Tonsillectomy in Adults: Types, Indications & Preparation

Tonsil removal, or third tonsil excision, is a simple procedure that can significantly improve the quality of life and protect against serious complications in both children and adults. This is especially important for people with recurrent tonsillitis, as a Tonsillectomy in adults can help reduce chronic infections and related health issues. The decision to completely remove the tonsils remains with the doctor, as this procedure has specific contraindications. To determine whether a Tonsillectomy in adults is appropriate for your situation, schedule an appointment with an ENT specialist at our Consultant ENT private clinic.

What is a tonsillectomy?

The procedure is carried out using various methods. These are:

electrocoagulation
radiofrequency coblation
techniques using a shaver (microdebrider)

However, the classic approach, i.e., tonsil enucleation, is usually used. Tonsillectomy is performed in adults under infiltration or general anesthesia, and in children under general anesthesia. The procedure takes an average of one hour. The patient typically goes home after approximately four hours. The procedure leaves a wound in the mouth. The mucosal healing process is characterized by the presence of fibrin, a white coating. Discomfort and/or sore throat are felt for several days. Recovery after tonsillectomy usually takes 10-14 days.

Functions of the tonsils in the body

The tonsils are collections of absorptive tissue. The lymphatic ring, also known as the pharyngeal lymphatic system, consists of the following tonsils:

palatine
pharyngeal (adenoids)
lingual
tubular

Their main function is to protect against various types of pathogens (bacteria, viruses, and fungi). The presence of tonsils is intended to protect the rest of the respiratory and gastrointestinal tracts from the penetration of harmful microorganisms. They act as a filter for all disease-causing pathogens. Furthermore, the tonsils are also responsible for the production of immune system cells. Complete removal of the tonsils is called a tonsillectomy, while partial removal is called a tonsillotomy. Surgery to remove the third (pharyngeal) tonsil is called an adenotomy.

Indications for tonsillectomy

The main indications for tonsillectomy include recurrent pharyngitis and tonsillitis. A doctor may recommend tonsillectomy if a patient has had at least three episodes of tonsillitis in the past year or five episodes in the past two years. Other indications for the procedure include a sore throat accompanied by a high fever (above 38 degrees Celsius) and swollen lymph nodes in the neck. A throat swab should reveal the presence of streptococci; when combined with clinical symptoms such as a sore throat, streptococci carry a high risk of serious complications such as glomerulonephritis or myocarditis.

Another indication for tonsillectomy in adults

Another indication for tonsillectomy in adults and children is the presence of a peritonsillar abscess, which is usually a complication of tonsillitis. Furthermore, an ENT specialist may recommend removal of the palatine tonsils if they are so large that they interfere with swallowing. Chronic bad breath can also be an indication for surgery, as can recurrent otitis media. Large tonsils can also interfere with speech (especially in children), leading to slurred speech.

Tonsillectomy in children and adults

Tonsillectomy in children and adults is also necessary in cases of persistent enlargement of only one tonsil (asymmetric tonsillar enlargement raises concern and suspicion of a possible tumor).

The main indication for tonsillectomy in adults

The main indication for tonsillectomy in adults is tonsillitis. Viruses are often the cause of the infection. Among bacteria, the main causative agent is the group A hemolytic streptococcus. Children under three years of age are usually diagnosed with viral tonsillitis, while in adolescents and adults, tonsillitis is more often caused by bacteria. Factors that contribute to the development of tonsillitis include:

weakened immune system;
the presence of bacterial inflammation;
chronic infectious foci in the body;
inflammation of the nasal sinuses;
carious teeth;
Congenital anomalies of the structure of the tonsils.

Symptoms of this condition

Tonsillitis is an inflammation of the tonsils, which can be acute or chronic. Here are some typical symptoms of this condition:

Sore throat. Sharp or aching, gets worse when swallowing;
Redness and swelling of the tonsils. They are bright red and swollen. Sometimes a white or yellowish coating forms on the surface of the tonsils.
Enlarged and painful lymph nodes. These are the lymph nodes in the neck.
Elevated body temperature. In acute cases of the disease, the temperature can reach 38-39°C;
General malaise. Patients often complain of weakness, fatigue, and headache;
Bad breath. It is associated with purulent discharge.

Are there any contraindications to tonsil removal surgery?

The procedure is not always possible. Contraindications include the following:

velopharyngeal insufficiency
circulatory and respiratory disorders
cleft palate
acute inflammation of the respiratory tract
split language
certain blood diseases (eg, clotting disorders, leukemia)
open form of tuberculosis
chronic atrophic pharyngitis

Before referring the patient for surgery, the doctor will prescribe a series of diagnostic tests to rule out contraindications and determine the optimal treatment. If laryngological problems are bothering you or a loved one, don't delay – seek a comprehensive consultation with an ENT specialist in the Consultant ENT private clinic. Tonsillectomy is a surgical procedure to remove the tonsils, or palatine tonsils. It is one of the most common procedures. Tonsillectomy is most often performed on children; it is less common in adults.

Tonsils are small structures of lymphoid tissue

Before discussing how tonsils are removed in adults with tonsillitis, let's understand the role these anatomical structures play in our bodies. Tonsils are small structures of lymphoid tissue located in the throat and nasopharynx. They are part of the immune system and serve as the body's first line of defense against infection. The tonsils trap and neutralize bacteria, viruses, and other microorganisms that enter the body through the respiratory tract and food. However, if they become inflamed, a person develops tonsillitis. In this case, a procedure called complete or partial tonsillectomy is considered.

Indications for tonsil removal in adults

Chronic conditions

If sore throats recur more than three times a year and antibiotic treatment doesn't provide long-term relief, this may indicate chronic inflammation. In cases of frequent sore throats, tonsillectomy can help prevent further recurrences and improve overall health.

Complications of tonsillitis

Inflamed tonsils can lead to various complications, from abscesses and inflammation of adjacent tissues to swelling that makes breathing difficult. Such cases require surgical intervention to prevent more serious consequences.

When surgery is unavoidable

If enlarged tonsils block the airway, interfere with swallowing, or cause snoring that affects sleep quality, surgery becomes necessary. Tonsil removal may also be indicated if malignant changes in the tonsil tissue are suspected.

Tonsillectomy or tonsil removal: preparation

Before removing large tonsils, the patient must undergo preliminary preparation. After an initial consultation with an ENT specialist and determination of the indications for the procedure, the patient will undergo laboratory and instrumental diagnostics.

Preliminary examinations and tests

Preoperative laboratory tests include:

complete blood count;
blood "biochemistry";
blood clotting test;
laboratory tests to rule out chronic infections.

Preparatory procedures can be completed at our clinic.

Recommendations for preparation

If the patient is prone to allergic reactions or is taking blood-thinning medications, it is important to inform our doctor. In consultation with the physician, the patient should stop taking these medications several days before the surgery. A light meal is permitted six hours before the surgery, and the dry period begins two hours before anesthesia.

Consultations with specialists

Removal of the pharyngeal tonsil at our clinic involves a classic (cold) tonsillectomy. This is a full-scale surgical procedure, so the patient must also undergo an electrocardiogram with a cardiologist's report before the procedure. The latter is especially important if the tonsils are to be removed under general anesthesia. If the patient has chronic medical conditions, consultation with related specialists is recommended. For personalised assessment and safe treatment planning, you can speak with an ENT specialist West Yorkshire at our clinic.