Everyone is familiar with sore throats with angina. This is an unpleasant symptom, but in cold weather, almost everyone faces it. Chronic tonsillitis is called tonsillitis. This disease is characterized by inflammation of the palatine tonsils (glands). In the chronic form of exacerbation, 4 times a year or more can be observed. In severe cases, doctors suggest removing the tonsils. Scientifically, this operation is called a tonsillectomy. It has its advantages and disadvantages, but sometimes you can’t do without the removal of the palatine tonsils. As with any surgical intervention, there are special indications for tonsillectomy. If you can do without removing the tonsils, it is recommended to keep them. In such cases, one should limit oneself to conservative therapy and prevent exacerbations of tonsillitis.
Functions of tonsils and adenoids
Tonsils are immune structures. They are necessary to protect the body from the penetration of infectious agents. There are several groups of tonsils in the human body. All of them are combined into a single immunestructure - the Pirogov-Waldeyer ring. It includes 2 paired and 2 single tonsils. The most famous of them are tonsils. This is due to their location. The palatine tonsils are located in the oral cavity and are the first to encounter microbes that enter the body. The tonsils are composed of lymphoid tissue, so they immediately begin to fight the infection. This is accompanied by their increase and sore throat.
Another structure included in the Pirogov-Waldeyer ring is the unpaired nasopharyngeal tonsil. It is popularly known as adenoids. Most often, this tonsil becomes inflamed in children. Its increase is accompanied by difficulty in breathing in infants. Therefore, in severe cases, adenoids are recommended to be removed. Like the tonsils, the nasopharyngeal tonsil is composed of lymphoid tissue. With age, it gradually decreases in size. Adenoids protect the sinuses and lower respiratory tract from bacteria.
Indications for tonsillectomy
There are a number of cases when an operation to remove the tonsils is necessary. First of all, this is the overlap of the airways. Sometimes the tonsils become so enlarged that air cannot enter the body in sufficient quantities. The extreme degree of hypertrophy of the tonsils is an absolute indication for tonsillectomy. In addition, the following indications for an operation to remove the tonsils are distinguished:
- Angina, not amenable to conservative therapy.
- Frequent relapses and severe tonsillitis.
- Development of purulent complications. Among them are pharyngeal and paratonsillar abscesses.
- Risk of severe disease,developing against the background of angina. These pathologies include: myocarditis, glomerulonephritis and vasculitis.
Indications for removal of adenoids are frequent recurrences of infection and difficulty breathing. If, despite ongoing drug therapy, the nasopharyngeal tonsil is constantly increasing, surgical treatment is performed. Otherwise, the child will experience oxygen deficiency, which will provoke more serious complications. Among them are chronic sinusitis, otitis media, cerebral ischemia and even respiratory arrest.
It should be understood that in the presence of the above indications, the removal of tonsils and adenoids is a forced measure - it is impossible to do without surgical treatment. Parents whose children are at risk of developing complications should first of all take into account the opinion of the attending doctor.
Advantages and disadvantages of the operation
Given the protective function of the tonsils, the removal of the tonsils should be considered as a last resort. After a tonsillectomy, the barrier that held back infections disappears. Therefore, the risk of bacteria entering the lower respiratory tract is significantly increased. People who do not have palatine tonsils are more likely to experience more serious diseases than tonsillitis. Among them are bronchitis and pneumonia. This is especially true for the removal of tonsils in children. After all, babies are more susceptible to viral infections, so they are more likely to get colds.
Despite its shortcomings, tonsillectomy is one of the most common operations on the ENT organs. Earlier removal of tonsils in children andadults were more frequent. Currently, doctors are trying to save the tonsils and treat tonsillitis with medication. However, if there are absolute indications for surgery, tonsillectomy cannot be postponed. The benefits of this surgery include:
- Removing a permanent source of infection.
- Improved upper airway patency.
- Relief from persistent symptoms of sore throat.
It is up to the attending physician to decide whether or not to have surgery. It is impossible to make a decision on performing a tonsillectomy on your own. Only an otolaryngologist knows whether it is possible to save the organ or not. If there are indications, the removal of the tonsils is a mandatory procedure. Only tonsillectomy will help improve the patient's condition and avoid complications of angina.
Preparing for surgery
Tonsillectomy is a simple surgical procedure for experienced doctors. First of all, the doctor will determine how the tonsils will be removed. The choice of the method of anesthesia and preparation for the operation depends on this. Before performing a tonsillectomy, the doctor gets acquainted with the results of the patient's analysis. They should be in order. In the presence of an acute inflammatory process, the operation is postponed until the patient recovers. No special premedication is required. On the eve of surgery, the patient should not eat. Only light meals are allowed. If tonsillectomy is performed in the classical way, general anesthesia is required, which is carried out withthe help of a mask. Removal of tonsils with a laser is performed under local anesthesia. In this case, the patient is administered sedatives.
Tonsillectomy Methods
The operation to remove the tonsils has been known for several centuries. During this time, the technique of performing tonsillectomy has not changed much. The traditional removal of tonsils in adults is carried out using a special loop, surgical scissors and a scalpel. In addition to classical tonsillectomy, there are a number of modern methods. These include:
- Laser removal of tonsils.
- Ultrasonic scalpel operation.
- Radiofrequency ablation.
- Cryosurgery.
Each of the above methods allows you to save the patient from chronic tonsillitis. Some methods of tonsillectomy allow you to save part of the tonsils, others - to remove the lymphoid tissue completely. The choice of technique depends on the equipment of the medical institution, the presence of contraindications and the clinical picture.
Removal of adenoids in children
Adenoids, compared to palatine tonsils, are located deeper. Therefore, they cannot be removed from the oral cavity without a special tool. In most cases, patients for whom such an operation is indicated are children of preschool age. Preparation for surgery is the same as for tonsillectomy. The traditional removal of the nasopharyngeal tonsil is performed using a Beckman adenotome. This instrument winds up behind the soft palate and covers the organ. Rapid movement of the nasopharyngeal tonsilexcised. After that, the adenoid is removed from the oral cavity. The patient is in a sitting position during the procedure.
Surgery technique
In most cases, the removal of the tonsils in adult patients is performed by traditional surgery. On average, a tonsillectomy lasts 20 to 40 minutes. The operation begins with cutting off the upper pole of the tonsil. For this purpose, a shallow incision of the mucous membrane is performed and the introduction of a raspator behind the capsule of the tonsil. The edge of the tonsil is fixed with a special clamp. Then the tonsil is separated from the palatine arches and the middle part is separated. The lower pole of the tonsil is removed with a loop, since there is no capsule in this area. The operation is completed by coagulation of the bleeding vessels. A bed of palatine tonsils is packed and ice is applied to the neck area.
How is the postoperative period?
In the early postoperative period, the patient should be under the supervision of doctors. This is necessary to prevent bleeding and other complications. On the first day, the patient should not completely close his mouth and spit saliva. It is also forbidden to eat. Pain after removal of the tonsils is relieved with analgesics. In the early postoperative period, it is not recommended to talk. The diet in the early days should include only liquid food. To avoid infection of wounds and bleeding, antibiotics and hemostatics are prescribed. Such medicines include the drug "Dicinon". Keep your voice calmrefrain from gargling and smoking.
Advantages and disadvantages of laser tonsillectomy
An alternative method of tonsillectomy is the removal of tonsils with a laser. This method has a number of advantages. Firstly, the operation is not accompanied by bleeding, since the vessels are coagulated at the same time as the tonsillectomy is performed. Laser removal of the tonsils is performed under local anesthesia in an outpatient setting. This avoids not only hospitalization, but also the consequences of general anesthesia. Another indisputable advantage is the reduction of pain to a minimum.
Despite the advantages of laser surgery, it is worth noting that it is contraindicated for children under 10 years old. A possible complication of this intervention is a burn of the oral mucosa. In addition, it is not always possible to completely remove lymphoid tissue with a laser, and there is a risk of recurrence of the pathology.
Possible consequences of tonsillectomy
Tonsillectomy is successful in most cases. However, if the doctor's recommendations are not followed in the early postoperative period, dangerous consequences of the removal of the tonsils may develop. The first is bleeding. Other early complications of surgery include wound infection and voice changes. Often there is hypertrophy of regional lymph nodes, and the inflammation disappears 7-10 days after surgery. To prevent the spread of infection, antibiotic treatment is carried out. The voice is restored on its own a few weeks after the tonsillectomy. to long-term consequencesinclude decreased immunity. Due to the loss of the protective barrier, the patient is exposed to infections of the lower respiratory tract. To prevent this complication, it is recommended to take vitamins and immunomodulators.
Tonsil removal: doctors' reviews
Tonsillectomy has a number of significant drawbacks, so it is not recommended to perform it without strict indications. If it is possible to save the tonsils, doctors try to avoid removing the tonsils. Reviews of doctors agree that it is necessary to treat angina with medication and to prevent exacerbations of tonsillitis. If conservative therapy is powerless, surgery cannot be avoided.
