Tonsillectomy

ADENOIDECTOMY
TONSILLECTOMY
TONSILLECTOMY
TONSILLECTOMY
 surgical procedure in which both palatine tonsils are fully removed
from back the throat.
INDICATIONS:
 recurrent throat infections and obstructive sleep apnea (OSA)
RESULTS OF TONSILLECTOMY
For Recurrent throat infections
 results in fewer infections in the following one or two yea,
but unclear long term benefits
In OSA
 results in improved quality of life
Complications
 Vomiting
 trouble eating
 throat pain
 trouble talking
 Bleeding
1% within the first day, Another 2% after that

Death occurs as a result in between 1 in 2,360 and 56,000
procedures
 Following the surgery ibuprofen and paracetam
ol (acetaminophen) may be used to treat postop
erative pain.
 The surgery is often done using metal instrumen

ts or electrocautery.
 The adenoids may also be removed in which

case it is known as a "adenotonsillectomy"
Medical uses
Sleep Apnea
01
Recurrent or chronic tonsillitis

02
03 Peritonsillar abscess, periodic fever, aphthous

stomatitis, pharyngitis and adenitis (PFAPA)
04 Guttate
.
psoriasis, nasal airway obstruction, tonsil
cancer and diphtheria carrier state
Sore throat
American Academy of Otolaryngology & Head and Neck Surgery (AAO-HN
S) guideline in 2011 states tonsillectomy indicated the following:
Recurrent throat infection

 > 7 episodes in the past year, or
 > 5 episodes per year for 2 years,  one or more of the following:
or o temperature >38.3 °C
PLUS o cervical adenopathy,
 > 3 episodes per year for 3 years
 with documentation in the medic o tonsillar exudates,
al record for each episode of sore o positive test for Group A Beta-
throat hemolytic strep
The panel also recommended:
1. Watchful waiting for recurrent throat infection if there have been fewer
 7 episodes in the past year, or
 5 episodes per year for 2 years, or
 3 episodes per year for 3 years
2. Assessing the child with recurrent throat infection who does not meet crite
ria that may nonetheless favor tonsillectomy:
(not limited to the ff )
 multiple antibiotic allergy/intolerance,
 periodic fever
 aphthous stomatitis
 pharyngitis and adenitis
 history of peritonsillar abscess;
3. Asking caregivers of children with sleep-disordered breathing and tons
il hypertrophy about comorbid conditions that might improve after tonsille
ctomy, including growth retardation, poor school performance, enuresis,
and behavioral problems;
4. Counseling caregivers about tonsillectomy as a means to improve hea

lth in children with abnormal polysomnography who also have tonsil hyp
ertrophy and sleep-disordered breathing
5. Counseling caregivers that sleep-disordered breathing may persist or

recur after tonsillectomy and may require further management;
6. Advocating for pain management after tonsillectomy and educating caregivers
about the importance of managing and reassessing pain
7. Clinicians who perform tonsillectomy should determine their rate of primary an

d secondary post-tonsillectomy hemorrhage at least annually.
Obstructive sleep apnea
 Tonsillectomy improves obstructive sleep apnea (OSA) in most

people
 The procedure is recommended in those who have OSA that

has been verified by a sleep study
Rationale for Adenoidectomy
ADENOIDE
Children with otitis media:
CTOMY  enlargement of the adenoids may cause
obstruction of the nasopharynx and blockage
of the eustachian tube,
Enlarged adenoids prevent ventilation of the
middle ear–mastoid system.
 increased bacterial colonization, which may
predispose to recurrent infections.
 adenoids are covered with biofilm, which may
act as a reservoir for bacteria causing middle
ear disease.
Procedure
 requires general anesthesia accomplished by either endotracheal intubation or larynge

al mask anesthesia
 performed using many different techniques
 curettage
 Electrocautery
 microsurgical debridement,
 coblation to remove the midline adenoid tissue.
 The adenoidectomy is completed when the choanae are completely opened and the n
asopharynx has a smooth, level contour.
 Care should be taken to avoid injury to the torus tubarius, which may
potentially result in stenosis and eustachian tube dysfunction.
 In children with submucous cleft palate without airway obstruction, a

denoidectomy is not recommended for otitis media, because of the ri
sk of velopharyngeal insufficiency.
 If obstruction exists, partial superior adenoidectomy should be perfor

med, leaving an inferior strip of adenoid tissue for palate closure.
COMPLIMENTARY AND ALTERNATIVE
MEDICINE
CAM for TONSILLITIS
Natural approach to tonsillitis
Lifestyle
Incorporate lifestyle habits that strengthen the
immune system ***
 Stop smoking
 Stress management
 Daily relaxation
 Healthy Exercise program
 Healthy eating plan
 Wash Hands appropriately
Nutrition
Avoid foods that weaken the immune system:
 Refined and processed foods.
 Dairy and high fat products.
 Sugar and high sugar products.
 Alcohol.
Vitamin/Mineral
These nutrients have been shown to help Tonsillitis:
 Vitamin C **
 Vitamin E *
 Selenium *
 Zinc *
 zinc lozenge **
Herbal
The following herbs are normally used for
Tonsillitis:
 Echinacea **
 Pineapple extract with bromelain **
 Hydrastis Canadensis **
 Liquorice root **
 wild indigo **
 sage **
Herbal gargle
 Gargle with a disinfectant
sage or tea tree oil steeped in hot water
 Echinacea
 Garlic and golden seal herbal extracts.
 Phytolacca- a herbal tincture, also makes a soothing gargle.
 Old fashioned gargle made from a teaspoon of lemon juice or
apple-cider vinegar and a glass of warm wate
Aromatherapy
 To soothe: Use sandalwood and lavender

 To fight infection: Use lemon, geranium, pine and
tea tree.
 To ease congestion: Use eucalyptus, peppermint
and cedarwood.
Natural Remedies for Sleep Apnea
1. Acupuncture
2. Herbs
 Passionflower
 valerian
3. Lifestyle changes
 avoiding alcohol and medications that make you sleepy
 maintaining a healthy weight
 sleeping on your side instead of your back
 quitting smoking

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ADENOIDECTOMY

1% within the first day, Another 2% after that

 The surgery is often done using metal instrumen

 The adenoids may also be removed in which

Recurrent or chronic tonsillitis

03 Peritonsillar abscess, periodic fever, aphthous

Recurrent throat infection

4. Counseling caregivers about tonsillectomy as a means to improve hea

5. Counseling caregivers that sleep-disordered breathing may persist or

7. Clinicians who perform tonsillectomy should determine their rate of primary an

 Tonsillectomy improves obstructive sleep apnea (OSA) in most

 The procedure is recommended in those who have OSA that

 requires general anesthesia accomplished by either endotracheal intubation or larynge

 In children with submucous cleft palate without airway obstruction, a

 If obstruction exists, partial superior adenoidectomy should be perfor

Natural approach to tonsillitis

 To soothe: Use sandalwood and lavender

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