TonsilsandTonsillectomy

Tonsils are glands at the back of the throat. There is one on either side, inside the muscles. They can be seen by looking into the mouth, one on either side of the uvula (which people, sometimes refer to as the “dangly bit” in the middle of the mouth) at the back. They are the same as the glands in the neck which become swollen when one has a throat infection.

They tend to grow in size until about the age of six years old. From the age of six the throat grows quicker than the tonsils so effectively they, very slowly, get smaller. They particularly reduce in relative size during the teenage years as the face starts to grow more.

They can cause two problems, blockage of breathing when asleep and tonsillitis.

Blockage of breathing when asleep, i.e. Snoring, Disturbed Restless Sleep, and Sleep Aponea (a word used to describe breathing which blocks completely).

This happens because the throat is made of muscles. Normally when we are awake there is a resting tone in those muscles. When we fall asleep however the muscles go slightly floppy i.e. with reduced tone. The walls of the throat therefore start to fall then towards the middle. If the tonsils are enlarged then they start to fall in as well such that there is less room for air to flow for breathing. Initially this can cause snoring, but as the tonsils grow further they can block the breathing completely. This situation is made worse if the adenoids which is another gland sitting at the back of the nose is also enlarged.

Once the tonsils fall in to obstruct the breathing then the carbon dioxide in the child’s blood rises, and this is detected by the child’s brain stem, which then leads to the child waking up to some extent. As the child moves from being in deep sleep, to be more awake the muscles in their throat becomes stronger and the airway becomes held open again. The tonsils move back into their original position and the breathing improves. The problem is that the child has missed out on the really good part of sleep i.e. the deep part of sleep. Effectively it’s the same as someone waking the child every few minutes the result is the child has had disturbed restless sleep and in the morning is over tired resulting in them being very sleepy or over active.

Parents often bring videos of their children asleep to demonstrate the problem and this is very helpful.

Tonsillitis

Tonsils themselves can be prone to recurrent infections with sore throat and fever, often needing antibiotics with time off school. They often appear bright red with white spots on when looking in the mouth.

Tonsillectomy, Coblation and Traditional Dissection Technique

This refers to removal of tonsils with “ectomy” meaning out. It is a very common operation. It takes about half an hour, although children are gone from parent’s eyes for just over an hour, as time is taken preparing and doing safety checks in theatre. Going through the mouth they can either be shaved back to the muscle (coblation technique), or separated from the muscle (traditional dissection technique). As most of the nerve fibres are in the muscle, the coblation technique which disturbs the muscle least is least painful. This technique is excellent where the reason for surgery is blockage of the airway when asleep. A very small amount (estimated less than 5%) of the tonsil is left behind though on the muscle. There is a theoretical chance of infection of this residual tonsil tissue in the future, so if tonsillitis it the main reason for surgery, we may decide together to use the more traditional dissection technique that removes all of the tonsil. Each child is treated as an individual with treatment especially for their needs.