Removal of tonsils indications and contraindications. What is a tonsillectomy, how is it done, types and consequences. Alternatives to Traditional Tonsillectomy

Even without a medical education, most people are able to distinguish the usual SARS from acute tonsillitis, or tonsillitis. And almost everyone knows that the first and main symptom of a sore throat is a sore throat. And if in the case of a banal “cold”, treatment at home without consulting a specialist often leads to positive results, then in case of acute tonsillitis, self-treatment is fraught with complications. In fact, respiratory viral infections and acute tonsillitis have little in common, except for the infectious nature, causes and area of ​​\u200b\u200bdamage.

The characteristic features of angina are a significant increase in body temperature above subfebrile numbers (above 38.0 ° C), severe sore throat. Up to the impossibility of swallowing and changes in the palatine tonsils that are visible even to the naked eye. In addition, tonsillitis is extremely dangerous for its complications, which can manifest itself both during the underlying disease and years after the relief of the external manifestations of the disease.

What is a tonsillectomy

Surgical removal of the tonsils, or tonsillectomy, has been practiced in medicine since ancient times. The first documented description of this operation dates back to the beginning of our era. Its author is the ancient Roman medical scientist Aulus Cornelius Celsus.

Since then, the method has undergone significant improvement, new types of treatment have been born, but the approach to the pathology of the tonsils is still considered relevant and often used.

Types and differences

To date, there are several ways to remove the tonsils, differing mainly in the tool that eliminates the focus of pathology. Based on this, the following types of tonsillectomy are distinguished:

  • Classic operation. Operation with surgical instruments - scalpels, scissors and a wire loop. It involves the dissection of the mucous surface, the removal of the tonsils and the drainage of paratonsillar abscesses.

Positive differences: a well-tested and time-tested method, which was the only one for quite a long time. Well known to surgeons with extensive experience.

Negative: a long time of rehabilitation and recovery of well-being after the operation.

  • Electrocoagulation. A more modern method of removing the tonsils, using a very high frequency electric current as a tool.

Positive differences: simultaneous “cauterization” of blood vessels during the operation, which eliminates the risk of heavy bleeding.

Negative: there is a risk of thermal damage to nearby tissues due to the high temperature of the instrument used.

  • Ultrasonic tonsillectomy. High-frequency ultrasound is characterized by less intense thermal radiation compared to the effect of electric current with similar results.

Positive differences: a short postoperative period, less trauma.

Negative: the possibility of burns, heavy bleeding.

  • Radiofrequency ablation (coblation ) . With this method, the radio waves generated by a special apparatus are converted into thermal radiation, which excised the tissue of the tonsils, contributing to their reduction.

Positive differences: minimal trauma, good tolerance.

Negative: long exposure time (up to several weeks), partial removal of tonsil tissue, and therefore a high likelihood of recurrence.

  • Laser tonsillectomy in turn is subdivided into infrared and carbon. It uses the same types of laser radiation.

Positive differences: painlessness, bloodlessness of the method.

Negative: the cost of the procedure.

  • is currently rarely used. It is based on necrotization of the tonsil after exposure to liquid nitrogen and its subsequent rejection.

Positive differences: no incisions, damage to surrounding tissues.

Negative: intoxication of the body with decay products during tonsil necrosis.

Indications and contraindications for tonsillectomy

Surgery is a radical method of treating diseases, it is used only in cases where conservative methods of medicine (drug therapy and other non-invasive methods of treatment) have proven to be unproductive or their use is inappropriate. Not many patients are ready to “go under the knife” immediately on the first recommendation of the attending physician. It is necessary to carefully study the presence or absence of indications for surgical intervention, the main of which in the case of tonsillectomy are listed below:

  • Frequent cases of exacerbations of tonsillitis of streptococcal etiology;
  • Regular relapses of acute tonsillitis (more than 6 cases per year);
  • The ineffectiveness of drug therapy;
  • Local complication of angina in the form of paratonsillar abscess;
  • Chronic forms of tonsillitis in the stage of decompensation;
  • The presence of complications from other body systems of an infectious-inflammatory nature (rheumatism, kidney pathology, endocarditis, etc.);
  • An increase in the size of the tonsils to the extent of their obstruction of the functions of swallowing and breathing.

Before carrying out the prescribed procedure, it is also necessary to study the contraindications to tonsillectomy:

  • Diseases of the blood system (leukemia, hemorrhagic vasculitis, anemia, thrombocytopenia);
  • Congenital and acquired malformations of the vessels of the pharynx (aneurysms, submucosal pulsation);
  • Psychiatric diseases;
  • Tuberculosis in active phases;
  • Various pathologies of internal organs in the stage of decompensation, including diabetes mellitus;
  • Concomitant infectious diseases;
  • Completion of the menstrual cycle;
  • Caries;
  • Purulent diseases of the skin.

In the event that one or more of the following conditions is detected in a patient, it is necessary to notify the treating specialist.

Advantages and disadvantages of tonsillectomy

The attitude towards tonsillectomy for many years of its use is still ambiguous. Proponents of this method see in it, first of all, getting rid of the disease as a result of a single medical procedure, the absence of repeated cases and relapses of the disease, the elimination of the source of infection and the causes of frequent complications. Opponents of tonsillectomy point to the loss of a functioning organ by the body, which plays an important role in the formation of full-fledged immunity, as well as the existing percentage of complications and side effects after the procedure. One way or another, only a leading specialist who is well acquainted with the history of the disease and the state of the body sent for surgery can insist on an operation, and the last word certainly remains with the last one.

How is the operation

The scheme and technique of performing an operation on the tonsils depends on the instrument for tonsillectomy and the location of the organ. So, for example, surgery on the nasopharyngeal tonsil excludes the use of some high-tech instruments as a scalpel (for example, a laser) and more often uses mechanical means - adenoidotomes. Tonsillectomy and adenoidectomy, although they are essentially operations on one organ - the tonsil, but take into account its type and location. Common to all types of operations on the tonsils are the following features:

  • preparation for tonsillectomy includes the following diagnostic measures: examination by an otolaryngologist, blood tests - general and biochemical, to determine the blood group and Rh factor, antibodies to HIV, hepatitis, as well as a coagulogram; urinalysis and fluorogram;
  • carrying out in any case implies anesthesia, which can be both local and general;
  • the scheme of the operation, as a rule, includes opening the capsule in which the body of the tonsil is located, separating the tonsil from nearby tissues and extracting it;
  • after a tonsillectomy during the day, you should, if possible, limit the act of swallowing - when eating, drinking, talking, swallowing saliva, etc. Also, a special diet after tonsillectomy is observed for 2 weeks.
  • within a week after the procedure, intensive restoration of damaged tissue occurs with the formation of yellowish deposits. The temperature after tonsillectomy may rise during this period.

Complications and possible consequences

The most common complications after tonsillectomy surgery are:

  • Bleeding. Dangerous within 2 weeks after the operation, if they occur, you should immediately contact medical specialists;
  • Quite often, there are prolonged severe sore throats, which are desirable to stop by oral administration of analgesics;
  • An increase in body temperature up to 38.5 ° C:
  • Burns of the oropharyngeal mucosa can occur during the use of modern methods and are usually detected in the early postoperative period;
  • The change in the timbre of the voice is most typical for children, in adults there are more often violations of taste sensations.

The operation to remove the palatine tonsils is called. During surgery, the tissue and connective tissue capsule of the tonsils are removed. A few decades ago, tonsillectomy was considered practically the only way. Nowadays, due to the emergence of effective methods of treating this disease, operations to remove the tonsils are performed much less frequently than before.

There are clear indications and a number of contraindications for this operation, which are guided by otorhinolaryngologists.


Indications for tonsillectomy

  • Often recurrent exacerbations of chronic tonsillitis with the appointment of adequate therapy (more than 7 cases within one calendar year);
  • decompensated form of chronic tonsillitis;
  • increased risk of developing renal or cardiovascular complications;
  • systemic complications developed as a result of chronic tonsillitis (rheumatism, polyarthritis, heart disease, kidney disease, etc.);
  • , which arose due to an increase in the size of the tonsils;
  • development of purulent complications of tonsillitis (and phlegmon).

Only in the latter case, when purulent complications of tonsillitis occur, the operation is performed in the acute period of the disease and is accompanied by massive antibacterial therapy. In all other cases, surgical intervention is performed during the period of remission of chronic tonsillitis (it is desirable that 2–3 months pass after the last exacerbation subsides).


Contraindications for tonsillectomy

Most often, tonsillectomy is performed due to chronic tonsillitis.

Contraindications to any surgical intervention are divided into absolute (surgical manipulations under no circumstances can be performed on the patient at this time) and relative (the operation is possible under certain conditions).

Absolute contraindications to the operation to remove the palatine tonsils are:

  • blood diseases (clotting disorders, acute and chronic leukemia);
  • anomalies in the structure of the vessels of the pharynx (submucosal pulsation of vessels, aneurysm);
  • pulmonary tuberculosis in active form;
  • diseases of the cardiovascular system, liver, kidneys in the stage of decompensation;
  • severe diabetes mellitus.

Relative contraindications to surgery include:

  • exacerbation of chronic diseases of internal organs;
  • menstruation in women;
  • dental caries;
  • stage of decompensation in patients with diabetes mellitus;
  • unfavorable epidemic period (outbreaks of influenza, measles, poliomyelitis).

Thanks to advances in medicine, some conditions where surgery is categorically contraindicated can be compensated so much that, if necessary, a tonsillectomy can be performed. Recently, the age of patients has also ceased to be a limitation for the operation. Currently, when there is an absolute indication, tonsillectomy is performed in children over the age of 2 years and the elderly.

Preparation for surgery implies a mandatory examination, which includes clinical and biochemical blood tests, blood clotting tests and a general urinalysis. If necessary, the doctor refers the patient to a consultation with other specialists.


Types of tonsillectomy

To date, several methods of tonsillectomy have been developed, which differ significantly from each other in the technique. Modern methods allow minimizing the volume of blood loss during manipulations, reducing the duration and facilitating the course of the postoperative period, as well as reducing the risk of postoperative complications.

The classic version of the operation, which has existed for many years, is extracapsular tonsillectomy. During surgery, the tonsils are removed under anesthesia (general or local) using a special loop. Despite the fact that this method of removing the tonsils is considered the most traumatic, it is chosen in the presence of complications in the form of paratonsillar abscesses and phlegmon. Within 5-7 days after extracapsular tonsillectomy, the patient should be in the hospital under medical supervision.

Electrocoagulation is a method based on the use of high-frequency electric current. This method differs from the previous one by small blood loss, however, complications may occur in the postoperative period as a result of thermal effects on nearby tissues.

Laser removal of the tonsils is one of the most modern methods of surgical treatment of chronic tonsillitis. Two types of lasers are used for tonsillectomy: infrared and carbon. Regardless of this, blood loss during the operation is minimized; in the postoperative period, the patient is practically not bothered by pain in the area of ​​the postoperative wound. Manipulations can be performed under local anesthesia on an outpatient basis, so that patients can quickly return to their usual lifestyle.

The most promising way to remove palatine tonsils is bipolar radiofrequency ablation. This technique allows you to "dissect" tissue, separating molecular bonds without the use of thermal energy. Removal of the tonsils by this method is carried out under general anesthesia, but tissue trauma and blood loss during such an operation are minimal, and the risk of postoperative complications is also reduced.

On the first day after tonsillectomy, patients are prohibited from eating, swallowing, it is not recommended to talk, they need to sleep on their side. From the second day of the postoperative period, patients are allowed to take liquid food (liquid cereals, pureed soups, purees, yogurts). The diet is gradually expanded, within 2 weeks after the operation, patients are advised to eat a sparing diet. Also, during this time, physical activity and movements that cause a rush of blood to the vessels of the brain (for example, tilts) are not recommended.

Postoperative complications


Oral cavity before and after tonsillectomy.

With proper preparation for tonsillectomy, complications after tonsillectomy are rare. Operated patients may develop bleeding and infectious processes. Extremely rare are transient diabetes insipidus, agranulocytosis, scarring of the palatine arches and soft palate, and other conditions that require adequate treatment.

Bleeding most often occurs on the first day after surgery. The danger of this condition lies not only in the blood loss itself, but also in the fact that the likelihood of blood aspiration during sleep increases with the subsequent development of asphyxia. Also, the risk of bleeding increases 5–8 days after tonsillectomy. This is usually a small bleeding associated with the discharge of the scab. To avoid this complication, it is necessary to strictly follow the recommendations and prescriptions of the doctor.

The risk of developing infectious and inflammatory complications is increased in debilitated patients, as well as in violation of doctor's prescriptions in the postoperative period. Usually, these complications can be avoided by prescribing adequate antibiotic therapy in the postoperative period, and in some patients even during preparation for surgery.

About the operation to remove the tonsils and the indications for this operation in the program "School of Dr. Komarovsky":

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The operation to remove the tonsils is carried out with chronic tonsillitis, which is often accompanied by aggravated tonsillitis. Against the background of frequently recurring tonsillitis, pyelonephritis, periarteritis nodosa, joint diseases, inflammation of the prostate gland, and infective endocarditis often develop. Due to the high risk of complications, experts often recommend surgical treatment of chronic tonsillitis. Often, only surgery can save the patient from constantly recurring recurrences of angina, which greatly weaken the body's defenses and reduce the patient's quality of life.

Innovative technologies available to the specialists of the KONSTANTA Clinic in Yaroslavl make it possible to perform minimally invasive surgical interventions on the pharyngeal tonsils with high efficiency. We guarantee our patients high-quality services of experienced doctors with many years of ENT practice behind them. Our Clinic is equipped with modern equipment, with the help of which we carry out high-quality diagnostics and control the effectiveness of both conservative and surgical treatment of chronic tonsillitis and other diseases that are within the competence of otolaryngologists.

DIAGNOSTICS OF CHRONIC TONSILLITIS

With often recurrent tonsillitis, consultation with an ENT specialist is necessary. The sooner you make an appointment with the doctor, the sooner the specialist will provide qualified assistance. The doctor makes a diagnosis based on the history, examination and the results of the studies. The main method for diagnosing chronic tonsillitis is pharyngoscopy. During the study, the otolaryngologist reveals the characteristic signs of the disease: swelling of the mucosa, fusion of the palatine arches with the tonsils, the formation of adhesions, friability of tissues, the accumulation of pus in lacunae, swollen lymph nodes.

The most severe is the toxic-allergic form of chronic tonsillitis. Relapses occur several times a year, may be accompanied by infectious and inflammatory processes of internal organs and neighboring tissues, the formation of abscesses. The patient experiences severe weakness, body temperature may rise, sore throat causes great anxiety and reduces the quality of life. A simple form of chronic tonsillitis occurs with more meager symptoms: the patient is concerned about sore throat, which is aggravated by swallowing and chewing, weakness and decreased performance.

A common mistake of patients with chronic tonsillitis is the uncontrolled use of medications, including antibiotics. With antibacterial drugs, you only slow down the spread of the infection, but over time, pathogenic microorganisms adapt to the action of even the most powerful drugs that lose their therapeutic effect. While the infectious focus of the tonsils is in the oropharynx, antibiotics will give only temporary relief, but will not solve the problem.

TREATMENT OF CHRONIC TONSILLITIS: WHY EXACTLY OPERATION?

Medical tactics for chronic tonsillitis is selected on the basis of numerous diagnostic data and examinations. Specialists weigh all the pros and cons, assess the risks of complications and make professional forecasts for the future.

In most cases, tonsillectomy is performed with the development of a toxic-allergic form of chronic tonsillitis, which, unlike a simple form of the disease, occurs with severe symptoms of intoxication, immune suppression and a high risk of developing infectious complications.

Radical removal of the tonsils in chronic tonsillitis is absolutely justified: if the conservative treatment of tonsillitis is ineffective, only surgery can get rid of the focus of chronic infection in the pharynx and prevent the spread of infection.

Experts identify more than 100 concomitant diseases that occur with long-term current tonsillitis: psoriasis, nephritis, eczema, prostatitis, scleroderma, lupus erythematosus, rheumatism and other pathologies. Do not postpone the operation if the specialist insists on it. Tonsils lose their main protective functions and turn into a dangerous focus of infection.

There are certain indications for the surgical treatment of chronic tonsillitis, on the basis of which the doctor makes a decision on the need for an operation.

MAIN INDICATIONS FOR REMOVAL OF TONGALES IN CHRONIC TONSILLITIS:

  • pain in the joints;
  • pathological changes on the ECG;
  • the development of serious complications that affect the heart, blood vessels, joints and internal organs: endocarditis, pericarditis, glomerulonephritis, pyelonephritis, vasculitis, rheumatism, arthritis;
  • chronic intoxication, high risk of sepsis;
  • development of paratonsillar abscess;
  • cardiac arrhythmia, heart pain.

The main goals of surgical treatment are to remove the focus of chronic infection, eliminate the symptoms of tonsillitis, prevent the development of infectious complications and stop the intoxication of the body. With a highly qualified surgeon, tonsillectomy allows you to successfully complete all these tasks and save the patient from constant discomfort.

The operation to remove the tonsils should be carried out only within the walls of a medical institution that has all the necessary technical equipment. Our Clinic employs qualified specialists, well-trained and experienced, who have many years of practical experience behind them, allowing them to carry out surgical treatment of chronic tonsillitis with high efficiency.

Tonsillectomy has not only indications, but also contraindications. They must be taken into account when choosing treatment tactics. Specialists identify absolute and relative contraindications to the removal of the tonsils.

Absolute contraindications include:

  • severe heart failure;
  • serious violations of the kidneys;
  • endocrine pathologies, in particular - decompensated type of diabetes mellitus;
  • bleeding disorders, which may be complicated by bleeding or thrombosis;
  • oncological diseases;
  • active form of tuberculosis.
  • exacerbation of any infectious and inflammatory processes;
  • menstruation in women;
  • pregnancy;
  • increase in body temperature.

Relative contraindications to tonsillectomy:

FEATURES OF PREPARATION FOR TONSILLECTOMY

Before surgery, patients undergo a comprehensive examination. The list of studies includes:

  • general blood analysis;
  • general urine analysis;
  • blood test for APTT, fibrinogen, PTI;
  • Blood for RW, HIV, HBs Ag (hepatitis B), HCV (hepatitis C);
  • glucose, total bilirubin, blood creatinine;
  • fluorogram;
  • ECG with interpretation.

5 days before surgery, specialists prescribe to patients who are to have surgical removal of the tonsils, taking medications that reduce the risk of bleeding. It is forbidden to eat and drink directly on the day of the operation.

If during a comprehensive examination, specialized specialists reveal somatic pathology, the operation may have to be postponed. The doctor will prescribe the appropriate medication, based on the results of which a decision will be made on the possibility of performing a tonsillectomy.

AT WHAT AGE IS THE SURGICAL TREATMENT OF CHRONIC TONSILLITIS MOST OFTENATED?

The operation can be performed at any age, in accordance with the existing indications for surgery. Due to anatomical features, children are shown tonsillotomy - partial removal (cutting) of the tonsils or conservative therapy. Adults undergo tonsillectomy - complete removal of hypertrophied tonsils. Minimally invasive surgical treatment of tonsillitis allows for surgical intervention with minimal tissue trauma, without severe blood loss and with a short rehabilitation period.

Tonsillectomy is one of the most common operations in the modern practice of ENT specialists. Despite this, patients should be monitored in the early postoperative period so that qualified staff of the Clinic can monitor the patient's health and, in case of signs of deterioration or complications, provide the necessary medical assistance.

ANESTHESIA FOR TONSILLECTOMY AND TONSILLOTOMY

Tonsil removal surgery can be performed under general or local anesthesia. The decision to use one or another method of anesthesia is made by the doctor based on the anamnesis data, the results of the examination and examination of the patient. Local anesthesia today is rarely used in early childhood, because due to the peculiarities of the psyche, a child under 8-10 years old cannot calmly accept the operation. Therefore, we recommend performing tonsillectomy in childhood using short-term general anesthesia.

In the Clinic "CONSTANTA" a tonsillectomy is performed under the control of video microscopy. During surgery, an anesthesiologist is present in the operating room, who fully controls the patient's condition. Modern drugs that we use for general anesthesia are not accompanied by the development of complications characteristic of the drugs used in the past. The patient quickly recovers and recovers under the strict supervision of competent specialists of the Clinic.

FEATURES OF LOCAL ANESTHESIA

Specialists use a solution of lidocaine or dicaine as a local anesthetic. They irrigate the mucous membrane of the oropharynx, after which loss of sensitivity occurs. Local anesthetic drug is additionally introduced into the mucous membrane. Within 5-10 minutes after that, the specialist begins to perform the operation.

GENERAL ANESTHESIA FOR TONSILLECTOMY

Removal of the tonsils under general anesthesia is used mainly in childhood. Before the operation, sedatives are prescribed. The anesthetic is administered intravenously, which allows you to quickly put the patient to sleep. After that, the doctor proceeds to remove the tonsils. If during the use of local anesthesia the patient sits and is conscious, then during surgery under general anesthesia, the patient is in the operating room in a prone position with his head thrown back.

The operation is carried out quickly, under the supervision of experienced specialists. Tonsils are removed using a raspator, a tool that provides low-traumatic removal of hypertrophied tissues while maintaining the functional features of a healthy mucosa. The vessels coagulate, so there is no bleeding. The doctor carefully examines the tissues after the removal of the tonsils to assess the condition of the bed and blood vessels. It is important to carry out a tonsillectomy as cleanly as possible, leaving no part of the tonsils. This will ensure that the disease does not recur in the future.

FEATURES OF THE POSTOPERATIVE PERIOD

Despite the fact that tonsillectomy is one of the most common operations in modern otolaryngology, qualified specialists should monitor the patient's condition in the postoperative period. The patient is transferred to the ward on a stretcher or in a sitting position, depending on the type of anesthesia used. For quick recovery, it is recommended to use dry ice every two hours for 5-15 minutes. This prevents the appearance of edema and inflammation.

The state of health is restored in a few days after the operation. On the first day, you can not swallow saliva - you need to keep your mouth ajar so that it flows by gravity. In the early postoperative period, you can not talk. If there is a slight sore throat, the doctor prescribes an anesthetic. It also recommends the use of non-steroidal anti-inflammatory drugs, which, in addition to the analgesic effect, prevent the development of an inflammatory reaction. In general, patients tolerate the operation easily and can return to their usual activities almost immediately.

The first days after the operation, you can eat mostly soft pureed food. Avoid hot drinks. According to indications, specialists can prescribe drugs that prevent bleeding. Antibacterial drugs are used to prevent the development of infectious complications.

Within two weeks after surgery, the mode of physical activity is limited. It is forbidden to visit the bathhouse, actively engage in sports. It is also impossible to actively gargle for the first days after tonsillectomy.

CONSEQUENCES OF TONSILLECTOMY

The operation to remove the tonsils in most cases is successful. A huge role is given to the professionalism of the operating doctor, anesthesiologist and other specialists who control the patient's well-being. If you turn to a competent otolaryngologist who has the necessary technical equipment at his disposal, follow the doctor's recommendations before surgery and in the postoperative period, then the risk of complications is minimized.

At the first signs of malaise and deterioration of well-being, you should contact your doctor. Since the pharyngeal tonsils have a rich circulatory network, there is still a risk of bleeding after tonsillectomy. Therefore, if the doctor detects prerequisites for blood loss, the operation is postponed or additional medications are prescribed to prevent bleeding during surgery or on the first day after it.

The most dangerous is the first week after the operation. During this period, tissue healing and rejection of fibrin formed at the site of the removed tonsil occurs. Do not take any action yourself. Contact qualified specialists of the Clinic who will provide the necessary amount of medical care and prevent the development of serious complications.

After tonsillectomy, cases of recurrence of the disease are not excluded. But the high professionalism of the surgeons of our Clinic and the use of innovative technology allow us to minimize any risks and ensure maximum infectious safety for our patients.

WHAT ARE THE ALTERNATIVES TO THE SURGICAL TREATMENT OF CHRONIC TONSILLITIS?

Ttonsillectomy is considered the gold standard in modern otolaryngology. But other methods of removing pharyngeal tonsils are available to specialists today. For example, cryosurgical treatment. The method is based on the use of low-temperature liquid nitrogen, which necrotizes tissues. After its impact, the tonsil becomes pale, hardens, and then gradually rejected. At the same time, the risk of bleeding is minimal, which allows the use of cryosurgery in patients with a high probability of blood loss during surgery or in the postoperative period.

Also in demand is the removal of pharyngeal tonsils with a laser, which has antiseptic and anti-inflammatory properties. The procedure is carried out under local anesthesia, simultaneously with the removal of the tonsils, the vessels are coagulated. They are “soldered”, and this reduces the risk of blood loss several times.

Reduced immunity provokes the development of frequent sore throats, which in turn often lead to the development of chronic tonsillitis.

Many patients are afraid of such a diagnosis, since the first thing that comes to mind is the removal of the tonsils. If you come to an experienced specialist, he will say that there are no extra organs in the body and the tonsils perform their equally important function, so removal requires a careful approach and must be 100% justified.

Removal of tonsils (tonsils): when is such a procedure necessary?

Several decades ago, the removal of the tonsils in chronic tonsillitis was commonplace and was carried out for almost every patient. In particular, when the doctor diagnosed stage 2 or 3 hypertrophy.

According to a medical statement, the tonsils are able to function in children up to 5-6 years, then their work stops, and they lose their value. In the era of the USSR, the removal of tonsils was a mandatory procedure for children under 3 years old. Now you can remove the tonsils at will or need for both children and adults.

Today, otorhinolaryngologists are less critical about tonsil removal and are trying to start with medical treatments to mitigate the effects. This is due to the fact that progress in pharmaceuticals has gone far ahead. Pharmacies offer a wide range of drugs that can reduce the inflammation of the tonsils, and in combination with UHF, avoid unnecessary surgical intervention.

The doctor may insist on the removal of the tonsils in the following cases:

  • angina, which develops more than 3 times a year;
  • disruption of organs against the background of tonsillitis;
  • development of inflammatory and purulent processes;
  • in the case when none of the methods of conservative treatment does not give a therapeutic effect.

There are various ways to remove tonsils. Each method is selected by the ENT doctor strictly individually, based on the general condition of the patient and the severity of the case.

Tonsillotomy and its methods

Today, modern methods of tonsillectomy are practically painless and as comfortable as possible. Modern clinics use European-made equipment, which allows for operations with minimal trauma and rehabilitation period.

Now the tonsils are not completely removed unless indicated. Tonsillotomy allows you to save the main function of the tonsils, removing only part of the lymphoid tissue. This removal method has several methods, which allows you to choose the most appropriate option for removing tonsils:

  • removal with liquid nitrogen (cryosurgery);
  • tissue excision with a carbon laser.

Such tonsil removal methods are popular and have positive reviews. They are as comfortable and painless as possible, do not lead to bleeding. The postoperative period is quite short and is not accompanied by severe sore throat, so these methods are often recommended for children.

The only disadvantage of this method is the possibility of lymphoid tissue to increase again. Therefore, after any type of tonsillotomy, the doctor prescribes constant courses of drug treatment. Follow-up therapy is necessary to maintain the therapeutic effect of the operation.

Surgery as a method of removing tonsils

Surgical removal of the tonsils is carried out using special tools for dissecting soft tissues. The operation is performed under general anesthesia and has several disadvantages:

  • the rehabilitation period is up to 2 weeks, which is quite difficult for children;
  • the risk of bleeding;
  • violation of the use of general anesthesia.

In the modern world, it is not practical to use a similar method of removing tonsils, so many clinics have abandoned it. A surgical operation can incur quite serious complications, because only 2-3 mm from the tonsils are vital blood channels. At the slightest damage to them, bleeding is simply inevitable.

Laser destruction

Relatively new method, used since the late 90s. It is based on the use of tissue heating by a laser device, due to which the lymphoid tissue evaporates. To date, laser tonsil removal is the most sparing method of surgery, which has many advantages:

  • minimal soreness;
  • there is no bleeding during the operation;
  • carried out on an outpatient basis;
  • the duration of stay in the hospital is not more than 24 hours;
  • the shortest period of rehabilitation and wound healing.

Electrocoagulation method

This method is based on the effect of an electric current, which cauterizes the tonsil tissue necessary for removal. Electrocoagulation is quite safe, the risk of bleeding is minimal, as is the pain itself. However, the current can also affect surrounding tissues, which can cause discomfort. Also, the procedure is contraindicated in the presence of diabetes, diseases of the cardiovascular system and during pregnancy.

Whether it is worth removing the tonsils, today the patient can decide on his own. However, do not forget that any methods of treating tonsillitis, including the removal of the tonsils, should be accompanied by immunostimulating therapy. Without fail, a patient suffering from chronic tonsillitis must adhere to the following recommendations:

  • giving up bad habits, in particular smoking;
  • change your diet by introducing healthy foods;
  • regularly carry out hardening, play sports;
  • in the season of exacerbation of infectious diseases, take drugs for immunity and vitamin complexes.

Many qualified specialists argue that the treatment of tonsillitis should begin with the use of conservative methods, and removal is what should be resorted to last.

Reduced immunity provokes the development of frequent sore throats, which in turn often lead to the development of chronic tonsillitis. Many patients are afraid of such a diagnosis, since the first thing that comes to mind is the removal of the tonsils. If you come to an experienced specialist, he will say that there are no extra organs in the body and the tonsils perform their equally important function, so removal requires a careful approach and must be 100% justified.

Removal of tonsils (tonsils): when is such a procedure necessary?

Several decades ago removal of the tonsils with chronic tonsillitis was a common practice and was carried out for almost every patient. In particular, when the doctor diagnosed stage 2 or 3 hypertrophy.

According to a medical statement, the tonsils are able to function in children up to 5-6 years, then their work stops, and they lose their value. In the era of the USSR, the removal of tonsils was a mandatory procedure for children under 3 years old. Now you can remove the tonsils at will or need for both children and adults.

Today, specialists in the field of otorhinolaryngology are less critical about tonsil removal and try to start using drug treatments to alleviate effects. This is due to the fact that progress in pharmaceuticals has gone far ahead. Pharmacies offer a wide range of drugs that can reduce the inflammation of the tonsils, and in combination with UHF, avoid unnecessary surgical intervention.

The doctor may insist on the removal of the tonsils in the following cases:

· angina, which develops more than 3 times a year;

· disruption of organs against the background of tonsillitis;

· development of inflammatory and purulent processes;

· in the case when none of the methods of conservative treatment does not give a therapeutic effect.

There are various ways to remove tonsils. Each method is selected by the ENT doctor strictly individually, based on the general condition of the patient and the severity of the case.

Tonsillotomy and its methods

A dozen years ago, the removal of the tonsils introduced parents and children into complete shock. Many mothers remember how their children cried and screamed before the operation. But for a child, such a procedure is not only physically unacceptable, but can forever leave the fear of going to the doctor.

Today, modern methods of tonsillectomy are practically painless and as comfortable as possible. Modern clinics use European-made equipment, which allows for operations with minimal trauma and rehabilitation period.

Now the tonsils are not completely removed unless indicated. Tonsillotomy allows you to save the main function of the tonsils, removing only part of the lymphoid tissue. This removal method has several methods, which allows you to choose the most appropriate option for removing tonsils:

· removal with liquid nitrogen (cryosurgery);

· tissue excision with a carbon laser.

Such methods tonsil removal popular and have positive reviews. They are as comfortable and painless as possible, do not lead to bleeding. The postoperative period is quite short and is not accompanied by severe sore throat, so these methods are often recommended for children.

The only disadvantage of this method is the possibility of lymphoid tissue to increase again. Therefore, after any type of tonsillotomy, the doctor prescribes constant courses of drug treatment. Follow-up therapy is necessary to maintain the therapeutic effect of the operation.

Surgery as a method of removing tonsils

At pressure of the tonsils surgically performed using special instruments for dissection of soft tissues. The operation is performed under general anesthesia and has several disadvantages:

· the rehabilitation period is up to 2 weeks, which is quite difficult for children;

· the risk of bleeding;

· violation of the use of general anesthesia.

In the modern world, it is not practical to use a similar method of removing tonsils, so many clinics have abandoned it. A surgical operation can incur quite serious complications, because only 2-3 mm from the tonsils are vital blood channels. At the slightest damage to them, bleeding is simply inevitable.

Laser destruction

Relatively new method, used since the late 90s. It is based on the use of tissue heating by a laser device, due to which the lymphoid tissue evaporates. For today laser tonsil removal this is the most sparing method of operation, which has many advantages:

· minimal soreness;

· there is no bleeding during the operation;

· carried out on an outpatient basis;

· the duration of stay in the hospital is not more than 24 hours;

· the shortest period of rehabilitation and wound healing.

Electrocoagulation method

This method is based on the effect of an electric current, which cauterizes the tonsil tissue necessary for removal. Electrocoagulation is quite safe, the risk of bleeding is minimal, as is the pain itself. However, the current can also affect surrounding tissues, which can cause discomfort. Also, the procedure is contraindicated in the presence of diabetes, diseases of the cardiovascular system and during pregnancy.

Whether it is worth removing the tonsils, today the patient can decide on his own. However, do not forget that any methods of treating tonsillitis, including the removal of the tonsils, should be accompanied by immunostimulating therapy. Without fail, a patient suffering from chronic tonsillitis must adhere to the following recommendations:

· giving up bad habits, in particular smoking;

· change your diet by introducing healthy foods;

· regularly carry out hardening, play sports;

The tonsils (tonsils) play a protective role in the body. A person with air inhales a lot of microbes, and the task of the tonsils is to detain a significant part of them. The tonsils synthesize cells involved in the circulatory system. Many people try to solve the problem with tonsillitis with surgery. Is surgery justified?

Tonsil removal - pros and cons

Previously, the operation to remove the tonsils for chronic tonsillitis was done by everyone. During the study, American doctors proved that the tonsils are not useless organs that can be removed without consequences. Recesses in the tonsils are a kind of laboratory in which a number of functions take place:

  • analysis of food and air;
  • the production of protective proteins as a result of the body's reaction to pathogens.

The operation to remove the tonsils (tonsillectomia) reduces the body's defenses and reduces resistance to infection and disease. The table presents three arguments that will help you figure out why in some cases you need to abandon the operation:

Why are tonsils removed

Frequent outbreaks of tonsillitis, tonsillitis contribute to the accumulation of infections on the pharyngeal tonsils, which are subject to scarring. The answer to the question and the reasons why tonsils are cut out is unambiguous. So that microbes with angina do not spread to the lungs and bronchi, doctors eliminate the chronic focus of infection. The tonsils affected by the disease do not act as a protective organ, but form a place for the development of microbes, the presence of which in the body affects other internal organs.

Is it worth removing the tonsils

Even knowing all the disadvantages of surgical intervention from reviews, it is impossible to reliably determine whether tonsils need to be removed. The following doctors can discuss with you the indications for surgery:

  • allergist-immunologist;
  • pediatrician;
  • therapist;
  • urologist;
  • gynecologist.

List of cases when you may be assigned an operation:

  1. A person with a sore throat has developed sepsis or jugular vein thrombosis, group A beta-hemolytic streptococcus. If antibiotic treatment is not possible due to a severe course of the disease (an abscess in the throat, high fever, suppuration of the tonsils) or allergies, then surgery may be the only way out .
  2. When conducting special tests to determine the reactions that occur in the mouth with the participation of the tonsils, it turned out that they do not respond to the load. With insufficient secretion of protective proteins with saliva, the operation will prevent chronic tonsillitis, rheumatism, and kidney disease.
  3. Pathological changes in the tonsils. If the body is prone to angina attacks, then the operation is not mandatory. However, as a result, the connective tissue can become lymphoid and be a place of gathering of microbes.

Removal of tonsils - consequences

If the operation to remove the tonsils could not be avoided, then after the procedure the protection in the pharynx disappears. This place becomes susceptible to the penetration of viruses. Other consequences of the removal of the tonsils: weakened immunity, pain within a week after removal, swelling of the larynx, an open wound where the tonsils were torn out, general stress for the body. Antibiotics are prescribed to protect the injured area from bacteria. In rare cases, after surgery, bleeding in people with rheumatism is not excluded.

Indications for tonsillectomy

Five years ago, tonsillectomy was considered commonplace. Today, a doctor can offer to remove the tonsils only when health problems cannot be solved in a non-surgical, “peaceful” way. Qualified specialists give their indications for the removal of tonsils in adults, when there is no other way out. It:

  • the appearance of chronic tonsillitis and its exacerbation due to persistent tonsillitis;
  • tonsillitis with complications, including diseases of the nervous system, rheumatism, diseases of the thyroid gland, kidneys, heart, infectious nonspecific polyarthritis;
  • the formation of purulent abscesses that affect the larynx, phlegmon of the neck, paratonsillar (peritoneal abscess);
  • phlegmonous tonsillitis (intratonsillar abscess);
  • angina occurs more than 5 times a year with poor health and high fever;
  • neoplasms of the palatine tonsil;
  • obstructive sleep apnea syndrome - snoring, shortness of breath;
  • there was a sharp weakening of the immune system;
  • uncomplicated tonsillitis is not amenable to conservative treatment methods.

Contraindications for tonsillectomy

The therapist (pediatrician) together with the ENT doctor can finally determine the need for tonsillectomy based on the medical history and assessment of local changes. To find out if it is possible to perform an operation to remove, the patient is assigned a comprehensive examination:

  1. general urine analysis;
  2. biochemical and general blood test;
  3. determination of blood clotting time, coagulogram.

Contraindications to tonsillectomy are divided into temporary (relative) and absolute. The latter include:

  • diabetes mellitus (severe form);
  • hemorrhagic diathesis, acute and chronic leukemia;
  • severe neuropsychiatric illnesses may preclude safe surgery;
  • diseases of the heart, kidneys, lungs and liver in the stage of decompensation;
  • anomalies of the vessels of the pharynx (aneurysm, submucosal pulsation of the vessel);
  • active form of pulmonary tuberculosis. Find out more about what are.

Among the temporary contraindications are:

  • the period of poliomyelitis and epidemic outbreaks of influenza;
  • acute infectious diseases or prodromal signs of childhood infections;
  • tuberculous bronchoadenitis and tuberculosis intoxication;
  • pustular skin diseases;
  • dental caries;
  • severe ketonuria in patients with diabetes mellitus;
  • exacerbation of chronic inflammatory diseases of internal organs;
  • acute dermatitis or chronic dermatitis in the acute stage;
  • menstruation.

Tonsil Removal Methods

Modern otolaryngologists provide a wide range of tonsillectomy techniques. Methods for removing tonsils differ not only in price, but also:

  1. method of influence;
  2. the degree of tissue trauma;
  3. volume of blood loss;
  4. the severity of pain after surgery;
  5. recovery period.

The attending physician will tell you which of the following methods should be chosen in each case:

  • removal of the palatine tonsils with a laser;
  • surgery - a classic operation to cut out the tonsils;
  • coblation - removal by cold plasma method;
  • radio wave tonsillectomy;
  • microdebrider technology;
  • cauterization of the tonsils with current (electrocoagulation);
  • cryo-freezing (cryolysis).

Removal of tonsils by laser

In addition to the old method of removing tonsils by cutting out, there are modern ones, including laser tonsillectomy. Why is the use of a laser scalpel considered effective? The device has a destructive effect on tissue through unidirectional radiation with the same wavelength. The effect caused depends on the length. The sintering effect of the laser eliminates the risk of bleeding. Among the types of laser removal are:

  1. Complete removal of the tonsils (radical tonsillectomy), in which they can no longer grow.
  2. Cutting only the upper layers (laser ablation).

Various types of lasers are used:

  • when most of the tonsil is affected, a fiber-optic laser is used;
  • upon detection of foci of inflammation inside, they act with a holmium laser;
  • infrared laser can fasten tissue;
  • the effect of tissue evaporation gives a carbon laser, which reduces the volume of the tonsil and the site of infection.

Surgery to remove tonsils

The old method of getting rid of persistent sore throats is the excision of the tonsils, which is performed under general anesthesia and permanently eliminates the source of infection and the breeding ground for bacteria. During the operation, the following medical instruments are used: a wire loop or surgical scissors, a scalpel. The disadvantages of this method are:

  • a pronounced pain symptom in the postoperative period (when the tonsils begin to heal);
  • bleeding;
  • decrease in the body's ability to protect against bacteria;
  • development of laryngitis, bronchitis, pharyngitis;
  • allergies.

Removal of tonsils by cold plasma method

Coblation is the removal of tonsils with the help of a cold plasma apparatus (coblator), which converts electrical energy into a plasma stream. All this is done by two electrodes and an electrolyte between them. The current takes a short path from minus to plus due to the potential difference that exists between the electrodes. The electrolyte (electrically conductive liquid) is saline solution on the tonsil.

Plasma formation occurs due to the ion flow formed between the anode and cathode. To break the bond in organic compounds, there is enough energy in the plasma, while the temperature does not exceed 60 degrees. Removal of tonsils by coblation means their cold destruction. Soft tissues decompose into low molecular weight nitrogenous compounds, carbon dioxide, water, so they can be dissected or removed volumetrically.

Radio wave tonsillectomy

How is the radio wave method of removing tonsils? The radio signal transmitted by the electrode “evaporates” the intracellular fluid and causes tissue dissection. High-frequency waves are absorbed by the intracellular fluid, due to which the chance of damage to adjacent tissues and organs is reduced with the radio wave method of tonsillectomy. Among the advantages of this method are the following:

  • tissue is slightly damaged during incision;
  • the process of regeneration and tissue repair is accelerated;
  • minimal risk of complications after surgery;
  • scars do not form at the site of removal.

Electrocoagulation of the tonsils

Excision of tonsil tissue using a high frequency electric current is called tonsil electrocoagulation. This method is considered an undesirable method of removal due to the consequences that may occur in the postoperative period as a result of the effect of current on the surrounding tissues. The procedure is carried out using a device that is heated with electric current up to 400 degrees. When the tissue is charred, the amount of blood loss is minimal, but the burn after this method will be long and painful to heal.

Cryodestruction of tonsils

In otolaryngology, cryofreezing of the tonsils is increasingly used by modern doctors. How does freezing tonsils with liquid nitrogen work? Under the influence of cold, pathogenic microorganisms are destroyed; when frozen, the affected tissue areas die. The directed action of cold allows you to save healthy parts of the tonsils, which are necessary for the production of immune cells, providing local immunity and protection against viruses and microbes.

How tonsils are removed

In medicine, the task of removing the tonsils is considered a simple operation. An anesthesia chosen by the doctor is used to relieve pain during the procedure. After the anesthesia takes effect, cutting or excision of diseased tissues begins with the chosen method. At the end of the removal, the patient is turned over on the right side, an ice lotion is placed on the neck to reduce blood loss. After surgery, your doctor will prescribe antibiotics to prevent infection from entering the open wound.

How to remove tonsils in adults

To avoid bleeding, 14 days before surgery, the doctor prescribes drugs that increase blood clotting. For a month, it is necessary to give up drugs such as ibuprofen and aspirin. How the tonsils will be removed, the specialist decides: partially or completely. With severe hypertrophy of the lymphoid tissue, partial removal can be performed. On the day of the operation, 6 hours before the procedure, you need to stop eating, drinking juices and dairy products, and 4 hours before the procedure, stop drinking water.

The removal of the tonsils in adults is done under local anesthesia. 30 minutes before the start of the operation, the patient is given an intramuscular injection with a sedative. Lidocaine (an anesthetic) is injected into the tissues around the tonsils. The patient is transferred to the operating room, put on a chair. Damaged organs are cut out through the mouth without making any incisions on the chin or neck.

Tonsillectomy in children

The timing of adenotonsillotomy in a child depends on the method. For example, the classic removal of tonsils in children takes about an hour, and the cryodestruction procedure takes several minutes. The difference between the children's procedure and the adult one lies in the anesthesia, from which the children will wake up when everything is over. How are tonsils cut out? The course of the operation is designed for several stages:

  1. The use of anesthesia: children are prescribed inhalation or mask general anesthesia. The child's mind turns off the gas coming through the mask.
  2. The tonsils are completely removed by the chosen method or leaving healthy cells.
  3. The child is taken out of anesthesia.

Tonsillectomy - postoperative period

If after the operation a yellowish or white coating has formed at the site of removal, then you should not worry: when the surgical wound heals, everything will look normal. However, it should be remembered that while plaque is present, it is forbidden to disinfect and gargle. The fastest recovery after tonsillectomy and rehabilitation will come if the patient adheres to the following recommendations within 14 days:

  • talk less;
  • do not lift weights;
  • eat soft cool food and follow a diet;
  • drink plenty of water, try to avoid coughing;
  • Do not smoke;
  • abandon the solarium, baths;
  • do not fly;
  • brush your teeth with care;
  • bathe under a cool shower;
  • for pain relief, take drugs with paracetamol;
  • do not drink aspirin and ibuprofen (bleeding may open).

What can you eat after the removal of the tonsils

After the operation, on the first day, the patient is strictly forbidden to eat anything, but you can drink water. Nutrition after tonsillectomy on the second day should include cool food, liquid cereals, vegetable and meat purees, soups, yogurts, ice cream. Within 4 days you need to follow a diet after tonsillectomy, exclude hot or warm food. The wound heals for about a week, but if there is no tissue recovery within the specified period, then you should consult a doctor. After complete regeneration and with the permission of the doctor, you can return to a normal diet.

Complications of tonsillectomy

On the website of Dr. Komarovsky, many reviews are written that the removal does not bring consequences. Complications after surgery act only as an opportunity for the development of ailments. Consequences are completely optional. The risks of complications can be minimized if you contact a qualified specialist who will help you choose the removal method for a particular patient, taking into account the characteristics of the medical history.

Possible complications after tonsil removal in adults:

  1. The bleeding that has begun does not go away due to an incorrect clotting system. To avoid this phenomenon, the patient should check the blood clotting parameters before the operation and, if necessary, postpone the operation.
  2. Complications of an infectious nature due to the spread of purulent infection through the lymphatic and blood vessels. This can happen if a person's immunity is severely reduced, so tonsillectomy is not prescribed for patients with cancer, AIDS, during acute bacterial or viral infections.
  3. The development of allergic reactions to drugs that are used as painkillers (anesthetics). Before the operation, persons predisposed to allergies take a course of antihistamines.
  4. In case of inaccurate laser surgery or electrocoagulation, a burn of the mucous and soft tissues is possible.

Cost of tonsillectomy

In Moscow, the price for removal of adenoids varies depending on the prestige of the clinic and hospital, the professionalism of doctors, and the chosen method of tonsillectomy. In some institutions, they will not only perform an operation, but you can also order a ward, be under the supervision of doctors in the postoperative period, which will help reduce the risk of complications after the procedure. How much does it cost to remove tonsils in Moscow, see the table:

Video: How tonsils are removed

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