From the Guidelines
Tonsillectomy is a safe and effective procedure for reducing the frequency and severity of subsequent infections in children with recurrent sore throat, with benefits lasting for at least 2 years, as evidenced by a 2019 clinical practice guideline update 1. The consequences of tonsillectomy can be significant, with both short-term and long-term effects on the patient's quality of life.
- Immediately after surgery, patients typically experience throat pain, difficulty swallowing, and possible bleeding risks within the first two weeks.
- Pain management usually involves acetaminophen and sometimes prescription pain medications, with a soft diet recommended for 1-2 weeks and adequate hydration being crucial for recovery.
- Long-term consequences may include a slightly increased risk of respiratory infections early in life, though the body adapts over time, and some patients report reduced frequency of sore throats and sleep improvements, especially those who had recurrent tonsillitis or sleep apnea before surgery. The decision to perform a tonsillectomy should be based on individualized factors, including the severity of illness, frequency of infections, and presence of modifying factors such as multiple antibiotic allergies or specific clinical syndromes like PFAPA or recurrent peritonsillar abscess, as outlined in the 2019 guideline update 1.
- Modifying factors can be categorized into exceptions to recognized criteria, specific clinical syndromes, and poorly validated clinical indications, and should be considered when making a decision about tonsillectomy.
- The benefits of tonsillectomy, including reduced frequency and severity of infections, should be weighed against the potential risks and complications, such as bleeding, voice changes, and taste alterations. Overall, tonsillectomy can be a beneficial procedure for patients with recurrent sore throat, with significant improvements in quality of life and reduction in morbidity, as supported by the 2019 clinical practice guideline update 1.
From the Research
Consequences of Tonsillectomy
- Pain and bleeding are two of the most common complications of tonsillectomy, which can delay recovery and lead to hospital readmission 2
- Tonsillectomy may lead to an increased incidence of related infectious diseases, although it does not negatively affect cellular and humoral immunity 3
- Tonsillectomy can lead to a dramatic and persistent improvement of skin lesions in patients with pustulosis palmaris et plantaris (PPP) and other tonsil-related skin diseases 4
- Compared to tonsillectomy, tonsillotomy may have a similar efficacy in adults, but with advantages in terms of pain, analgesics use, patient satisfaction, operation time, and post-operative complications 5
- Tonsillectomy may be indicated in cases of recurrent tonsillitis, especially when caused by antibiotic-resistant bacteria such as Staphylococcus aureus 6
Postoperative Complications
- Postoperative haemorrhages are more frequent after tonsillectomy than tonsillotomy 5
- Lidocaine spray may be effective in reducing the severity of pain after tonsillectomy, but benzydamine spray can cause a burning or stinging sensation in some patients 2
Immune System Effects
- Tonsillectomy and adenoidectomy may not have significant effects on cellular immunity, but can lead to an increased incidence of certain illnesses, especially infectious diseases 3
- The removal of tonsils and adenoids does not negatively affect humoral immunity, although there may be some contrary results 3