low grade fever, bad breath, earaches and fatigue. The frequency and severity of these post-surgical problems vary widely from person to person. It is widely believed that children tend to have a shorter and "easier" recovery.General Anesthesia
Tonsillectomies are performed under general anesthesia. General anesthesia comes with its own set of risks. These risks range from the minor - nausea and vomiting - to the life threatening - such as respiratory failure, malignant hyperthermia and even death.
You are less likely to experience serious complications if you've successfully undergone general anesthesia in the past. Individuals with a family history of malignant hyperthermia, pseudocholinesterase deficiency, muscular dystrophy or sudden death from general anesthesia are themselves at a higher risk. You should inform your anesthesiologist if any of your family members have experienced these complications. Medications may need to be adjusted to avoid potential problems.
You are also more likely to have respiratory problems after anesthesia if you have a chronic respiratory condition such as asthma or sleep apnea. However, thousands of individuals suffering from sleep apnea successfully undergo general anesthesia every day.
One source estimates the rate of deaths attributed directly to anesthesia to be less than one in 100,000 patients. You can reduce your risk by following the instructions given to you before your surgery, (especially about eating and drinking), and fully disclosing your health information to your doctor.Bleeding After Surgery
There is always a risk of hemorrhaging (bleeding) during and after any surgery, but because the tonsils are close to major blood vessels, bleeding is a special concern. Bleeding after a tonsillectomy is not common; however, it is perhaps the most serious risk of the operation itself. Serious complications from bleeding, including re-hospitalization, additional surgery and death, are very rare, but they can happen. There are two times during which post-operative bleeding is most likely to occur: within the first 24 hours after surgery and six to 10 days after surgery when the scabs come off. It is estimated that 0.2% to 2.2% of patients hemorrhage within 24 hours after surgery, and 0.1% to 3.7% of patients experience post-operative bleeding six to 10 days after surgery.
Diseases such as hemophilia or anemia increase your risk of bleeding after a tonsillectomy. The use of certain medications such as aspirin, ibuprofen, naproxen or prescription blood thinners like Coumadin (warfarin) can also increase the risk. Your doctor will recommend you stop taking these medications before surgery and should give you specific instructions regarding the use of these medications after your tonsils are removed. There is also some evidence that the steroid dexamethasone, commonly used during surgery to prevent nausea, may slightly increase your risk of bleeding. Dehydration can also increase the risk that your scabs will come off too early and cause bleeding.
It should be noted that during the actual surgery you may swallow some blood. This blood may come out in saliva or be vomited out later. In this case the blood will appear brown (it is commonly described as looking like coffee grounds). This is not a concern. However, bright red blood coming from the tonsil beds at any time is unacceptable and you should get immediate medical attention. For more information read:
- Is Bleeding After a Tonsillectomy an Emergency?
- Post-Operative Bleeding After a Tonsillectomy
- Five-Year-Old Dies After Tonsillectomy
Another risk of any surgical procedure is infection. This is relatively rare with tonsillectomies; when it does occur, it can usually be cured by antibiotics. Signs of an infection should be reported to your doctor immediately. They include: a fever greater than 101 degrees Fahrenheit; severe or persistent ear pain (the surgery can cause ear infections, but ear pain is also a common complaint after a tonsillectomy, so you should be aware of other signs and symptoms indicating an ear infection); and symptoms of an upper respiratory infection, such as coughing, mucus that is an abnormal color (green, for example) or difficulty breathing (a symptom that can be an emergency).Other Rare Complications
There is a small risk for other rare complications, including: burns during surgical cautery; upper airway obstruction from excessive scar tissue; damage to the teeth during intubation (the insertion of a breathing tube for general anesthesia); the accidental inhalation of stomach contents while under anesthesia (aspiration pneumonia); and allergic reactions to medications given during and after surgery.
Because no two people are alike and the human body is so complex, there is a very rare chance that you will experience complications that have never been documented.Adenoidectomies
Adenoidectomies are commonly performed at the same time as a tonsillectomy. It is possible to have your adenoids removed with or without removing the tonsils. Your surgeon will decide if the removal of your adenoids is necessary. An adenoidectomy is considered a separate surgery from a tonsillectomy and carries its own risks. For more information read:
The Bottom Line
It is estimated that roughly 380,000 tonsillectomies are performed annually in the United States. By far the majority of these operations are considered successful. It is difficult to obtain data on deaths related to tonsillectomies in the United States, but a study in Israel revealed one death per 12,000 surgeries. Whether the deaths were due to the tonsillectomy, an allergic reaction or general anesthesia is not known.
While the risks of having your tonsils removed should not be taken likely, if your enlarged tonsils are decreasing your quality of life, you are otherwise healthy and do not have a family history of muscular dystrophy or malignant hyperthermia, it is probably worth it to have them removed. However, this is a decision that only you, with the assistance of your surgeon, can make. For more information read:
- Having Your Tonsils Removed
- Readers Respond: What Was the Worst Part of Having Your Tonsils Removed?
- Readers Respond: The Best Foods to Eat After a Tonsillectomy
- What Are Risks of Having Your Tonsils Removed?
- Tonsillectomy Techniques Studied
Medscape. General Anesthesia. Accessed: October 25, 2011 from http://emedicine.medscape.com/article/1271543-overview
Uptodate. Tonsillectomy and adenoidectomy in children. Accessed: October 24, 2011 from http://www.uptodate.com/contents/tonsillectomy-and-adenoidectomy-in-children (subscription required).