Tonsillectomy, primary or secondary; age 12 or over

CPT4 code

Name of the Procedure:

Summary

Tonsillectomy is a surgical procedure to remove the tonsils, which are glands located at the back of the throat. It's commonly done to treat chronic tonsillitis or other tonsil-related issues.

Purpose

The purpose of a tonsillectomy is to alleviate problems caused by inflamed or infected tonsils, such as difficulty swallowing, breathing problems, recurrent throat infections, or obstructive sleep apnea. The goal is improved quality of life through reduced infection rates and alleviation of related symptoms.

Indications

Recurrent episodes of tonsillitis
Chronic tonsillitis unresponsive to other treatments
Obstructive sleep apnea caused by enlarged tonsils
Difficulty swallowing due to tonsil size
Suspicion of tonsillar malignancy

Preparation

Patients are instructed to fast (no food or drink) for at least 6-8 hours before the procedure.
Certain medications, particularly blood thinners, may need to be adjusted or stopped.
Preoperative evaluations, including physical examination and possibly blood tests, are conducted.

Procedure Description

Anesthesia: The patient is placed under general anesthesia, meaning they will be completely asleep and feel no pain during the procedure.
Positioning: The patient is positioned flat on their back with their mouth held open using a special instrument.
Tonsil Removal: The surgeon uses a scalpel, cautery, or specialized surgical instruments to carefully remove the tonsils.
Hemostasis: The surgeon ensures bleeding is controlled, typically using cautery or suture techniques.
Completion: The procedure is completed, and the patient is awakened from anesthesia and monitored.

Duration

The procedure typically takes about 30 to 45 minutes.

Setting

Tonsillectomy is usually performed in a hospital or surgical center.

Personnel

Surgeon (typically an otolaryngologist)
Anesthesiologist
Surgical nurses or assistants

Risks and Complications

Common Risks: Pain, bleeding, infection, swelling
Rare Risks: Adverse reactions to anesthesia, dehydration, damage to surrounding tissues
Complications: Postoperative bleeding, delayed healing, changes in voice or taste

Benefits

Significant reduction in the frequency of throat infections
Alleviates symptoms of obstructive sleep apnea and improves sleep quality
Easier swallowing and breathing
Most benefits are realized within two to three weeks post-surgery

Recovery

Pain management with prescribed medications, ice packs, and fluids
Soft or liquid diet for the first few days
Rest and avoidance of strenuous activities for at least two weeks
Follow-up appointment with the surgeon to monitor healing

Alternatives

Antibiotic therapy for infections
Watchful waiting for less severe symptoms
Partial tonsillectomy (removal of only part of the tonsils)
Pros and Cons: Non-surgical options may relieve symptoms temporarily but might not provide a long-term solution. Surgery provides a more definitive resolution but involves recovery time and risks.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, patients may experience a sore throat, difficulty swallowing, and mild ear pain. Pain management typically involves prescribed pain medications and comfort measures like ice packs. Patients are encouraged to stay hydrated and rest to facilitate recovery.