Painful, swollen tonsils; the symptoms, causes and treatment available locally

18 August 2015

Mr John Phillips, consultant ENT surgeon at Spire Norwich Hospital discusses the symptoms, causes and treatment available for patients suffering from painful, swollen tonsils and tonsillitis.

Tonsillitis can lead to a sore and throbbing throat is the fatigue, inability to swallow and painful neck. So why do we have tonsils and why do we suffer from these dreadful infections? Mr John Phillips, consultant ear, nose and throat (ENT) surgeon at Spire Norwich Hospital answers some questions:

What are the tonsils and adenoids for and why do we have them?

“In the back of your throat there is a ring of defense that protects your throat and your lungs from harm. This ring is made up of special glands that trap germs that attempt to enter your body either via your mouth or your nose. The glands situated at the back of the throat on each side are the tonsils. The glands situated at the back of the nose are called the adenoids.”

Why do they cause problems?

“The two main reasons why tonsils and adenoids cause problems are due to them either being too big, or repeatedly becoming infected. If they are too big they can cause anything from mild snoring to problems breathing; this can be a particularly serious issue in children.

"If they keep getting infected this may result in tonsillitis (inflammation of the tonsils) or adenoiditis (inflammation of the adenoids). Those who have had tonsillitis, will agree it’s not just any old sore throat - the pain is horrible, you may be unable to work and if you are a child you may miss time off school.

“When doctors are asked why they entered their specialty of choice, many recall experiences during their childhood that inspired them. I have horrible memories of tonsillitis as a child until my tonsils were finally removed. I can’t say this was the great moment that made me want to become an ENT surgeon, but tonsillitis can be very unpleasant and it certainly gives me insight into what my patients are going through when they describe their symptoms.”

What treatment is available?

“The best option for patients with severe breathing problems or recurrent tonsillitis is a tonsillectomy (removal of the tonsils). A tonsillectomy still remains one of the most commonly performed operations throughout the world. In cases where symptoms are less severe there is always the option of holding back to see whether the frequency of tonsillitis lessens with time.

“Removing the tonsils and adenoids, like all operations, carries a small but real risk of complications. The risk we concern ourselves about the most is bleeding after the operation. Fortunately this risk is low, and locally this risk is about 4%, ie, four out of every 100 people having their tonsils removed will bleed within two weeks after their operation”.

What is the best way to remove the tonsils?

“There are many different ways to remove the tonsils. The traditional and most widely used method in England is to gently peel the tonsils away from the neighbouring tissues using a technique referred to as 'cold steel dissection'. Centuries ago tonsils were removed using something called a 'tonsil guillotine’; this is still performed in some parts of the world and can be performed without any anaesthetic.

"Over the last few decades many alternative techniques have been described to remove the tonsils. These techniques include the use of lasers, electrocautery, coblation and harmonic scalpels. Lasers dissect the tonsils using a beam of light, electrocautery involves using a high-frequency electric current to dissect the tonsils. Coblation involves dissecting tissue using radio frequency energy and allows surgery to take place at lower temperatures with the view of causing less thermal damage to surrounding tissues.

"A harmonic scalpel is a special surgical instrument that uses ultrasound to make the blade of the scalpel vibrate, this allows the cutting edge to both dissect the tonsils and seal blood vessels at the same time

“As tonsillectomy is such a common procedure a few years ago a national audit of tonsillectomies was performed in England and Northern Ireland to consider the different rates of bleeding after surgery. This audit involved collecting data from over 40,000 patients in 277 hospitals. The audit was very useful demonstrating that despite recent innovations in technique, cold steel tonsillectomy was the technique with by far the lowest associated risk of post-operative bleeding.”

Are there any risks or complications with tonsillectomies?

“Even when a tonsillectomy is performed using the best techniques by the most experienced and diligent surgeon, bleeding after tonsillectomy may still occur. Unfortunately, the exact reasons why aren’t completely understood, but it is possibly due to the fact that people heal differently.”

What should I do if I suffer from tonsillitis?

“Tonsillitis is not usually a serious condition. If you suffer from recurrent tonsillitis, unable to eat or drink due to pain or have breathing difficulties you should visit your GP for assessment and advice. Your GP will discuss whether onward referral to an ENT Consultant is necessary.”

For further information on tonsillectomies or to make a private appointment with Mr John Phillips please contact one of the team on 01603 255 614.

All surgery carries an element of risk and the content of this page is provided for general information only.  It should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professional.

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