eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Pediatric Otolaryngology

Tonsillectomy: Follow-up

Author: Amelia F Drake, MD, Chief, Division of Pediatric Otolaryngology, Newton D Fischer Distinguished Professor of Surgery, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine
Coauthor(s): Michele M Carr, DDS, MD, MEd, Associate Professor, Department of Otolaryngology, Hershey Medical Center
Contributor Information and Disclosures

Updated: Aug 6, 2009

Outcome and Prognosis

Compared with watchful waiting, tonsillectomy or adenotonsillectomy provided an additional, but small, reduction in the episodes of sore throat, days of school absence associated with sore throat, and upper respiratory infections.14 Results of other studies have suggested an overall patient satisfaction and improved quality of life.

Paradise and colleagues monitored patients who had recurrent throat infections. Those who had tonsillectomy had fewer throat infections in the first 2 years after treatment than those who did not have tonsillectomy.15

Levels of alpha-streptococci (inhibitory protective bacteria) have been shown to increase after tonsillectomy.16 This further explains why tonsillectomy decreases the rate of streptococcal infection (including pharyngitis).

Recent literature that looks at the persistence of obstructive sleep apnea syndrome in children after surgery shows that adenotonsillectomy yields improvements in respiratory abnormalities in children with obstructive sleep apnea, but complete normalization occurs in only 25% of the patients.17 The main determinants for surgical outcome include obesity, which is an increasing occurrence in children, and apnea hypopnea index (AHI) at diagnosis.18 Authors noted that, in cases of ADHD, it is helpful to treat not just the disorder of attentional issues, but also underlying sleep problems, which have adverse effects on daytime behavior and attention.19 Lastly, studies are now recognizing the high incidence of obstructive sleep issues in certain populations such as the cleft palate population.20

Future and Controversies

Research on tonsillectomy is still popular. Whether an optimal method of tonsillectomy exists, whether perioperative steroids are useful, and whether outpatient tonsillectomy is safe are still unclear.

To treat airway obstruction from large tonsils, tonsillotomy with lasers may be less painful than tonsillectomy and just as successful. Radiofrequency reduction of the volume of submucosal tissue may also be used to achieve this end in adults. Well-designed studies are necessary to prove the effectiveness of these methods.

Further research on the efficacy of tonsillectomy to treat recurrent sore throats is still needed. We know of no definitive studies since the original study by Paradise et al, which showed that tonsillectomy is beneficial in patients with recurrent sore throats.15

 


More on Tonsillectomy

Overview: Tonsillectomy
Workup: Tonsillectomy
Treatment: Tonsillectomy
Follow-up: Tonsillectomy
Multimedia: Tonsillectomy
References
Further Reading
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References

  1. Gabriel P, Mazoit X, Ecoffey C. Relationship between clinical history, coagulation tests, and perioperative bleeding during tonsillectomies in pediatrics. J Clin Anesth. Jun 2000;12(4):288-91. [Medline].

  2. Howells RC 2nd, Wax MK, Ramadan HH. Value of preoperative prothrombin time/partial thromboplastin time as a predictor of postoperative hemorrhage in pediatric patients undergoing tonsillectomy. Otolaryngol Head Neck Surg. Dec 1997;117(6):628-32. [Medline].

  3. Fujikawa S, Hanawa Y, Ito H, Ohkuni M, Todome Y, Ohkuni H. Streptococcal antibody: as an indicator of tonsillectomy. Acta Otolaryngol Suppl. 1988;454:286-91. [Medline].

  4. Carr MM, Williams JG, Carmichael L, Nasser JG. Effect of steroids on posttonsillectomy pain in adults. Arch Otolaryngol Head Neck Surg. Dec 1999;125(12):1361-4. [Medline].

  5. Ozcan M, Altuntas A, Unal A, Nalca Y, Aslan A. Sucralfate for posttonsillectomy analgesia. Otolaryngol Head Neck Surg. Dec 1998;119(6):700-4. [Medline].

  6. Carr MM, Muecke CJ, Sohmer B, Nasser JG, Finley GA. Comparison of postoperative pain: tonsillectomy by blunt dissection or electrocautery dissection. J Otolaryngol. Feb 2001;30(1):10-4. [Medline].

  7. Pizzuto MP, Brodsky L, Duffy L, Gendler J, Nauenberg E. A comparison of microbipolar cautery dissection to hot knife and cold knife cautery tonsillectomy. Int J Pediatr Otorhinolaryngol. May 30 2000;52(3):239-46. [Medline].

  8. Lee KC, Bent JP 3rd, Dolitsky JN, Hinchcliffe AM, Mansfield EL, White AK. Surgical advances in tonsillectomy: report of a roundtable discussion. Ear Nose Throat J. Aug 2004;83(8 Suppl 3):4-13; quiz 14-5. [Medline].

  9. Nelson LM. Radiofrequency treatment for obstructive tonsillar hypertrophy. Arch Otolaryngol Head Neck Surg. Jun 2000;126(6):736-40. [Medline].

  10. Telian SA, Handler SD, Fleisher GR, Baranak CC, Wetmore RF, Potsic WP. The effect of antibiotic therapy on recovery after tonsillectomy in children. A controlled study. Arch Otolaryngol Head Neck Surg. Jun 1986;112(6):610-5. [Medline].

  11. Colreavy MP, Nanan D, Benamer M, et al. Antibiotic prophylaxis post-tonsillectomy: is it of benefit?. Int J Pediatr Otorhinolaryngol. Oct 15 1999;50(1):15-22. [Medline].

  12. Rakover Y, Almog R, Rosen G. The risk of postoperative haemorrhage in tonsillectomy as an outpatient procedure in children. Int J Pediatr Otorhinolaryngol. Jul 18 1997;41(1):29-36. [Medline].

  13. Randall DA, Hoffer ME. Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg. Jan 1998;118(1):61-8. [Medline].

  14. van Staaij BK, van den Akker EH, van der Heijden GJ, Schilder AG, Hoes AW. Adenotonsillectomy for upper respiratory infections: evidence based?. Arch Dis Child. Jan 2005;90(1):19-25. [Medline].

  15. Paradise JL, Bluestone CD, Bachman RZ, et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N Engl J Med. Mar 15 1984;310(11):674-83. [Medline].

  16. Richtsmeier WJ, Shikhani AH. The physiology and immunology of the pharyngeal lymphoid tissue. Otolaryngol Clin North Am. May 1987;20(2):219-28. [Medline].

  17. Tauman R, Gulliver TE, Krishna J, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr. Dec 2006;149(6):803-8. [Medline].

  18. Lam YY, Chan EY, Ng DK, et al. The correlation among obesity, apnea-hypopnea index, and tonsil size in children. Chest. Dec 2006;130(6):1751-6. [Medline].

  19. Galland BC, Dawes PJ, Tripp EG, Taylor BJ. Changes in behavior and attentional capacity after adenotonsillectomy. Pediatr Res. May 2006;59(5):711-6. [Medline].

  20. Maclean JE, Waters K, Fitzsimons D, Hayward P, Fitzgerald DA. Screening for obstructive sleep apnea in preschool children with cleft palate. Cleft Palate Craniofac J. Mar 2009;46(2):117-23. [Medline].

  21. Fowler RH. The rise of the tonsil operation. In: Tonsil Surgery: Based on a Study of the Anatomy. Philadelphia: FA Davis Co; 1931:54-60.

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Further Reading

Clinical guidelines

Thomas M. Specific management of IgA nephropathy: role of tonsillectomy. Nephrology 2006 Apr;11(S1):S146-8.

Finnish Medical Society Duodecim. Sore throat and tonsillitis. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2007 Feb 2

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Keywords

tonsils, tonsillectomy, tonsillectomy surgery, tonsillectomy procedure, sore throat, swollen tonsils, tonsil infection, tonsillitis, palatine tonsils, tonsillectomy adults

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Contributor Information and Disclosures

Author

Amelia F Drake, MD, Chief, Division of Pediatric Otolaryngology, Newton D Fischer Distinguished Professor of Surgery, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine
Amelia F Drake, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American Society of Pediatric Otolaryngology, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Michele M Carr, DDS, MD, MEd, Associate Professor, Department of Otolaryngology, Hershey Medical Center
Michele M Carr, DDS, MD, MEd is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

Ari J Goldsmith, MD, Chief of Pediatric Otolaryngology, Long Island College Hospital; Associate Professor, Department of Otolaryngology, Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center
Ari J Goldsmith, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gregory C Allen, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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