Tonsillectomy (tonsil removal surgery) is one of the most common surgical interventions in the world. The frequency of tonsillectomy has increased especially in the last 30 years. The reason for this is that the relationship between tonsil size and sleep apnea syndrome and cardiovascular diseases is clearly understood.
Tonsillectomy in Istanbul, Turkey
Why Patients Pain Very Sense After Tonsils Surgery ?
Tonsils are located at the entrance of the throat adjacent to the muscles of swallowing, where there are many sensory nerves. During tonsillectomy, there was more or less mucosal injury and damage to the muscles swallowing; it is natural to see pain after the operation. For weeks after the old tonsil operation methods, solid food can not be renewed; the swallowing of the patient's spit was considered a normal condition.
Current tonsillectomy techniques are designed to minimize bleeding and pain. Among them, the method known as "Thermal Welding Method" is the most advantageous.
General Information About Tonsillectomy Operation
Tonsillectomy operation is among the most common surgical procedures worldwide. Tonsils are taken because they cause problems associated with sleep-disordered breathing and recurrent throat infections.
In each patient, the decision to operate is made taking into account the benefits and harms of tonsillectomy operation.
Tonsillectomy operation is not recommended in the summer months because of the increased risk of bleeding due to dilation of the vessels in hot weather and healing due to the patient's loss of water by sweating. This surgery can be done in other seasons. Between 1915 and 1960, tonsillectomy operation was the most common surgical procedure in the USA. However, there was a decrease in tonsillectomy surgery rates for the treatment of throat infections between 1977-1989. Physicians thought that the sensitivity of the immune system may decrease and the tonsils may cease to be a problem in the following years. The frequency of tonsil surgery has increased again in the last 35 years after 1989. This is due to a better understanding of the relationship between tonsil enlargement and sleep-disordered breathing and the persistent negative effects on the cardiovascular system in prospective patients with large tonsil.
The main reason that the frequency of tonsillectomy operation has increased in recent years is the diseases associated with sleep-disordered breathing.
Benefits and Harm of Tonsillectomy Operation
The benefits of the tonsillectomy operation can be summarized as follows:
- Frequency of recurrent upper respiratory tract infections, reduced drug use
- Increased sleep quality
- Increased quality of life
- Reduced risks associated with upper respiratory infection
Looking ahead, prevention of sleep apnea syndrome and associated cardiovascular diseases
Damages of the tonsillectomy operation:
Pain after surgery
- There is a risk of bleeding after surgery
- May have nutritional difficulties after surgery
- Voice changes after surgery
It was published in English on the link"Clinical Practice Guideline: Tonsillectomy in Children (Update)-Executive Summary".
Negative Effects of Tonsillectomy Operation on Health
The negative health effects that can be seen in the early postoperative period due to tonsillectomy operation can be grouped as follows:
- risks of anesthesia
pain after surgery
- Can be counted as postoperative bleeding.
The bleeding rate ranges from 0.2% to 2.2% in the first 24 hours after the operation after tonsil surgery.
Apart from these, there may be trauma to the pharynx, throat and palate, and anesthesia risks such as difficult intubation, laryngospasm, edema in the larynx, aspiration, heart disorders, nausea, vomiting, and pulmonary edema.
Since the operation is performed by opening the mouth, lip injuries and jaw joint injuries are also rarely seen.
I have not encountered any of the above-mentioned risks and complications except for a small amount of bleeding in just a few patients.
Children with tonsil and adenoid enlargement have long been accustomed to a small intake of oxygen. Oxygen can enter the lungs after surgery and, although very rarely, cause respiratory distress. In the hospitals where tonsil and adenoid surgery will be performed, the experience of the anesthesia team, the presence of intensive care units and the presence of different responsible physicians at the beginning of these units may reduce these risks.
Negative effects or problems that may occur later in the operation:
- Sore throat related malnutrition and dehydration (fluid loss in the body)
- ear pain (usually starts on the 3rd day after tonsil surgery and disappears and disappears within a few days)
- stenosis due to damage in the nasal area (especially after traumatic adenoid surgeries)
- velopharyngeal insufficiency (when the adenoid and tonsil surgery is performed, the airway width in the nasal area increases and the air can escape from the mouth to the nose while talking a lot, it can be seen in the first few weeks after the operation, it usually resolves spontaneously, surgical narrowing can be performed in patients who do not recover by themselves)
Complications have been reported to be more common in those with craniofacial disorders.
Although it is very rare in the late period after the tonsillectomy operation, the following adverse conditions may also occur:
- taste disturbances
- vascular injuries and severe bleeding
- permanent neck pain
With the new method of thermal welding, which causes minimal tissue damage and blood loss, these risks can be reduced after the tonsil surgeries performed in the hospitals where the crowded and experienced anesthesia team has intensive care conditions.
Studies on children with large tonsils have shown that tonsil surgery has many benefits than harm. In the last year, the clear relationship between tonsil size and severity of sleep apnea syndrome has been shown and the frequency of tonsil surgery has increased.
Tonsil Size and Sleep Apnea Syndrome
Tonsils are an element of the immune system. It is the element of the "Walldeyer Lymphatic Ring" in our throat, which has a role in defending the body against microbes. Besides their immune functions, the tonsils in the respiratory area in the throat area, when they are larger than normal, cause many negative effects on health.
In people with large tonsils, a decrease in sleep quality has been observed with increasing tonsil size. In children with large tonsils and sleep apnea, a serious increase in blood pressure, an increase in stress hormones during sleep and many negative effects have been shown.
The reason for the increase in the frequency of tonsil surgery in recent years is the clearer understanding of the relationship between tonsil growth and sleep apnea.
Tonsillectomy Operation Techniques
Tonsillectomy operation was first performed by the Roman surgeon Celsus and defined a technique in the tonsil tissue in the form of tearing, pulling with a hook and cutting with a scalpel.
Today, many tonsillectomy operation techniques have been defined and many surgeons can still use a scalpel during tonsil surgeries. Tonsil surgery techniques can be listed as follows:
- Cold knife technique
It is the process of removing the tonsils using scalpels. This technique is applied especially in young patients and under general anesthesia conditions. Although healing after surgery is fast, the risk of bleeding may be high.
- Electrocautery assisted tonsil surgery
The electrocautery burns the tonsil tissue and separates it from the outer tissue. This technique causes less blood loss than the cold knife technique. However, it can cause thermal damage to tissue other than tonsils. After the operation, pain may be excessive due to heat damage.
- Harmonic scalpel technique
This medical device is in the form of a blade, with 55,000 vibrations per second with ultasonic energy. With bare power, blade vibration is not observed. The vibrational energy cuts the tissue and also ensures the stopping (coagulation) of bleeding.
- Ablation with radiofrequency (somnoplasty)
By using monopolar radiofrequency, tonsil tissue can be reduced under local anesthesia and office conditions. There are controversies about this method that there may be pain and there may be small abscess areas in the badmere.
- Laser tonsil reduction (laser tonsil ablation)
The carbon dioxide laser or KTP laser can be used to evaporate and shrink the tonsil tissue. This procedure is recommended for respiratory tract obstruction caused by chronic recurrent tonsillitis, chronic sore throat, severe halitosis, or enlarged tonsils. When laser-induced mucosal burns, severe pain can be observed.
- Microdebrider assisted tonsil reduction
Microdebrider is a medical device with a rotating and vacuuming tip. Tonsil tissue can be shaved with the help of endoscopic method and microdebrider. Since cut tonsil tissues are left behind, there is a risk of postoperative bleeding.
- Coblation method
The Coblation device creates an ionized saline layer that disrupts molecular bonds, without the use of heat. This mechanism can be used to remove all or only part of the tonsils. Although less pain and less need for care are advocated after surgery; In this method, it is emphasized that there is a risk of late bleeding.
- Thermal welding method
The "Starion Thermal Welding System" works with the latest thermal welding technology, which is the least developed in the environment. In this system produced by Starion Company, the heat energy produced at the tip of the probe can be used in two different modes. In the first mode, the veins in the tissue are shrunk and the tissue is cut so that the heat transmission to the second environment is minimal.
Tonsillectomy Operation With Thermal Welding Method and Its Advantages
Tonsil surgery is one of the most common surgical procedures in the world. The procedure is performed under general anesthesia. The patient's head is tilted back a little. Tonsil surgery begins after the automatic retractor is placed, which opens the mouth steadily. The last and most current operation technique is tonsil surgery with Thermal Welding System. There is no need to use additional knives, scissors and other tools in this system. Processing begins from the upper part of the tonsil front plica. First of all, the tissue vessels are coagulated using thermal energy with the bleeding-stopping mode, and then removed together with the tonsil capsule with the cutting mode. At the end of the operation, if there is bleeding area with bipolar radiofrequency, it can be stopped. Along with tonsil surgery, adenoid surgery and ear tube surgeries can also be performed.
Indications of Tonsillectomy Operation
In the last published guide, in which patients the tonsillectomy operation should be performed is indicated as follows:
- Have recurrent tonsillitis
. 7 times a year, tonsillitis and more
. Having tonsillitis at least 5 times a year in the last 2 years
. Having tonsillitis at least 3 times a year in the past 3 years
Surgery can be planned earlier among children in this group, especially in case of throat infections due to throat cultures and throat infections due to A ß-hemolytic streptococcus bacteria despite treatment.
This long-reported indication of recurrent throat infections can be changed for the following three conditions:
1. Multiple antibiotic allergies (as a condition that makes tonsillitis treatment very difficult)
2. In the presence of a specific clinical picture such as PFAPA (periodic fever, aphthous stomatitis, pharyngitis and adenitis). In this table, tonsil and adenoid surgery is the most effective treatment method (with recurrent attacks of severe tonsillitis and antibiotics are insufficient, cortisone fever drops dramatically).
3. Having peritonsillar abscess. In this case, there is an accumulation of inflammation in the space outside the tonsil. Tonsil surgery can be planned earlier, as this condition, which is at risk of recurrence, will result in a more risky and more serious infection picture than tonsillitis.
Respiratory disturbances in sleep
Especially in patients with large tonsils, symptoms such as sleep apnea, snoring and decreased sleep quality may occur. In children with sleep apnea syndrome, unlike adults, the disease usually causes only tonsil and adenoid growth. Therefore, sleep testing (polysomnography) is not always necessary in children with witnessed sleep apnea and sleep-disordered breathing. Tonsil and adenoid surgery is planned together in children who have tonsil growth and adenoid enlargement during the examination and have sleep-disordered breathing.
In addition to the conditions presented above and stated that tonsillectomy operation is required, tonsillectomy operation is performed for diagnostic purposes, especially in adult patients, due to the fact that there is a significant asymmetry between the tonsils and this asymmetry increases over time.
Contraindications for Tonsillectomy Operation
Tonsillectomy Operation is inconvenient in the following cases:
- Bad risk of anesthesia or uncontrolled medical disease
- Cleft palate
- The child's age and body weight are small
- Polio (polio) epidemic
Apart from these, there are sources that suggest that tonsil surgery in women may be risky in terms of bleeding in women.
Proper Use of Thermal Welding Device is Important!
Thermal Welding Device has two separate modes. At the tip of the funnel, the first mode is to close the small vessels with heat energy to stop the bleeding and to provide the second mode of cutting. Although the first mode is used in excess, it is a system that prevents heat transfer in the probe tip; increases the likelihood of heat injury to the surgical site. For this reason, I prefer to stop the small bleeding areas that occur during the operation with mucosa suture, without using the first mode too much.
How is Bloodless, Knifeless, Painless Tonsillectomy (Thermal Wedding Tonsillectomy) Performed?
Above, the videos of thermal welding tonsillectomy operation are shown.
Although pain occurs after tonsillectomy; taking soft oral water from the mouth and constantly washing the surgical field, keeping the body water level high accelerates healing. Especially in patients who do not consume watery oral food due to pain, a vicious cycle can occur, such as a growing sore throat and a growing restriction on nutrition.
In the photo above, the patient who had tonsillectomy operation with Thermal Welding method has a surgical field appearance after surgery. It can be seen that the front and rear pilates are sewn together with fusible stitches. Since the pain medication is injected into the surgery area, there are small bleeding areas connected to the needle entry points.
Before and 1 week after tonsillectomy operation
In the video above, the patient who underwent tonsillectomy has an endoscopic view of the throat region before and after surgery. After tonsil surgery, white colored, fibrotic, healing tissues appear in the tonsils removed.
During the tonsillectomy operation, varying amounts of trauma occur in the muscle and mucous structures outside the tonsil. The method that can be defended as "the best tonsil surgery method" can be explained as this "method that minimizes the amount of trauma". Among the tonsil surgery techniques, "Thermal welding method", which has very little tissue trauma and heat damage, has many advantages over other methods. As tissue damage decreases, the amount of post-operative pain and recovery time will decrease.
Is Painless and Bloodless Tonsillectomy Operation Possible?
Postoperative Care For Tonsillectomy Operation
After the tonsillectomy operation, no food and water are taken by mouth during the first 4 hours after the surgery, for the effect of anesthesia drugs to pass. Eating grained ice cream, cold yogurt or cold milk dessert first after surgery may help reduce pain in the surgery area.
The most important factor that increases recovery after tonsillectomy operation is frequent ingestion of water or watery food.
After the operation, ear pain, starting from the 3rd day, increasing at night and continuing up to the 10th day, can be seen.
In the area where the tonsils are removed in the first week after the operation, white healing tissues appear. Families can mistakenly confuse this with inflammation.
I recommend my patients, who need to recover quickly and want to start their normal daily work in the earliest period, to get up at night and drink water at regular intervals, chew gum during the day and consume warm broth, chicken broth, dairy products with high protein content.
In some foreign sources, it is emphasized that operating cold steam machines at night can reduce dry throat and pain that may occur in the throat area.
Many of my patients who underwent surgery with the thermal welding method stated that the postoperative pain was very low and that the postoperative start-up period was shorter than other techniques.
Drugs to be used after tonsillectomy operation:
The main factors that determine the pain and postoperative recovery rate after tonsil surgeries are the patient's constant contact with water or watery food in the surgical field, and there is no loss of fluid in the body. However, in Thermal Welding Technique, the risk of post-operative pain and bleeding is lower since there is very little heat damage and tissue damage to the muscle tissue outside the tonsil.
Don't Forget to Drink Water!
After the tonsillectomy operation, a very effective factor in recovery is the patient's drinking of water.
Although there are various discussions about which intervals and how much water to drink; low and frequent drinking is beneficial for keeping the throat area moist and maintaining the body water ratio.
After tonsil surgery, watery foods (soup, non-acidic fruit juices ...) are also useful besides water.
Chewing gum at empty intervals where water or any aqueous food is not consumed can be beneficial for cleaning the surgical site by increasing saliva production.
I prefer to emphasize the importance of drinking water in the form of "drink water as your throat hurts, drink often ...".
Pay Attention to Oral Frequent Drinking Water After Tonsil Surgery!
Frequent intermittent drinking of water is very important after the operation. In addition, protein content is important for accelerating healing of high mild, warm foods. The first 10 days after tonsillectomy is the most risky period in terms of bleeding. Drinking frequent water will also keep the surgical field moist. For example, drinking half a glass of water in half an hour (taking time off at night and drinking water can speed up healing in the same way). Bleeding is more common on the 10th day, especially due to the change in collagen structure at 10th day. For this reason, nutrition and care for the first 10 days are very important. After tonsillectomy, eating acidic, salty and overly spicy foods with hard, hot, sharp edges is inconvenient. Such foods may cause mucous membrane damage and healing to be adversely affected; hot food can cause enlargement of the veins and start of the bleeding. Gum chewing can help to accelerate healing by providing an antiseptic secretion to wash the saliva and throat pathways.
What's The Earliest Age For Tonsillectomy?
According to previous sources, the tonsillectomy operation was reported to be undesirable for 3 years and under 15 kg weight. In addition to developing anesthesia techniques, tonsil and adenoid surgery has started to be performed in children under 3 years of age as a result of understanding the risks of severe sleep apnea syndrome in children with severe tonsil and adenoid enlargement.
On the website of the American Academy of Otolaryngology-Head and Neck Surgery - https://www.entnet.org/, the latest tonsil surgery treatment guide published for families and physicians (Clinical Practice GuidelineTonsillectomy In Children - Clinical Practice Guideline: Tonsillectomy in Children (Update)).
In the current treatment protocols, it is the best option to wait for patients who are under 3 years of age and who do not have severe respiratory arrest attacks due to tonsils or very often tonsil with medical treatment. There are no strictly reported upper age limits for tonsillectomy operation.
Many positive effects on heart health have been reported in children with large tonsils, except for the treatment of sleep apnea and tonsil surgery. However, in some cases, tonsil surgeries may need to be done earlier.
Recovery After Tonsillectomy Surgery Is Faster In Children Than Adults!
As the age of the patient undergoing tonsillectomy surgery decreases, the rate of recovery usually increases after surgery. It is reported that post-operative pain is higher than that of children, especially in adult patients. In addition, the most important factor in postoperative recovery is the patient's frequent consumption of water and juicy foods.
Tonsillectomy surgery has many proven benefits in children with frequent throat infections and drug use, children with sleep apnea.
Voice and Speech Changes After Tonsillectomy Operation
After the tonsillectomy operation, there may be changes in the voice and speech of patients.
In patients with large tonsils, there is a serious increase in airway after surgery. However, there may be edema and pain in the soft palate and small tongue. Depending on this, patients may experience difficulty or voice changes while talking. Generally, improvement may occur in this case after a few weeks. However, in children whose tonsils and adolescents are taken together, the distance behind the palate (velopharyngeal space) also increases. For this reason, how much air increases to the nose when talking (velopharyngeal insufficiency / hypernasality), as the breathing is started from the nose, the sinuses can also contribute to the shaping of the sound and there may be differences in the tone. Many troubles will disappear within a few weeks after the operation. If velopharyngeal insufficiency continues, follow-up of a speech therapist and, if necessary, re-narrowing of this region can be performed.
- Speech Outcomes after Tonsillectomy in Patients with Known Velopharyngeal Insufficiency
- Surgical Management of Velopharyngeal Insufficiency
- Effects of oropharyngeal surgery on velopharyngeal competence
- Surgical Management of Velopharyngeal Insufficiency
- Effects of oropharyngeal surgery on velopharyngeal competence
Tonsillectomy Operation Cost in Istanbul, TurkeyThe price of bloodless, painless, and knifeless tonsil operation performed with Thermal Welding Device varies between 2,500 - 4,000 US Dollars according to hospitals. 1 day hospitalization, blood tests and all instruments are included in this price list.
How Many Days Do You Need to Stay in Istanbul After Tonsillectomy Operation?
It is suitable to stay in Istanbul for 7-10 days after the bloodless, painless and knifeless tonsil operation performed with Thermal Welding Device. Our patients are returning to their earlier country. Of course the ideal is to stay here and come back to the checkup.
I'm performing the bladeless bloodless tonsillectomy with Thermal Welding equipment ...
This is about 15-30 minutes.
I wish you a good luck on your surgery ...
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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Mobile phone: +90 533 6550199
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47