How long does it take for tonsils to heal. What are the main symptoms of tonsillitis. Which treatments are most effective for tonsillitis. When is tonsil surgery necessary. How can tonsillitis be prevented.

Understanding Tonsillitis: An Overview of Throat Inflammation

Tonsillitis is an infection affecting the tonsils, two masses of tissue located at the back of the throat. These structures play a crucial role in the body’s defense system, acting as filters to trap germs and produce antibodies. However, when overwhelmed by bacteria or viruses, tonsils can become swollen and inflamed, leading to tonsillitis.

This condition is particularly common in children but can affect individuals of all ages. Tonsillitis manifests in three primary forms:

• Acute tonsillitis: Symptoms typically last 3-4 days but may persist for up to 2 weeks.
• Recurrent tonsillitis: Characterized by multiple episodes within a year.
• Chronic tonsillitis: Involves a long-term tonsil infection.

Recognizing Tonsillitis Symptoms: Key Indicators of Infection

Identifying tonsillitis early is crucial for prompt treatment. The primary symptoms include:

• Inflamed and swollen tonsils
• Throat pain or tenderness
• Fever
• Red tonsils with white or yellow coating
• Painful blisters or ulcers on the throat
• Difficulty swallowing
• Swollen glands in the neck or jaw
• Bad breath
• Scratchy or muffled voice

Do these symptoms differ in children? Indeed, children may experience additional signs such as:

• Upset stomach and vomiting
• Stomach pain
• Excessive drooling
• Loss of appetite

Unraveling the Causes and Risk Factors of Tonsillitis

Tonsillitis can be triggered by both bacterial and viral infections. The most common culprits include:

• Streptococcus bacteria (strep throat)
• Adenoviruses
• Influenza virus
• Epstein-Barr virus
• Parainfluenza viruses
• Enteroviruses
• Herpes simplex virus

Certain factors may increase the risk of developing tonsillitis:

1. Age: Children between 5-15 years are more susceptible to bacterial tonsillitis, while viral cases are common in very young children.
2. Exposure to germs: Frequent contact with other children in schools or camps increases the likelihood of infection.
3. Occupation: Adults working closely with children, such as teachers, may have a higher risk of contracting tonsillitis.

Diagnosing Tonsillitis: Medical Evaluations and Tests

Accurate diagnosis is essential for effective treatment. Healthcare providers typically follow these steps:

1. Physical examination: Checking for red, swollen tonsils, fever, and signs of infection in the ears and nose.
2. Throat swab: Testing for strep bacteria, with results available in 10-15 minutes or a few days for more thorough lab tests.
3. Blood test: A complete blood cell count (CBC) to determine whether the infection is viral or bacterial.
4. Rash check: Examining for scarlatina, a rash associated with strep throat infection.

Is a throat culture always necessary for diagnosing tonsillitis? While not always required, a throat culture can provide definitive evidence of bacterial infection, guiding appropriate treatment decisions.

Tonsillitis Complications: When Infection Escalates

While most cases of tonsillitis resolve without incident, complications can arise, particularly with bacterial infections. These may include:

• Peritonsillar abscess: A collection of pus around the tonsil
• Middle ear infection
• Obstructive sleep apnea
• Tonsillar cellulitis: Deep tissue infection

Untreated strep infections can lead to more severe conditions:

• Rheumatic fever
• Scarlet fever
• Sinusitis
• Glomerulonephritis (kidney infection)

Effective Treatments for Tonsillitis: From Medication to Home Remedies

Treatment approaches vary depending on the cause of tonsillitis:

Bacterial Tonsillitis Treatment

For bacterial infections, antibiotics are the primary treatment:

• One-time injection or oral pills taken for several days
• Improvement usually occurs within 2-3 days
• Complete the entire course of antibiotics as prescribed

Viral Tonsillitis Management

Viral tonsillitis doesn’t respond to antibiotics. Instead, focus on supportive care:

• Rest
• Hydration with warm or cold fluids
• Consumption of smooth foods (e.g., ice cream, applesauce)
• Use of a cool-mist vaporizer or humidifier
• Gargling with warm salt water
• Throat lozenges for relief

How long does it typically take for tonsillitis to heal? The duration varies, but most cases of viral tonsillitis resolve within 7-10 days. Bacterial tonsillitis often improves within 24-48 hours of starting antibiotics, though full recovery may take 7-14 days.

Tonsillectomy: When Surgery Becomes Necessary

In some cases, surgical removal of the tonsils (tonsillectomy) may be recommended. This procedure is considered when:

• Tonsillitis recurs frequently (7 or more times in one year, 5 or more times per year for two consecutive years, or 3 or more times per year for three consecutive years)
• Enlarged tonsils cause breathing difficulties or sleep apnea
• An abscess develops that doesn’t respond to other treatments

What is the recovery process like after a tonsillectomy? Recovery typically takes 10-14 days. Patients may experience throat pain, difficulty swallowing, and fatigue during this period. A soft diet and pain management are crucial for a smooth recovery.

Preventing Tonsillitis: Strategies for Reducing Risk

While it’s not always possible to prevent tonsillitis, certain measures can reduce the risk of infection:

• Practice good hygiene: Wash hands frequently and thoroughly
• Avoid sharing utensils, food, or drinks with others
• Replace toothbrushes after a bout of tonsillitis
• Boost immune system through a balanced diet, regular exercise, and adequate sleep
• Avoid exposure to secondhand smoke
• Stay hydrated to keep the throat moist and less susceptible to infection

Can probiotics help prevent tonsillitis? Some studies suggest that probiotics may support immune function and potentially reduce the frequency of upper respiratory infections, including tonsillitis. However, more research is needed to confirm their effectiveness.

Living with Recurrent Tonsillitis: Managing Chronic Throat Infections

For individuals experiencing recurrent tonsillitis, managing the condition can be challenging. Consider these strategies:

• Work closely with an ENT specialist to develop a personalized treatment plan
• Keep a record of infection frequency and severity to inform treatment decisions
• Explore potential triggers or contributing factors, such as allergies or environmental irritants
• Consider immunotherapy if allergies are a significant factor
• Discuss the potential benefits and risks of tonsillectomy with your healthcare provider

Is there a link between tonsillitis and the immune system? Yes, recurrent tonsillitis may indicate an underlying immune system issue. In some cases, immune function testing may be recommended to identify any deficiencies or abnormalities that could contribute to frequent infections.

Tonsillitis in Adults: Unique Considerations and Approaches

While tonsillitis is often associated with children, adults can also develop this condition. Adult tonsillitis presents some unique challenges:

• Symptoms may be more severe or prolonged in adults
• Complications, such as peritonsillar abscess, are more common in adults
• Differential diagnosis is crucial, as symptoms can mimic other conditions like mononucleosis or throat cancer

How does the treatment approach differ for adult tonsillitis? While the basic principles remain the same, adults may require more aggressive pain management and longer recovery periods. Tonsillectomy in adults is generally considered a last resort due to increased surgical risks and longer recovery times compared to children.

The Role of Nutrition in Tonsillitis Recovery and Prevention

Proper nutrition plays a vital role in both recovering from tonsillitis and preventing future infections. Consider these dietary recommendations:

• Consume foods rich in vitamin C to boost immune function (e.g., citrus fruits, berries, leafy greens)
• Include zinc-rich foods like lean meats, nuts, and seeds to support healing
• Stay hydrated with water, herbal teas, and clear broths
• Opt for soft, easy-to-swallow foods during acute infections
• Consider probiotic-rich foods or supplements to support gut health and immunity

Can certain foods exacerbate tonsillitis symptoms? Some individuals may find that acidic, spicy, or rough-textured foods irritate the throat during a tonsillitis episode. It’s best to avoid these foods until symptoms improve and focus on soothing, nutrient-dense options.

Alternative and Complementary Therapies for Tonsillitis Management

While conventional medical treatments remain the primary approach for tonsillitis, some individuals explore complementary therapies to manage symptoms and support recovery:

• Herbal remedies: Echinacea, sage, and licorice root have traditional uses for throat infections
• Honey: Known for its antibacterial properties and soothing effects on sore throats
• Essential oils: Certain oils like tea tree and eucalyptus may have antimicrobial effects when used in steam inhalation
• Acupuncture: Some studies suggest potential benefits for immune function and pain relief
• Homeopathy: While controversial, some individuals report symptom relief with homeopathic remedies

Are alternative therapies safe and effective for tonsillitis? While some complementary approaches may offer symptomatic relief, it’s crucial to consult with a healthcare provider before trying any alternative treatments, especially for bacterial infections that require antibiotic therapy.

The Future of Tonsillitis Treatment: Emerging Research and Innovations

As medical science advances, new approaches to tonsillitis treatment and prevention are being explored:

• Targeted antibiotics: Research into more precise antibiotic therapies to reduce side effects and antibiotic resistance
• Immunomodulatory treatments: Developing therapies to boost the immune response against specific pathogens
• Nanotechnology: Exploring nanoparticle-based drug delivery systems for more effective treatments
• Microbiome research: Investigating the role of the throat microbiome in tonsillitis susceptibility and prevention
• Gene therapy: Potential future applications in addressing genetic factors that may influence tonsillitis risk

How might these advancements change tonsillitis management in the coming years? While many of these approaches are still in early research stages, they hold promise for more targeted, effective, and less invasive treatments for tonsillitis in the future. Continued research may lead to personalized treatment strategies based on individual patient factors and pathogen profiles.

Symptoms, Causes, Treatments, Surgery, and Remedies

Written by Mary Anne Dunkin

Medically Reviewed by Poonam Sachdev on May 09, 2023

• What Is Tonsillitis?
• Tonsillitis Symptoms
• Tonsillitis Symptoms in Children
• Tonsillitis Causes and Risk Factors
• Tonsillitis Diagnosis
• Tonsillitis Complications
• Tonsillitis and Strep Infection
• Tonsillitis Treatments
• Tonsillitis Prevention
• More

Tonsillitis is an infection of your tonsils, two masses of tissue at the back of your throat.

Your tonsils act as filters, trapping germs that could otherwise enter your airways and cause infection. They also make antibodies to fight infection. But sometimes, they get overwhelmed by bacteria or viruses. This can make them swollen and inflamed.

Tonsillitis is common, especially in children. It can happen once in a while or come back again and again in a short period.

There are three types:

• Acute tonsillitis. These symptoms usually last 3 or 4 days but can last up to 2 weeks.
• Recurrent tonsillitis. This is when you get tonsillitis several times in a year.
• Chronic tonsillitis. This is when you have a long-term tonsil infection.

The main symptoms of tonsillitis are inflamed and swollen tonsils, sometimes severe enough to make it hard to breathe through your mouth. Other symptoms include:

• Throat pain or tenderness
• Fever
• Red tonsils
• A white or yellow coating on your tonsils
• Painful blisters or ulcers on your throat
• Headache
• Loss of appetite
• Ear pain
• Trouble swallowing
• Swollen glands in your neck or jaw
• Fever and chills
• Bad breath
• A scratchy or muffled voice
• Stiff neck

In children, symptoms may also include:

• Upset stomach
• Vomiting
• Stomach pain
• Drooling
• Not wanting to eat or swallow

Bacterial and viral infections cause tonsillitis. A common cause is Streptococcus (strep) bacteria, which can also cause strep throat. Other common causes include:

• Adenoviruses
• Influenza virus
• Epstein-Barr virus
• Parainfluenza viruses
• Enteroviruses
• Herpes simplex virus

Some things may put you at greater risk of getting tonsillitis:

• Age.Children tend to get tonsillitis more than adults. Kids who are between the ages of 5 and 15 are more likely to get tonsillitis caused by bacterial infections. Tonsillitis from viral infections are more common in very young children. Elderly adults are at higher risk for tonsillitis too.
• Germ exposure.Children also spend more time with other kids their age in school or camp, so they can easily spread infections that lead to tonsillitis. Adults who spend a lot of time around young children, such as teachers, may also be more likely to pick up infections and get tonsillitis.

Your doctor will do a physical exam. They’ll look at your tonsils to see if they’re red or swollen or have pus on them. They’ll also check for a fever. They may look in your ears and nose for signs of infection and feel the sides of your neck for swelling and pain.

You might need tests to find the cause of your tonsillitis. They include:

• A throat swab. Your doctor will test saliva and cells from your throat for strep bacteria. They’ll run a cotton swab along the back of your throat. This might be uncomfortable but won’t hurt. Results are usually ready in 10 or 15 minutes. Sometimes, your doctor will also want a lab test that takes a couple of days. If these tests are negative, a virus is what caused your tonsillitis.
• A blood test. Your doctor may call this a complete blood cell count (CBC). It looks for high and low numbers of blood cells to show whether a virus or bacteria caused your tonsillitis.
• Rash.Your doctor will check for scarlatina, a rash linked to strep throat infection.

Complications usually happen only if bacteria caused your infection. They include:

• A collection of pus around your tonsil (peritonsillar abscess)
• Middle ear infection
• Breathing problems or breathing that stops and starts while you sleep (obstructive sleep apnea)
• Tonsillar cellulitis, or infection that spreads and deeply penetrates nearby tissues

If you have strep bacteria and don’t get treatment, your illness could lead to a more serious problem, including:

• Rheumatic fever
• Scarlet fever
• Sinusitis
• A kidney infection called glomerulonephritis

Your treatment will depend in part on what caused your illness.

Medication

If your tests find bacteria, you’ll get antibiotics. Your doctor might give you these drugs in a one-time injection or in pills that you’ll swallow for several days. You’ll start to feel better within 2 or 3 days, but it’s important to take all of your medication.

Home remedies

If you have a virus, antibiotics won’t help, and your body will fight the infection on its own. In the meantime, you can try some home remedies:

• Get lots of rest
• Drink warm or very cold fluids to help with throat pain
• Eat smooth foods, such as flavored gelatins, ice cream, and applesauce
• Use a cool-mist vaporizer or humidifier in your room
• Gargle with warm salt water
• Suck on lozenges with benzocaine or other medications to numb your throat
• Take over-the-counter pain relievers such as acetaminophen or ibuprofen

Tonsillectomy surgery

Tonsils are an important part of your immune system, so your doctor will try to help you keep them. But if your tonsillitis keeps coming back or won’t go away, or if swollen tonsils make it hard for you to breathe or eat, you might need to have your tonsils taken out. This surgery is called tonsillectomy.

Tonsillectomy used to be a very common treatment. But now, doctors only recommend it if tonsillitis keeps coming back. That means you or your child has tonsillitis more than seven times in one year, more than four or five times a year for the past two years, or more than three times a year for the past three years.

Usually, your doctor uses a sharp tool called a scalpel to take out your tonsils. But other options are available, including lasers, radio waves, ultrasonic energy, or electrocautery to remove enlarged tonsils.

Discuss your options with your doctor to decide the best treatment for you.

Tonsillectomy recovery

Tonsillectomy is an outpatient procedure, meaning you won’t need to stay in the hospital. It usually lasts less than an hour. You can probably go home a few hours after surgery.

Recovery usually takes 7 to 10 days. You may have some pain in your throat, ears, jaw, or neck after the surgery. Your doctor can tell you what drugs to take to help with this.

Get plenty of rest and drink lots of fluids while you’re recovering. But don’t eat or drink any dairy products for the first 24 hours.

You might have a low fever and see a little blood in your nose or mouth for several days after the surgery. If your fever is over 102 or you have bright red blood in your nose or mouth, call your doctor right away.

The best way to prevent tonsillitis is through good hygiene, including:

• Washing your hands often
• Not sharing food, drink, utensils, or personal items like toothbrushes with anyone
• Staying away from someone who has a sore throat or tonsillitis

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Tonsillitis – Better Health Channel

Your tonsils are the two small pads of glandular (lymphatic) tissue located each side of the back of your throat. They are part of your immune system. They make antibodies and white blood cells (lymphocytes) to attack germs inside your mouth. This makes the tonsils part of your first line of defence against bacteria in food or air.

The tonsils are relatively small in the first year of a baby’s life and increase in size as a child grows older. They are usually at their largest between the ages of four and seven years.

Tonsillitis occurs when your tonsils become infected, and can be caused by either bacteria or viruses. Tonsillitis can develop in people of all ages. However, adults who get tonsillitis have generally had more infections in their lives, so they no longer get sick as often as children.

Symptoms of tonsillitis

The symptoms of tonsillitis include:

• White or yellow spots of pus on the tonsils
• Sore throat – although some children complain of pain in their tummy, rather than a sore throat
• Swollen lymph glands under each side of the jaw
• Pain when swallowing
• Fever
• Bad breath.

Bacteria, viruses and tonsillitis

When tonsillitis is caused by bacteria (about 15 per cent of all tonsil infections), it is usually a streptococcus bacterium. It is not easy to tell when tonsillitis is caused by bacteria – your doctor may do a throat swab (gently rubbing sterile cotton wool on a stick over the tonsil) and send it for testing.

There are many viruses that can cause tonsillitis. Antibiotics do not help if the tonsillitis is caused by a viral infection.

Complications of tonsillitis

Tonsillitis can lead to a number of complications, including:

• Chronic tonsillitis – infection of the tonsils which does not clear up. The person may go on feeling unwell and tired
• Secondary infections – the infection can spread to the person’s nose, sinuses or ears
• Glue ear (otitis media) in children – the adenoids are part of the same group of lymph nodes as tonsils. When the adenoids swell up (usually when the tonsils are also large), they can block the Eustachian tube, which goes from the back of the throat to the middle ear. This is the thin tube that you push air along when you ‘pop’ your ear. If this tube stays blocked most of the time, sticky fluid forms in the middle ear which interferes with hearing. This is called a glue ear
• Quinsy – if the infection spreads into the tissue around the tonsils, an abscess can form in the throat, also known as a peri-tonsillar abscess. This causes severe pain and can interfere with swallowing and even breathing. Antibiotics may help, but sometimes an operation is needed to drain the abscess.

Treatment of tonsillitis

Because most attacks of tonsillitis are caused by viruses, most of the treatment is aimed at helping to relieve the symptoms such as pain and fever. Paracetamol can help and the person should rest. Most children with tonsillitis do not feel well and it hurts them to swallow. Try cool drinks (cold drinks can hurt), ice blocks and ice cream. Don’t worry if a child stops eating for a day or two. Usually, they pick up quickly when the infection has gone.

For tonsillitis that is caused by bacteria, antibiotics are prescribed.

Tonsillectomy

If attacks of tonsillitis become frequent and severe, or cause complications, your doctor might suggest an operation, known as tonsillectomy.

Reasons for tonsillectomy can include:

• Recurrent bouts of tonsillitis accompanied by pain, discomfort and high temperature
• Chronic tonsillitis that doesn’t clear up with antibiotics
• Frequent ear infections associated with tonsillitis
• Breathing difficulties due to enlarged tonsils
• Abscesses forming in the throat (peri-tonsillar abscesses or quinsy)
• A child failing to thrive because of difficulty in swallowing due to frequent infection and enlargement of their tonsils.

Medical issues to consider before tonsillectomy

Before doing a tonsillectomy, your doctor will give you a complete physical check-up. The tonsil pad has a large blood supply, and special note will be taken whether you have any abnormal bleeding tendencies. Your doctor will check to see if your tonsils are actively inflamed and, if so, will prescribe antibiotics for a few weeks to control the infection before the surgery.

Making a decision about tonsillectomy for children

Tonsillectomy is mainly done in children to treat snoring, obstructive sleep apnoea or frequent tonsillitis. If symptoms are mild, a wait and see approach is recommended as problems often get better as children get older.

You and your doctor are in the best position to decide if this operation will help your child.

Safer Care Victoria has developed a Making a decision about tonsillectomy fact sheetExternal Link to support parents in making an informed decision about tonsillectomy for their child together with their doctor.

Safer Care Victoria have also developed several videosExternal Link where parents share their thoughts about how they made the decision to have their child’s tonsils removed.

Tonsillectomy procedure

A tonsillectomy is performed under general anaesthesia. The surgeon props open the person’s mouth and clamps their tonsils with special instruments. The glandular tissue is contained inside a skin lining which the surgeon cuts using scalpel, scissors, laser or an electric current (electrocautery). The surgeon then removes the tonsils. Each tonsil pad has a substantial blood supply, so electrocautery is often used to fuse the blood vessels and reduce the risk of haemorrhage.

Care for children having a tonsillectomy

Safer Care Victoria has developed resources to help families understand what to do before a child’s day of tonsillectomy (tonsil surgery), what to expect on the day of surgery and how to care for their child after this surgery.

See the fact sheets here:

• Before your child has tonsil surgery
• Caring for your child after tonsil surgery
• Pain management plan after tonsil surgery

Safer Care Victoria has developed a number of videos where parents share their stories about caring for their child before, on the day of and after tonsil surgery.

Immediately after a tonsillectomy operation

After the operation you can expect:

• When you wake up, you will be lying on your side – this is to prevent choking if any bleeding occurs from the tonsil pad
• A sore throat
• Pain-relieving medication, if necessary
• The nursing staff will regularly check your pulse, blood pressure, breathing rate and your throat for any signs of bleeding
• For the first four hours after the operation, you will probably not be allowed to have any food or liquids
• You may find it difficult to eat or drink, but you will be encouraged to do so – the more often you use your throat, the better
• You can expect a hospital stay of just one day or so.

Complications of tonsillectomy

Possible complications of tonsillectomy include:

• The pain may ease within two days or so, but may flare up again up to six days after the operation. You may also have ear pain.
• There can be excessive bleeding (haemorrhage) from your tonsil pads. Most cases of haemorrhage occur within one week of surgery.
• The scabs that form on the wounds may give you a bad taste in your mouth.

Self-care after tonsillectomy

Be guided by your doctor about how to care for yourself at home, but general suggestions include:

• Do not smoke.
• Avoid vigorous exercise immediately after the operation.
• Usually, you should have a week or so at home before returning to work or school.
• Avoid crowded, enclosed areas (such as cinemas) for at least one week, to reduce the risk of infection.
• Your sore throat may last for two to three weeks, but try to get back to your normal diet as soon as possible – avoid sticking to a jelly and ice cream diet.
• Some foods can cause irritation and pain – avoid sour drinks (such as citrus fruit juices), spicy foods and roughly textured foods for about 10 days.
• Avoid taking aspirin, since this pain-relieving medication can cause bleeding. Only take medications recommended by your doctor or surgeon.

Long-term outlook after tonsillectomy

A tonsillectomy won’t lower the risk or frequency of problems such as upper respiratory tract infections (the common cold), chest infections, laryngitis, middle-ear infections, sinusitis or nasal allergies. However, it will stop the tonsillitis and allow you to swallow more easily. You will probably lose your bad breath, if that was a problem.

Where to get help

• Your doctor
• Ear, nose and throat specialist
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)

Tonsillectomy (removal of tonsils): recovery after surgery

February 17, 2022

Tonsillectomy is an operation to remove the palatine tonsils, which is one of the most common and routine operations in otorhinolaryngology. The frequency of radical interventions in chronic tonsillitis remains high – about 600,000 tonsillectomy are performed annually in the world.

Why a tonsillectomy is needed

Most often, the need to remove the palatine tonsils is due to the need eliminate the focus of chronic infection , which they are.

At the initial stages, chronic tonsillitis is recommended to be treated conservatively, and if the treatment is carried out comprehensively and correctly, then often it can give a positive result.

Why do you still need to remove the tonsils?

According to the results of many different studies, there are a wide variety of pathogens, including streptococci, staphylococci, Haemophilus influenzae, lymphotropic viruses and other infections that contribute to the development of chronic tonsillitis.

But the leading role in the development of chronic changes in the palatine tonsils, as well as local and general complications of chronic tonsillitis, is played by beta-hemolytic streptococcus from group A (S. pyogenes) – a microorganism that also uses anaerobic respiration for its life. This bacterium is more often found in the deep sections of the depressions (crypts) of the palatine tonsils, since they contain the least amount of oxygen, which is the most favorable environment for the reproduction of anaerobic microorganisms.

Chronic tonsillitis becomes a focus of infection, a chronic infectious-allergic disease with a local inflammatory reaction in the palatine tonsils – all this is a consequence of the activity of not only beta-hemolytic streptococcus, but also its antigens and various pathogenicity factors, namely streptolysins. ³

As a source of infection, chronic tonsillitis causes intoxication of the body. A separate problem is various complications of chronic tonsillitis, for example, paratonsillitis and paratonsillar abscess are quite common.

In addition to outpatient care, inpatient treatment with surgery may be required in the treatment of such complications.

Common complications of chronic tonsillitis are: tonsillogenic sepsis (life-threatening condition), rheumatoid arthritis, endocarditis, glomerulonephritis. These conditions significantly reduce the quality of life of patients and can lead to disability. ⁴

In connection with the above, the main tactic of treatment is the sanitation of the focus of infection, in other words, the elimination of the pathogen. There are two methods of treatment – conservative or surgical.

The choice of method is currently clearly regulated and based on the classification of B.S. Preobrazhensky and V.T. Palchun. ⁵

This classification is based on the symptoms of chronic tonsillitis , as well as the presence and severity of toxic-allergic reactions and the presence of complications. The classification distinguishes 2 forms of chronic tonsillitis:

• simple (characterized by the presence of only local signs of chronic tonsillitis and tonsillitis no more than 1-2 times a year)
• toxic-allergic: toxic-allergic form I and toxic-allergic form II ⁶

Indications for tonsillectomy

The main indications for tonsillectomy are:

• Frequent exacerbations of chronic tonsillitis (more than twice a year)
• Purulent complications (peritonsillar abscess, neck phlegmon)
• Development of complications – rheumatism, diseases of the heart, kidneys, diseases of the nervous system, skin episodes of stopping breathing during sleep (obstructive sleep apnea syndrome)
• Ineffectiveness of conservative treatment of chronic tonsillitis, carried out in a complex of 2-3 courses
• Neoplasms of the palatine tonsil

Tonsillectomy is performed during remission of the inflammatory process, that is, without exacerbation of chronic tonsillitis.

With the development of such a complication as a paratonsillar abscess, the removal of the palatine tonsils is carried out simultaneously with the opening and drainage of the purulent focus. This operation is called abscess tonsillectomy.

Tonsil hypertrophy

Tonsil hypertrophy is a persistent enlargement of the tonsils that interferes with breathing through the mouth. With hypertrophy, breathing during sleep is performed with episodes of stopping, snoring increases. Difficulties in swallowing food are possible, speech is difficult.

Examination of the pharynx is performed to determine the degree of enlargement of the tonsils. The doctor focuses on the edge of the anterior arch and the middle line of the pharynx (uvula-uvula). The distance is divided into three conditional parts .

There is a classification in which several stubbles of hypertrophy of the tonsils are distinguished:

• I degree of hypertrophy – an increase in the tonsil by 1/3 of the distance from the arch to the uvula (the tonsils look beyond the arches in the throat)
• II degree of hypertrophy – tonsils increased 2/3 of the distance from the arch to the uvula
• III degree of hypertrophy – the tonsils are greatly enlarged, reach the uvula and can even touch it

Hypertrophy of the palatine tonsils should be distinguished from:

• chronic hypertrophic tonsillitis which is characterized by frequent exacerbations of chronic tonsillitis and signs of chronic inflammation on examination complications, i. e. an abscess inside the tonsil or paratonsillar region, which in very rare cases can occur without any common manifestations. ⁷

Contraindications for tonsillectomy

Contraindications can be absolute, when the operation is completely excluded for the patient and relative, when there are reasons that postpone surgery until these reasons are completely eliminated.

Absolute contraindications to tonsillectomy:

• blood diseases
• certain heart diseases
• tuberculosis
• liver cirrhosis

Relative contraindications to tonsillectomy:

• SARS and influenza
• exacerbation of chronic diseases
• menstruation
• pregnancy

Methods for removing tonsils 90 011

Modern otorhinolaryngology offers a wide range of tonsillectomy techniques. ⁸

Classical method of removal of palatine tonsils

The removal of tonsils is performed by separating the tonsil tissue together with the capsule from the surrounding tissues in a “blunt” way using a rasp. The separation of the tonsil ends with a wire loop. Bleeding is stopped, vessels are cauterized by electrosurgical method (electrocoagulation). This operation takes from 15 to 40 minutes. ⁹

Today, such an operation is used in ENT practice more often than others. The operation can be performed under general and local anesthesia.

The only disadvantage of this method, unlike others, is the highest risk of bleeding. However, the operation is fairly routine, and in relation to the number of operations performed, the risks of complications are low.

Laser tonsil removal

Tonsil removal uses a laser beam to destroy and coagulate the tissue. The laser beam coagulates the blood at the incision site and seals the vessels, which prevents bleeding. The laser method is less traumatic, with it there is less risk of complications. Also, in this way, both the complete removal of the palatine tonsils and their partial excision are possible.

Radio wave method of tonsil removal (Surgitron apparatus)

Tissue excision occurs with the help of a radio signal, which is transmitted by an electrode and causes intracellular fluid to evaporate and tissue to be dissected.

The advantage of this method is that thermal tissue damage is several times lower than when using laser or electrosurgical methods. Tissues are less injured, as a result of which the patient experiences less pain in the postoperative period; the level of tissue regeneration is maintained. Complete tissue healing occurs without the formation of a rough scar.

Cryodestruction

This method of removing tonsils consists in the local effect of liquid nitrogen on them using a special nozzle. The nozzle is selected individually, taking into account the characteristics of the anatomy, since its contact with the palatine tonsil must be especially clear and tight for a more effective impact.

Cryotherapy causes microcirculation disorders, which ensures the absence of bleeding during and after surgery. This method is painless and bloodless, it does not form a rough scar. The method is recommended for patients with an increased risk of bleeding, severe heart failure and pathology of the endocrine system.

Difference between tonsillotomy and tonsillECTOMY

Tonsillotomy is an operation in which the enlarged tonsils are removed not entirely, but partially. This type of surgical intervention is indicated for patients with grade III hypertrophy of the palatine tonsils, when they occupy the entire space from the anterior palatine arch to the uvula. With tonsillotomy, part of the enlarged tonsils is removed. Tonsillotomy, in contrast to the more radical method of complete removal of the tonsils, allows you to save their protective functions. Also, this method is recommended for the treatment of children.

Anesthesia for tonsillectomy

Tonsillectomy is performed under local anesthesia or anesthesia.

In local anesthesia, the tonsil and surrounding tissues are chipped with anesthetic drugs, while the patient is conscious and sitting in a chair.

In the second method, inhalation incubation anesthesia is used, in which the patient is put into a drug-induced sleep. The patient wakes up immediately after the operation in the ward.

Both methods of anesthesia have their advantages and disadvantages, so only the doctor who will perform the operation, as well as the anesthesiologist, can choose the desired method. The state of health of the patient and his wishes are also taken into account.

Postoperative recovery

The operation requires the patient to stay in the hospital for several days. After the operation, the patient is transferred to the ward under further medical supervision.

The first day for the patient is the most unpleasant, as it is not recommended to swallow, you can not eat and drink, and the patient may be disturbed by a strong pain syndrome. Bed rest is observed for 2-3 days. If the tissues heal well, there are no signs of bleeding, then the patient can be discharged for further outpatient monitoring. On average, a patient is discharged from the hospital within a week. Finally, the tissues heal within three weeks. All this time, the patient may be disturbed by pain and discomfort in the throat, as well as periodically rise in temperature.

Within 10-20 days after the operation, that is, throughout the recovery period, the patient is advised to follow a diet: hot, cold, sour, spicy foods should be excluded, as well as the use of coarse food in the form of cookies, gingerbread, crackers, as such food can irritate the injured area. It is recommended that the food be soft: in the form of baby food, cereals, various soufflés.

In the postoperative period it is forbidden:

• to play sports, lift weights, as the load can lead to bleeding
• go to baths, saunas, take a hot bath
• eat hot food and drinks

As noted above, pain is the most unpleasant ailment that accompanies the patient during the entire recovery period from the first day after surgery. The pain may disturb the patient at rest, and may intensify with swallowing and talking. To improve the patient’s well-being and reduce pain in the postoperative period after tonsillectomy, drugs for general and local anesthesia are used. The local preparations used should also have an anti-inflammatory effect.

Tantum

^® Verde after tonsillectomy

The use of benzydamine in the early period after tonsillectomy showed that in 12 (60.0%) patients there was a complete disappearance of complaints, in 5 (25%) patients there was a marked improvement in subjective sensations and only in 3 (15%) patients, the treatment was ineffective. ¹⁰

When using Tantum ^® Verde as a spray after removal of the palatine tonsils, a local anesthetic effect was observed after 15-20 seconds. With regular use of benzydamine, most patients experienced faster pain relief after surgery. ¹⁰

Benzydamine is known to have an anti-inflammatory antiseptic effect. ^13.14 The drug is also safe for use in the postoperative period in children. ¹¹

Tantum Spray ^® Verde

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Tantum Solution ^® Verde

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Complications of tonsillectomy

The most formidable complication during and after removal palatine tonsils is bleeding from the site of the surgical intervention – the tonsil niche. Bleeding can be vascular, parenchymal, arterial, venous, and the cause may also be invisible.

Bleeding in the postoperative period was observed in 1.5-13% of patients. A favorable outcome of the operation depends on the knowledge of the location of large tonsillar vessels of the palatine tonsils and the use of modern, less traumatic surgical methods. ¹²

It is worth noting what may disturb the patient after surgery:

• Small blood clots
• Pain and discomfort at rest and swallowing
• Cicatricial changes in the palate

Tonsillectomy is a serious surgical intervention that requires an integrated approach, from indications for surgery, preparation, to strict adherence to all recommendations. The accuracy of each step can contribute to a favorable outcome of the operation and minimize the risk of complications.

How to survive recovery after tonsil removal

Column

Health

March 31, 2022

How will the operation go, what will help to cope with the pain and when will the long-awaited relief come.

Lizaveta Dubovik

Director of the Medical Projects Office at Palindrome.

At the beginning of March, my tonsils were removed. Before the operation, I read a lot about recovery, and in good sources: I work as a medical editor and I know what to trust.

But in fact, everything turned out to be much more painful and unpleasant than described: for a week I could not drink water and sleep, I hardly ate anything, and in the morning I groaned from pain. Therefore, when it became easier for me, I decided to collect tips for those who will have their tonsils removed and want to prepare better than me for recovery in one material.

Important: I tried to take information from reliable sources about the average course of the process and recommendations for recovery, but I added my own thoughts. My experience may not match yours. Be sure to discuss recovery expectations with your doctor.

What you should know before removing the tonsils

If you are going to remove the tonsils, it is hardly necessary for you to explain where they are: these are the very lumps of lymphoid tissue that swell and hurt with a cold. In people with chronic tonsillitis, they are usually especially large, become acutely inflamed during illness, covered with plaque, fester.

If tonsils interfere with life and normal sleep, inflammation cannot be cured with antibiotics, abscesses and bleeding occur, the doctor may recommend removing them.

Children undergo surgery much easier than adults and recover faster. That is why, if you have lived to 21 with your tonsils, then you will have to fight for them. There are certain criteria for their removal:

• At least 7 episodes of acute inflammation in the previous year.
• At least 5 episodes per year for the last 2 years.
• At least 3 episodes per year for the last 3 years.

If at this stage you understand that perhaps the operation is still not needed – sore throats are not so frequent and the condition is not so bad – contact another lore for a second opinion. And think again, are you sure you are ready for removal. Because it will hurt a lot.

How the operation works

Believe me, the operation is the simplest thing that awaits you. I had my tonsils removed in a private clinic with a trusted doctor, because I realized that I had to provide myself with at least some minimal comfort. And I also had to do everything quickly, because my health had already turned into very bad: after the coronavirus, the tonsils became so huge that I could not breathe normally.

Patients are not kept in private clinics for a long time: I had the operation at 18:00, and in the morning at 10 I was sent home, fed with a baked pear. In state hospitals, the patient is observed for five days. To be honest, I didn’t really understand why, because, according to my feelings, you are discharged in the midst of horror.

The operation is performed under general anesthesia. It hurt a little when I woke up after it, but the nurse deftly poured an anesthetic down my throat, and I felt good. Then they injected me with some very strong and pleasant injection, so after half an hour I was already recording a video in Telegram about my own heroism and even scribbling in work chats. I felt very good: in the morning I calmly swallowed food, and immediately after the operation I drank water.

However, later the doctor said that it would be like this for a couple of days until I recovered from anesthesia and drugs. And on the third day, the main tin will begin. And so it happened.

What to eat if it hurts a lot

On the third day after the operation, I really felt unbearable pain. It all started at night: I woke up feeling like my ears were burning from the inside, and my saliva was acid. In a sitting position it became easier. But it didn’t work out to lie down at all.

A couple of days later I bought myself a pillow for patients with GERD (gastroesophageal reflux disease – when acid from the stomach breaks up the esophagus) to lie at an angle. It also helped with bouts of acid rush into the mouth wounds that the pain pills provoked.

I drank a lot of painkillers and with their help I somehow managed to survive. It was possible to eat only after the pill. The pain did not go away completely, but at least a couple of spoons of food fit. By the third day, the whole throat was covered with a nasty white coating and swollen so that it was not clear how to push food into it.

I had to look for suitable products. My discharge letter stated that I could not eat hot, spicy, sour and irritating food for two weeks, and alcohol for three. Then the doctor suggested that I independently look for what would come to me. He did not recommend children’s fruit purees because they contain lemon juice, and suggested that they try eating ice cream at first.

Foreign food recommendations after surgery include the following foods:

• any soft food;
• applesauce;
• Ice cream and popsicles;
• warm drinks;
• warm soup;
• paste;
• Sprite soda.

They also recommend eating toast and corn flakes. It will be hard, but it seems like it should help clean off dead cells. I came to this diet intuitively and really ate flakes just in batches – they are sweet and form into lumps that are easy to swallow.

Puree products, in my experience, go badly: they are light, just stick to the mountain and are not swallowed. You have to drink them down, and these are separate efforts for the throat – we will return to them later. As a result, you need to look for something moderately liquid, sweet (because it does not irritate), but heavy, so that it is swallowed by itself. Here are the foods I ate:

• melted ice cream, ordinary ice cream is better – satisfying, cool, fast;
• steamed and almost cooled noodles with butter and broth;
• microdumplings and dumplings with butter;
• sweet blueberries;
• corn flakes heavily soaked in milk.

I also sucked on hard candies and tried to chew gum to loosen my clenched jaw. All for the sake of calories. Believe me, these days you will become a prominent hunter for them: your body will be ready for any format of complementary foods.

But smoothies, curds and mashed soups did not suit me at all. They are too caustic and liquid, so they strove to get into the wrong throat, I constantly choked. Literally from every spoon.

There was a separate problem with water. For the first time in my life, I felt what it was like to drown when I tried to drink a couple of days after the operation. The water just flowed down the wrong throat. It was very painful to cough it up in such a state.

As a result, any sip of water was dangerous, and in 30% of cases I actually choked on it. I learned to drink only on the 8-9th day. Now I can’t stop doing it: drinking is wonderful. The tube helped me a little.

There is also an unpleasant smell of plaque in the throat – be prepared for the fact that all food will be saturated with this aftertaste. For example, I can’t imagine now how I eat ice cream: it’s all for me with the taste of healing flesh.

This smell, as my young man noted, extends to the premises. So yes, you will smell bad. Better to ventilate more often.

Rules to follow at home

The biggest risk after surgery is bleeding. Therefore, almost all doctor’s prescriptions are aimed at preventing their occurrence. Here’s what to do:

• take special tablets;
• refuse to take a bath and do not stand in a hot shower for a long time;
• reduce physical activity to a minimum;
• refuse to go to the sauna and not overheat at all;
• lie down and rest more.

These are very important requirements. It is better to provide yourself with at least 10 days of rest, taking a vacation or sick leave, and prepare for the fact that you won’t be able to move much.

I have already said that it will be uncomfortable to sleep – be sure to consider the option with a raised headboard or a few pillows. This will make it easier to breathe. I bought a pillow for GERD – it worked too.

In addition, you have to take antibiotics, and this is a separate challenge for the body. Tune in to the fact that the first week against the backdrop of recovery and a mountain of pills, your body will sausage: fever, nausea and diarrhea, pain, weakness. All this is normal.

If you start to bleed or if your general condition is too bad – it will be difficult to breathe, the temperature will become very high – you should immediately consult a doctor.

What is the result?

It was a terrible two weeks: it was so painful and so difficult for me, perhaps, it had never happened before. Even severe sore throats did not cause such prolonged suffering, and the lack of sleep and the opportunity to eat and drink was debilitating. I am finishing this material three weeks after the removal – now it still hurts a little, my throat is swollen and I can’t eat all the food.

But much can be learned from this experience. I learned to appreciate the opportunity to eat and drink, I understood how sleep is associated with recovery and healing, and now I try to protect it even more. The pain also helped with anxiety. When you focus on solving physically necessary tasks, the rest pales against this background.

I took a course of meditations on Headspace about pain and with their help I learned not to concentrate on the damage it brings, but to learn to coexist with it, to observe and direct attention. When you don’t run away from the pain, the truth becomes easier.

Words of support from relatives also helped me cope: everyone reminded me that I was going through such a serious challenge in order to be less sick, they called me a hero and listened to my whining. Thanks a lot to all these people for their support.

Please talk to your loved ones before the operation and enlist their support in this difficult time. This is the best thing we can do for each other. Try not to be alone and remember: all this is really temporary and is done so that later you do not get sick and feel better.