From the Research
Emergency tonsil surgery (tonsillectomy) is required when severe tonsillitis causes life-threatening complications or significantly impairs breathing or swallowing, with the most urgent indication being peritonsillar abscess (quinsy) that fails to respond to needle drainage and antibiotics. The most recent and highest quality study 1 provides guidance on the surgical management of tonsillitis, including the treatment of peritonsillar abscess. According to this study, abscess tonsillectomy should be preferred if complications have occurred or if alternative therapeutic procedures have failed. Some key points to consider in the management of tonsillitis and peritonsillar abscess include:
- The quality of evidence for tonsillectomy to resolve recurrent episodes of tonsillitis is moderate for children and low for adults 1
- Abscess tonsillectomy is a safe and effective treatment for peritonsillar abscess, with a low risk of postoperative bleeding 2
- Immediate tonsillectomy can be recommended as a safe surgical procedure in non-selected patients to evacuate quinsy without an additional risk of bleeding 3
- Post-tonsillectomy hemorrhage is a significant risk factor, and older age, a history of chronic tonsillitis, excessive intraoperative blood loss, and elevated postoperative mean arterial pressure are significant risk factors for post-tonsillectomy hemorrhage 4 In terms of specific indications for emergency tonsil surgery, these include:
- Peritonsillar abscess that fails to respond to needle drainage and antibiotics
- Enlarged tonsils causing obstructive sleep apnea with oxygen desaturation below 80% or severe difficulty breathing, especially in children
- Uncontrollable tonsillar bleeding, either spontaneous or following a previous tonsillectomy
- Suspected malignancy in the tonsils It is essential to note that while most tonsil issues can be managed with antibiotics, steroids, and supportive care, these emergency situations require prompt surgical intervention to prevent serious complications like airway compromise, sepsis, or aspiration. Anyone experiencing severe throat pain with difficulty swallowing saliva, drooling, muffled voice, or respiratory distress should seek immediate medical attention.