Tonsillectomy

One of the most common throat operations, tonsillectomy surgically removes the tonsils, masses of lymph tissue in the back of the throat that work with the adenoids and immune system early in life to defend the body against invading bacteria and viruses. Occasionally the tonsils become infected or abscessed, and, if these conditions continue, enlarged, causing breathing and swallowing problems such as snoring, disturbed sleep, chronic mouth breathing (possibly resulting in deformations of the face and mouth), ear infections and hearing loss.

Signs that you or your child may have tonsillitis (infected tonsils) include:

  • Tonsils that are enlarged, redder than usual, or have a white or yellow coating
  • Swelling that causes a slight voice change
  • Sore throat
  • Difficult or painful swallowing
  • Swollen lymph nodes (glands) in the neck
  • Fever
  • Bad breath

The first stage of treatment for chronic tonsil inflammation is a course of antibiotics or steroids; if this fails to resolve the problem, the tonsils may be removed. Removal is usually recommended for patients with three or more infections of the tonsils each year and patients with sleep-disordered breathing, and may also be recommended for patients with tumors or difficulty breathing.

Tonsillectomy requires local or general anesthesia depending on the technique and the patient’s age and preferences. Patients are released a few hours or the morning after surgery.

Surgery may be performed with a scalpel (“cold knife dissection”) under general anesthesia with minimal post-operative bleeding; by electrocautery, minimizing bleeding but increasing the risk for tissue damage by heat; with a harmonic scalpel, which offers precision cutting through ultrasonic vibrations; with a carbon dioxide laser (laser tonsil ablation, or LTA) that vaporizes tonsil tissue in 15-20 minutes with minimal pain; with a microdebrider, a shaving/suctioning device that removes the part of the tonsil blocking the airway; by monopolar radiofrequency ablation (somnoplasty), where thermal energy causes scarring that shrinks enlarged tonsils; or by bipolar radiofrequency ablation (coblation), where an ionized saline layer is created to remove the enlarged portions of the tonsil without heat energy.

Post-surgical complications may include pain in the throat or ears, swallowing problems, halitosis, infection, vomiting, fever and, rarely, bleeding.

 


Adenoidectomy

A very common throat operation, adenoidectomy surgically removes the adenoids, masses of lymph tissue in the back of the throat that work with the tonsils and immune system early in life to defend the body against invading bacteria and viruses. Occasionally the adenoids become infected and, after repeated infections, enlarged, causing breathing and swallowing problems such as snoring, disturbed sleep, chronic mouth breathing (possibly resulting in deformations of the face and mouth), ear infections and hearing loss. Signs that you or your child may have enlarged adenoids include:

  • Breathing through the mouth rather than the nose
  • Blocked-sounding nose when speaking
  • Frequent ear infection
  • Noisy breathing
  • Snoring
  • Sleep apnea (frequent pauses in breathing at night)

The first stage of treatment for chronic adenoid enlargement is a course of antibiotics or steroids; if this fails to resolve the problem, the adenoids may be removed. Removal may also be recommended for patients with chronic ear infections, tumors or difficulty breathing.

Adenoidectomy requires local or general anesthesia and patients are released a few hours or the morning after surgery. Post-surgical complications may include pain in the throat or ears, swallowing problems, halitosis, infection, vomiting, fever and, rarely, bleeding.

 


Surgery for Snoring and Sleep Apnea

Sleep-disordered breathing describes a group of abnormal breathing patterns experienced during sleep, which may manifest as light or heavy snoring, pauses in breathing (sleep apnea) or complete airway collapse. People with obstructive sleep apnea syndrome stop breathing while they sleep, sometimes hundreds of times pernight and sometimes for a minute or longer each time. The soft tissue at the back of the throat closes, blocking (obstructing) the person’s airway. A common warning sign of obstructive sleep apnea is snoring (especially snoring interspersed with gasps or lack of breathing), although the two are not always related. Because the brain and major organs are deprived of essential oxygen when breathing is disrupted, if left untreated sleep apnea can result in high blood pressure, cardiovascular disease, stroke, memory problems, weight gain, impotency, headaches, and daytime fatigue leading to job impairment and motor vehicle crashes.

There are many treatments available for sleep apnea and other sleep-disordered breathing problems. Snoring independent of sleep apnea can be lessened with changes in diet and weight loss and reduction of alcohol, tobacco and other drugs; if this fails, surgery of the soft palate may be elected. Traditionally, this involved a procedure called uvulopalatopharyngoplasty, which removes the tonsils, uvula and part of the soft palate to open the airway. Now, more advanced procedures such as Laser Assisted Uvula Palatoplasty (LAUP) and somnoplasty (radiofrequency ablation) are performed to stiffen the soft palate without the need for general anesthesia.

Before surgery is attempted, patients suffering from sleep apnea are given a breathing mask to wear at night that uses Continuous Positive Airway Pressure (CPAP), wherein air is forced past the obstruction for clear breathing. If this fails to correct the problem or if the patient is too uncomfortable to continue, surgical options may be considered, such as uvulopalatopharyngoplasty or a procedure using radiofrequency energy that shrinks the base of the tongue and the soft palate.