How painful is a tonsillectomy?
Tonsillectomy is the removal of two oval-shaped tissue pads, named tonsils, from the back of the throat. Tonsillectomy is a popular treatment for airway obstruction and recurrent tonsillar infection in children. However, the painful recovery of this procedure is unpleasant.
Tonsillectomy causes mild or moderate pain in most people. However, a few people may experience severe pain for the first two days after the surgery. On the third day, the pain may start subsiding. However, some may still experience severe pain on the third or seventh day after the surgery. Even adults may have a considerable amount of pain after the surgery. Adults usually require approximately 14 days of convalescence after a tonsillectomy before they can return to their regular diet and work. Children mostly have no pain or mild pain 14 days after a tonsillectomy.
A study reported that the techniques used for tonsillectomies, such as cold dissection, monopolar-bipolar dissection and coblation dissection, do not offer any relief from the pain.
However, with the intracapsular tonsillectomy (partial tonsillectomy/tonsillotomy) technique, children may experience minimum pain. In this method, the surgeon deftly shaves away the tonsil, leaving a small portion behind. By contrast, in a traditional total tonsillectomy, the surgeon removes the entire organ that increases bleeding risk and exposes the muscle behind the tonsil, increasing pain. Children with a partial tonsillectomy may not require opioid pain medication, return sooner to the school, and have a regular diet. However, it has complications such as tonsillar regrowth and potential recurrence.
The surgeon will provide some pain medication before, during and after a tonsillectomy for pain control. Before a tonsillectomy, the surgeon may give a combination of local anesthetic injections that include opioids and clonidine. They will provide some medications such as dexamethasone during the surgery to control pain, although its role in pain reduction is still unclear.
After the tonsillectomy, for the first and second week, you may experience more pain. Therefore, during this period, you may naturally take different combinations of analgesics medications. Your surgeon will prescribe pain medications that are safer for you such as acetaminophen, ibuprofen, or both. Moreover, they may give codeine, dexketoprofen, or metamizole that may be helpful for this pain. However, these medications may cause severe side effects such as bleeding and respiratory depression. Codeine in children younger than 12 years should be avoided because it can be harmful.
There is huge scientific ongoing research to find a technique or medication that will work best for each surgeon to conduct a painless tonsillectomy. However, there is no good solution yet for this problem. Nevertheless, distraction appears to be a successful strategy to reduce pain perception during and after a tonsillectomy.
What is a tonsillectomy?
Tonsillectomy is the removal of two oval-shaped pads of tissue (tonsil) situated one on each side at the back of your throat.
When will the surgeon suggest a tonsillectomy?
Usually, children who are 6 to 15 years of age are considered for this surgery. It is less likely to be performed in adults. An otolaryngologist (an ear, nose, and throat specialist) may suggest a tonsillectomy if you have
- Enlarged tonsils with a throat infection that may cause
- Three or more tonsil infections per year despite adequate medical therapy
- Tonsillitis (chronic infection and inflammation of the tonsils) causing persistent foul taste or breath despite adequate medications
- Peritonsillar abscess (accumulation of pus due to an infection behind the tonsil)
- An enlarged tonsil that is presumed to be cancerous
- A history of rheumatic heart disease due to a strep throat
- A recurrent middle ear infection due to colds and tonsillitis
What are the methods used for a tonsillectomy?
Considering your comfort level, the surgical time, symptom recurrence and complications, the surgeon will choose one of the below methods for a tonsillectomy:
- Cold dissection
- Carbon dioxide laser
- Monopolar-bipolar dissection
- Intracapsular tonsillectomy
Indian Journal of Otolaryngology and Head & Neck Surgery
Current Opinion in Otolaryngology & Head and Neck Surgery
Otolaryngology Head and Neck Surgery
CHOC Children's Hospital
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