Articles, Blog

MVH- Tonsillitis

December 3, 2019

(light music) – Good morning, I am Dr. Kelly Ence. I am an otolaryngologist, an
ear, nose, and throat doctor, and today I wanted to spend a few minutes talking about tonsil problems. And I can divide these into
infectious, or obstructive. The two major situations that we see. Recurrent tonsillitis
is a fairly common thing among children also extends into teenage years and adulthood. Someone might ask, what is tonsillitis? In the throat, we have tissue,
in the back of the throat, that consists of tonsils. The same tissue extends
into the back of the nose. Called adenoids. And these tissues will get infected or inflamed with a sore throat. Sometimes it starts as a viral infection, but very commonly is involved with, what everyone is aware
of, called strep throat, or a strep infection. But not all tonsillitis is strep. It’s important to realize that. We will see patients
who have had recurrent bouts of strep throat, and often the family and the patient are frustrated that they’ve had so many, and they’ve missed a lot of school, it interferes with a lot of activities. So there is an option. Again, the criteria of
our national academy, and based on a lot of good studies, is that, if the patient has had seven episodes of tonsillitis in one year, five episodes of tonsillitis per year, for two years in a row, or three episodes of tonsillitis per year for three years in a row. Then they fit criteria for which we feel they will benefit from
having their tonsils and adenoids removed. There are several other
indications for a tonsillectomy. One of them is, as I
previously alluded to, tonsils can be very large,
as well as adenoids. And, particularly
children under 10 can have obstructive symptoms from
large tonsils and adenoids. That can lead to snoring, gasping, difficulty swallowing,
and even sleep apnea. So those are situations for
which removing the tonsils and adenoids provide a
dramatic improvement. And that is, probably the second or maybe even the most common indication for removing tonsils and
adenoids that we see. People ask what a
tonsillectomy is, and again, it is a very common operation, one of the two most common operations done on the pediatric population. Tonsillectomy is done
as a same-day surgery in almost all cases now. The patient is put completely asleep, with general anesthesia, they have an I.V. started, many times after they’re asleep, and they are intubated, so
that we can work in the mouth, and be able to remove
the tonsils and adenoids, and there are several
techniques or methods of removing tonsils and adenoids. All of which combined for an operation that takes anywhere from 15 to 25 minutes. Most people that know
about a tonsillectomy are aware that it’s a
fairly painful recovery. And that’s the biggest downside. We’re able to provide analgesics, and measures to try and deal with that, but it is an uncomfortable
operation to recover from. All in all though, we
feel like it is beneficial enough to be worth going through that. Yeah, there are risks to any surgery, the most notable one,
which is a small percentage in tonsillectomy, is
postoperative bleeding. That risk is as high as 1% to 4% depending upon the studies you see. Usually most of them average around 2%, will have some bleeding, most of the time, approximately
a week after surgery. And this is often self limited, but sometimes requires
intervention by the surgeon. And that would be cauterizing
the bleeding vessel, or possibly returning
to the operating room to cauterize or put a suture
in to control the bleeding. A second complication
or risk, is dehydration. And that’s why I always
emphasize to the families and the patients the
importance of hydration, keeping the child drinking,
staying ahead of that. So that they do a lot better,
if they don’t get dehydrated. So it’s a matter of some encouragement. Pain management is also a
challenge, in some cases. And so occasionally, that
will have to be dealt with, but most patients do fairly well. One of the things that I find helpful, is starting encouraging the hydration from the very beginning, before the pain seems to get worse on the second or third day. That helps a lot. There are other little
tricks, like chewing gum, finding what they will
drink, eating popsicles, various things that can assist
in keeping them hydrated. The diet after tonsillectomy
is mainly restricted to avoiding hard, crispy things. If they chew up their food well they can eat fairly substantial soft food, but I encourage them to stay away from hard, crispy things
like taco chips and whatnot. A lot of them don’t have
much of an appetite, so it’s not usually much of an issue in limiting their diet, it’s
mostly encouraging hydration and fluids that we emphasize
for the first 10 days or so. I always encourage that
they don’t do anything exertional for two weeks. No sports, no heavy playing for two weeks, feeling like there is a
slight risk of bleeding if they overdo it in that time period. Most of them are kind of able
to self limit themselves, when they start feeling better, then they start increasing their activity. But it commonly is about
a two week recovery. Sometimes quicker. So, we’ve discussed issues with tonsils that we frequently see, and
mainly recurrent infection and the issue of tonsils and adenoids being large or hypertrophied. Those can both be addressed
with great benefit by surgery, if they fit the criteria. If you have some specific questions, feel free to contact the
hospital or my practice, or the American Academy of Otolaryngology, head and neck surgery
website has good information for the patient and the family to review.

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