Tonsillectomy Risks, Benefits and Alternative Options

About Tonsillitis and Tonsil Stones

Though it was once a more commonly practiced surgical procedure, the tonsillectomy surgery is now reserved only for certain situations. Tonsils are a part of the mouth which reside in the back of the throat in the form of structures which are “gland-like”. They contain lymphocytes, which the body uses to help fight infection. The role of tonsils in the immune system is that they act like a sort of net that traps viruses and bacteria which threaten to harm the body. When they do their job correctly, they act as an important part of keeping the body healthy. When they do not perform their function properly, they can develop tonsil stones (tonsilloliths) or they can become inflamed. This is a condition called tonsillitis.

Tonsil stones form when debris from the mouth hardens and calcifies, getting trapped in the tonsils. They are more likely to develop in people who have experienced repeated cases of tonsillitis. Tonsil stones may or may not have symptoms. Generally, though, they can cause white debris, sore throat, bad breath, ear pain, tonsil swelling, and difficulty swallowing. Many times, tonsil stones can be removed safely and easily at home with the use of swabs or saltwater gargles. Sometimes antibiotics are necessary to treat these tonsil stones, but the use of antibiotics is generally not recommended in these situations because they have side effects and can lead to resistant bacteria.¹

Tonsillectomy and Other Surgical Options

Rarely, surgery, which is performed without the use of general anesthesia, would be needed to remove the tonsil stones. There are times that tonsillectomy would be recommended, as tonsil stones tend to be more common in people with repeated bouts of tonsillitis.² The tonsillectomy surgical procedure may also accompany removal of the adenoids (adenoidectomy) as well. Adenoids are also part of the lymphatic system, and their swelling can cause ear infections.³ Tonsillectomy and adenoidectomy are usually performed with the patient under the influence of general anesthesia and take several days of recovery time. The procedures may be outpatient or require an overnight hospital stay. The resulting sore throat can last several days, affecting the patient’s ability to eat, drink, and speak. There is a risk of post-surgical bleeding or other possible complications, depending on the patient.

In general, tonsillectomies are performed when a patient has chronic tonsillitis or several bouts in one year, abscesses that will not drain, foul odor in the mouth which shows no signs of improvement with antibiotics, or if a person has sleep apnea.⁴ Recurrent strep throat is another reason a tonsillectomy may be recommended.

Intracapsular Tonsillectomy

One variation on traditional tonsillectomy is intracapsular tonsillectomy. In this variation, a small layer of the tonsil is left behind in order to provide a form of protection for the underlying throat muscles. The recovery from this procedure is faster and the risk of bleeding is lessened when compared to traditional tonsillectomy. Nonetheless, there is still a 1% chance that the tonsils can still become re-enlarged or infected.⁵ After tonsillectomy, cases of strep may disappear, but there is always a chance that these types of infections could return.⁶ During recovery, pain medication may be needed. The patient should increase the intake of fluids. There are risks of dehydration, fever, and difficulty breathing. The risk of dehydration might come from the patient avoiding the consumption of liquids, as the sore throat that accompanies recovery will probably make this action painful.⁷

Alternative Options

Because of the role which tonsils play in the immune system, the removal of the gland-like structures through tonsillectomy is not generally the first recommendation anymore. Instead of traditional tonsillectomy procedures where the patient’s tonsils are removed, somnoplasty is an alternative. In somnoplasty, the enlarged tonsils are shrunk with the use of electrodes, which are inserted into the tonsils. The energy wave is sent to burn away the tissues of the tonsil, and the procedure is performed while the patient is under local anesthesia. There are fewer side effects, such as bleeding, although the patient may have trouble swallowing for some time after the procedure. This difficulty with swallowing is temporary, though, and it only lasts for about two weeks.⁸

Somnoplasty is generally performed for adult patients with sleep apnea. Children would likely require a general, rather than local, anesthetic because, during somnoplasty, a patient would have to comply with a needle being pressed down their throat. There is not enough information available about whether or not somnoplasty can help with infected tonsils.⁹ Repeated infections can lead to the overuse of antibiotics, which may make the bacteria resistant and create issues for the patient in the future. There are more natural options that can help patients cope with repeated infections. These include performing cleanses of the lymphatic system via such methods like hydrotherapy, massage, diet, and herbs. Homeopathic kits could also help some patients.¹⁰