The anesthesiologist answers your question: Should you undergo tonsillectomy?

In the past two years, Xiao Li has been troubled by chronic tonsillitis and tonsil stones. A doctor suggested that instead of frequent inflammation, it would be better to simply remove the tonsils. Considering that the tonsils are an immune organ and play an important protective role in the body, Xiao Li has been struggling with whether to remove the tonsils...

Doctor-patient dialogue

Doctor: For tonsillitis and tonsil stones, surgery to remove the tonsils and adenoids is recommended. Xiao Li: Surgery? If the tonsils are removed, will it affect the immune function?
Doctor: Currently, a large number of studies at home and abroad have shown that tonsillectomy and adenoidectomy will not affect immune function. However, during the period of 1 to 3 months after removal, the immune system will undergo a certain degree of adjustment. At this time, you should pay attention to keeping warm and prevent colds.
Xiao Li: I see. Doctor, what other steps are involved in tonsillectomy? Can you tell me more about it?
What exactly is the tonsil?

The tonsils are located between the palatopharyngeal arch and the palatoglossal arch. They are oval in shape and are the largest in the pharyngeal lymphoid tissue. As an important immune organ in the oropharynx, the pharyngeal lymphoid tissue is home to many soldiers who protect our health - immune cells. When these "soldiers" encounter their natural enemies - bacteria and viruses - they will actively activate their defense mechanisms to fight them.

Among these bacteria and viruses, beta-hemolytic streptococci are most likely to provoke this group of powerful soldiers. Once a fierce battle occurs, a series of inflammatory reactions will occur, and patients will often experience severe sore throat and fever symptoms.

When is it necessary to have tonsils removed?

Tonsillectomy may be considered in the following situations:

(1) Repeated acute attacks of tonsillitis (more than 7 times per year) and a history of peritonsillar abscess.

(2) Enlarged tonsils cause snoring, otitis media, and sinusitis.

(3) Tonsillitis causes autoimmune diseases, such as valvular heart disease, nephritis, etc.

(4) Malignant tonsil tumors, uncontrollable tonsillar vascular bleeding, etc.

How to choose the anesthesia method?

Modern anesthesia methods include general anesthesia, spinal anesthesia, sedation under controlled anesthesia, local anesthesia, and the nerve block anesthesia technique that has been very popular in recent years. For different types of surgeries and different incision sizes, anesthesiologists often develop individualized anesthesia plans based on the conditions of each patient to achieve the best anesthesia effect.

For tonsillectomy, you can choose general anesthesia or local anesthesia, and each has its own advantages and disadvantages. Although general anesthesia can reduce the pain and anxiety of patients during surgery and reduce the difficulty of the operator's operation, it increases the possibility of complications related to the use of general anesthetics and endotracheal intubation. For tonsillectomy, the risk of postoperative bleeding under general anesthesia is greater than that under local anesthesia, and the hospital stay is longer.

Local anesthesia requires a high degree of patient cooperation. During the operation, the patient needs to actively cooperate with the otolaryngologist to complete the injection of local anesthetics. During the operation, the patient needs to keep his mouth open throughout the operation and resist nausea and vomiting caused by tongue compression. The patient has a greater psychological fear. However, local anesthesia has a lower risk of bleeding, and the patient can recover and be discharged from the hospital in a shorter time after surgery.

What should I pay attention to during preoperative preparation?

As the saying goes, there is only minor surgery, but no minor anesthesia. The risk of anesthesia is related to the size of the surgery, but it is more closely related to the patient's own disease state. Before surgery, the anesthesiologist will fully evaluate the patient to be operated on, including heart function, lung function, brain function, etc., especially the airway assessment. The airway is more important for otolaryngology patients because they often have a history of snoring, allergies, etc., and tonsillectomy is also mainly performed around the airway.

However, there is no need to worry. The specialty of anesthesiologists is to find predictable difficult airways. Common methods include: seeing if the patient's jaw is small; seeing if the neck is thick; seeing if there are any tumors in the head and neck; seeing if the mouth is open; seeing if the uvula (the tongue in the mouth) can be seen after the mouth is opened; seeing if the lower front teeth can bite the upper lip, etc. In addition, there are some advanced measurement methods, including the use of ultrasound to measure some indicators to reflect whether the patient has a difficult airway. Considering that the surgical site is very close to the airway, it is recommended to raise the head of the bed after surgery to avoid aspiration of wound exudate.

After evaluation, Xiao Li had no special medical history, denied snoring, had a standard oriental face, and his airway was assessed to be normal, with a non-difficult airway rating. However, considering that the surgical site was very close to the airway, it was recommended to raise the head of the bed after surgery to avoid aspiration of wound exudate.

What to do if you are worried about pain after surgery?

First of all, patients should be mentally prepared. The incidence of postoperative pain after tonsillectomy is high, the duration is long, and it is often not controlled in a timely and effective manner. At present, the recommended pain management model is multimodal analgesia, which refers to a model that uses multiple means and multiple drugs for pain management, thereby reducing the adverse reactions of a single method or drug.

The means of multimodal analgesia mainly refer to general anesthesia combined with nerve block, while the drugs of multimodal analgesia mainly refer to the combined use of opioids and non-steroidal anti-inflammatory drugs, etc., and can also be assisted by ice compresses, nebulization inhalation, etc.

What else should I pay attention to after the operation?

Prevention of postoperative bleeding: It takes 3 to 4 weeks for the surgical area to heal completely after tonsillectomy. Bleeding may occur before the surgical area is completely healed. Do not swallow oral secretions on the day of surgery, please spit them out gently; place toilet paper next to the pillow and clean it at any time to help observe the amount of secretions and bleeding, and avoid stomach discomfort caused by swallowing too much bloody secretions, or cause aspiration or even suffocation.

After the operation, a white membrane will be formed in the tonsil fossa to protect the surgical area. Please do not wipe it casually and wait for it to fall off on its own to avoid bleeding in the surgical area.

Do not cough, sneeze, shout, cry, or take a bath or soak your feet after surgery. Avoid strenuous exercise. Observe whether you have continuous swallowing movements. If you feel bloody or hot secretions flowing into your throat, or if you find blood in your secretions, you need to inform the medical staff immediately.

The white membrane falls off 7 to 14 days after surgery, which is a period when the surgical area is prone to bleeding. If bleeding occurs in the surgical area, please sit up immediately, lower your head, open your mouth to breathe, and try to spit out all oral and throat secretions to avoid aspiration. For a small amount of bleeding, you can drink ice water or ice cream (without impurities) and apply ice to the lower jaw to help stop bleeding. All patients with postoperative bleeding should return to the hospital for further evaluation and treatment.

Prevent postoperative infection: Drink plenty of water after each meal, rinse your mouth repeatedly with ice salt water or compound chlorhexidine mouthwash, which will help reduce food residue in the surgical area. Brush your teeth every morning and evening, keep your mouth and oropharynx clean, and prevent infection and bleeding in the surgical area. If infection in the surgical area is confirmed, the doctor will give systemic antibiotic treatment according to the situation.