Many parents are sure that cutting out the tonsils is the last thing to do, because without them the child will catch colds even more often. Is this true or not?

We need tonsils in order to neutralize infection that enters the body with food, water or air. This is the first guard post immune system. But if the body is weakened, and a lot of bacteria have entered the mouth, the tonsils cannot cope with their work, become inflamed, reddened, swollen and a sore throat begins - acute tonsillitis, as doctors say.

A sore throat is always an indicator that the child’s immune system is weakened. Because everyone happens to drink cold water, but not everyone gets sick after that. Everyone freezes sometimes, and everyone has streptococci and staphylococci in their mouths, but not everyone gets a sore throat. And everyone’s palatine tonsils are dotted with lacunae, but not everyone develops in these lacunae purulent plugs. So treating a sore throat is not only about eliminating the local source of inflammation in the throat, it is primarily about strengthening the immune system.

But sometimes an acutely onset disease takes a sluggish, protracted course. The sore throat seems to have been cured, no high temperature And terrible pain there is no sore throat, but some time after the illness the child begins to “chop” again, and in the evenings the temperature rises to 37.1–37.3°. And this condition lasts for weeks, while white dots - plugs - appear in the tonsils. That is, that same chronic tonsillitis occurs, which, if left untreated, can lead to surgery on the tonsils.

Chronic tonsillitis must be treated as soon as possible, without relying on the fact that it does not interfere with life and will someday go away on its own. Start with “grandmother’s remedies.” They are effective, affordable, and children tolerate such treatment well.

* You should gargle three times a day after meals. Infusion of chamomile (1 tablespoon per glass of boiling water, leave, cool, filter through cheesecloth) or infusion of rose hips and rowan (brew 1 teaspoon of berries in a glass of boiling water, leave and filter). The little ones can rinse with regular warm tea. Tea also disinfects.

* Three times a day, half an hour before meals, give your child a dessert spoon of honey. You should not immediately drink honey with water; you should hold it in your mouth for 1–2 minutes, slowly dissolving it.

* If your child can suck on a slice of lemon without sugar, offer him this medicine. In the fall, a patient with chronic tonsillitis should eat a glass of berries every day - sea buckthorn, lingonberries, cranberries or currants. In winter, eat more oranges and tangerines, drink tea with lemon.

* Include aromatherapy. For example, you can pour boiling water over lemon in a child’s room, then he will breathe a healing aroma. Or you can pour boiling water over a clove of garlic and breathe in the smell through your mouth for three to five minutes. It is enough to carry out such wet inhalations with garlic once a day.

* If you are not allergic to the star, pick up the balm with a match and throw it into a teapot with hot water. Essential oils eucalyptus, mint, cloves, cinnamon, which are part of this balm, have antimicrobial, antiviral and anti-inflammatory effects, harmonize the functioning of the immune system. The steam should be inhaled through the mouth for one to three minutes. One such procedure per day is enough, and the entire course of treatment is five to seven procedures.

* Except local treatment, aimed at relieving inflammation in the pharynx, it is imperative to strengthen the child’s immunity. Strengthen his diet with vegetables and fruits; cauliflower and white cabbage, carrots, garlic, green and onion, berries, citrus fruits, apricots, apples... But carbohydrates - chocolate, candies, flour products, as well as milk and eggs, it is better to limit for now.

* Watch your sleep - your child should definitely get enough sleep!

* Walk more, do exercises together, and exercise.

But “grandmother’s remedies” are often not enough; in order to cope with chronic tonsillitis, you have to go to the clinic for procedures. For example, washing the lacunae of the tonsils is very effective. The doctor uses a special syringe under pressure to inject antiseptic substances into the lacunae-pits and wash out the purulent plugs. And after washing, lubricates the tonsils with a 2% solution of iodine or lapis.

Widely used physical methods treatment of chronic tonsillitis: microwave therapy, ultraviolet irradiation, ruby ​​laser, UHF electric field, ultrasound treatment with biological active substances... The attending physician will decide which outpatient treatment method is right for your child.

There is only one way out - a scalpel

And yet, despite the availability of conservative treatment methods, sometimes the doctor believes that the tonsils need to be removed. The fact is that an infection from the tonsils spreads through the bloodstream throughout the body. And the tonsils are connected to 97 organs, including such important ones as the heart, kidneys, liver... Chronic tonsillitis can cause diseases of cardio-vascular system, bronchopulmonary, urinary. The adverse effect of a chronic focus of infection in the tonsils on the blood coagulation system, endocrine and metabolic processes, on the functioning of the adrenal cortex, on the occurrence of allergic conditions - bronchial asthma, microbial eczema- and collagen diseases such as rheumatism, scleroderma, lupus erythematosus... Not to mention diseases of the middle ear - otitis media, which can cause hearing loss.

And although parents’ fears that the child will still catch colds often after removal of the tonsils are not without foundation, the doctor, having compared the “severity of the evils,” chooses the lesser.

Signs that may cause a doctor to consider surgery:

* frequent headache;

* pale skin;

* loss of appetite;

* rapid fatigue and decreased performance: the child avoids playing with peers, has become lethargic, capricious;

* cervical lymph nodes are constantly enlarged, pain is felt when palpating them;

* discomfort in the heart area, joint pain;

* putrid smell from mouth.

And again immunity

The postoperative period is no less responsible for parents than surgery for the doctor. It is very important to strictly follow all appointments.

* When the child returns from the hospital, you need to prepare clean bed linen, ventilate the room, dim the bright lights...

* To prevent swelling of the larynx, it is recommended to place an ice pack or cold water on the wound area, especially in cases where the parents took the child home after outpatient surgery - partial removal of the tonsils.

* In the morning and evening, the patient should measure the temperature and record the thermometer readings.

*Even if the child is not prescribed bed rest, he must be under adult supervision at all times. Take a closer look at his appearance and behavior in the first days after the operation: are there any complications from the effects of anesthesia...

* For two weeks after throat surgery, you should not drink or eat hot foods. Also limit those foods that require intense chewing, fried and spicy foods. Bleeding must not be allowed.

*Should also be avoided physical stress, exposure to the sun, do not allow the child to take hot baths - only a warm shower... And be sure to sleep during the day - sleep restores immunity, it is necessary to help the body cope with the stress received as a result of the operation.

The recovery period will take a month. When recovery from surgery is behind you, begin hardening. The child, of course, still has a barrier to infections in his mouth - the so-called Pirogov’s palatine ring, but if the tonsils didn’t save him, then this ring won’t save him either, since his immunity will be reduced. The easiest way to strengthen it is to sleep plenty, walk a lot, move a lot and toughen up.

Which children are predisposed to chronic tonsillitis:

*those who were deprived breastfeeding;

* survivors of rickets and tuberculosis intoxication;

* having carious teeth;

* sick exudative diathesis;

* having enlarged adenoids, deviated nasal septum, inflammation of the paranasal sinuses;

* those who have a hereditary predisposition to nasopharyngeal diseases;

* those who often suffer from acute respiratory infections, who have had tonsillitis, measles, and scarlet fever.

tonsils

vernacular

called tonsils, actively protect human body from infections. When a doctor recommends their removal, you need to think through everything carefully, weigh the pros and cons.

”, coming together with a specialist to a reasonable conclusion. After all, deletion palatine tonsils often results in a significant loss for the body. Left without tonsils as a kind of barrier, a person can quite

get sick often

bronchopulmonary diseases, easy to catch viruses.

However, a much greater danger than possible cold, comes from the enlarged and inflamed palatine tonsils themselves, which are the source of chronic streptococcal infection. Its exacerbation leads to sore throat: the appearance of sore throat and fever.

Frequent sore throats are fraught with complications on the kidneys and heart, they contribute to the development of glomerulonephritis and rheumatism. And this is already serious illnesses, with whom you should not joke. Therefore, sometimes it is better to remove the tonsils rather than take unnecessary risks, especially when we're talking about about children. Shown or not surgical intervention- the doctor will determine. His verdict will depend on general condition human body, frequency colds, the size of the tonsils.

The surgical intervention itself lasts approximately ten minutes, accompanied by painful sensations, therefore carried out under local or general anesthesia. 7-9 days after the operation, the person returns to his normal lifestyle.

It should be noted that enlarged tonsils remain a very delicate topic, in which much depends on the experience of the otolaryngologist. Reasoning rationally, we can say that if it is possible to do without surgical intervention, then it is better to do so, but if surgery is still necessary, this issue must be resolved without delay.

The majority of adults and children experience tonsillitis once every three to five years, but there is a category of patients who experience three or more relapses per year. In many cases, the question becomes relevant: how to remove tonsils and how harmless is such an operation?

Modern doctors have proven that tonsils are part of the human immune system; they form a protective lymphadenoid ring. Some viruses or bacteria coming from external environment, remains on the surface of the tonsils, the tissues of which produce the number of leukocytes necessary to fight infection.

Experienced otolaryngologists explain why tonsils should not be removed without sufficient reason, especially before adolescence. The organ is preserved as long as it is functional and does not have a toxic effect on other systems. A healthy tonsil is a powerful barrier that prevents infection from entering the body.

But in adults, the operation is not so significant for the immune system: after 14-16 years, the tonsils are not the only barrier to bacteria or viruses. The sublingual and pharyngeal auxiliary tonsils are formed and take on part of the protective functions. Therefore, those whose tonsil tissues are inflamed and do not perform their functions should get rid of the presence of purulent deposits in the body.

When is it necessary to remove tonsils and what are the contraindications?

According to ENT doctors, there are absolute indications for tonsil removal in adults and children. Experts have developed a list of factors that indicate the need for surgical intervention:

• Constant tonsillitis - 3-4 diseases per year. As a consequence, the formation of ulcers in the tissues and constant infection of the body.
• The tissues of the tonsils change, become loose, and the organ no longer performs a protective function.
• The tonsils grow and make breathing difficult.
• Traditional treatment with antiseptics and antibacterial agents does not bring the expected result.
• Complications: Possible failures heart rate, pathologies in kidney function - renal failure, rheumatoid manifestations in the joints.

Age of the patient who was offered surgery, varies significantly: it can be a child, a teenager or an adult patient. And all visitors to the ENT office suffering from sore throats should clarify: in what cases the tonsils must be removed.

There are two possible forms of surgical treatment:

• Tonsillotomy - the hypertrophied part of the tonsil is removed. This method will be rational for those who have contraindications to complete organ removal. It is impossible to remove the tonsils completely different forms atherosclerosis, insufficiency of the pancreatic insular system. In such cases, a partial solution to the problem will be life-saving.
• Tonsillectomy involves complete removal purulent and loose tonsil with capsule. In this case, the internal source of inflammation that produces bacteria is removed, and the load on the body is reduced.

There are a number of temporary contraindications in which surgery can be postponed:

• Acute period of acute respiratory viral infection or acute respiratory infection.
• Caries, periodontitis in the acute phase.
• During pregnancy and breastfeeding.
• Exacerbations chronic diseases rheumatoid nature, malfunctions of the cardiovascular system, tuberculosis. Surgery is extremely undesirable for those who suffer from diabetes mellitus and severe hypertension.

In the above cases, it makes sense to stop acute conditions, and postpone the operation for several weeks. For pregnant or nursing mothers, the need and urgency of intervention is determined by a medical commission.

Methods for removing tonsils: advantages and disadvantages

Until recently, there was only one way to perform the operation, but today there are several options for tonsillectomy. The doctor chooses the required technique, assessing the characteristics of the disease and the patient’s body reaction:

• The traditional technique using a surgical instrument is often in demand for the category of adult patients who do not have other chronic diseases. Its advantage is the complete excision of problematic tissues; most otolaryngologists have extensive experience in performing such mechanical operations.
• The main disadvantage of such removal is long-term rehabilitation, which is problematic for people with poor healing ability. Applicable local anesthesia- in adults this is lidocaine, and 30-40 minutes before surgery an intramuscular injection is indicated sedative. Cover the face with a sterile napkin, leaving it free oral cavity, and perform the necessary manipulations. Time spent - 30-35 minutes.
• Usage laser beam or freezing liquid nitrogen. Such techniques are especially popular in the presence of local necrotic processes. When excision of tissue with a laser, the operation takes a matter of minutes, and there is no significant swelling afterwards. But concomitant burns of the mucous membrane adjacent to the tonsils are possible. When using nitrogen, a tonsillotomy is more often performed: the treated part of the tonsil dies and can be cut out almost painlessly.
• An innovative method is the use of ultrasound. This is an excellent opportunity to quickly cut off the tonsils with the capsule using an ultrasonic scalpel with a temperature of about 80°. But such a solution is unacceptable for patients with poor blood clotting.
• A rarely used method, just entering the history of medicine, is collocation. The tonsils are removed with a targeted bipolar radiofrequency knife. The advantage is the versatility of the technique: in this way you can remove the entire tonsil or part of it. But these manipulations can only be performed under general anesthesia.

Each method will be optimal in separately considered cases. Before the operation, the patient undergoes a full examination, and the doctor will explain in detail how the tonsils are removed.

Preparation for surgery and rehabilitation period

Partial removal of the tonsils is typical for children and adolescents or in cases of severe localization of inflammation in adults. When it is necessary to remove the tonsils completely, the patient is prescribed comprehensive examination. Mandatory analysis- determination of the number of platelets responsible for blood clotting. After receiving positive results, the day of the operation is set.

• 6 hours in advance, you should go into fasting mode: you exclude the intake of foods and juices.
• You cannot drink water 4 hours before.
• You should not take sedatives or tranquilizers on your own.

In the normal course of an operation to remove tonsils using a laser or ultrasound, the patient is on outpatient treatment. In other cases, the patient is left in the hospital for several days, depending on the type of surgery and the course of the postoperative period.

In the early days rehabilitation period injections of analgesics and antibiotics are indicated. A whitish film that appears covers the wound surfaces; gargling is prohibited until the wounds heal.

After any type of operation, the patient must observe the following regime:

• Limit vocal activity.
• Protect yourself from inhaling frosty or hot air.
• It is advisable to consume only soft foods or pureed soups.
• Daily drinking regime-2 liters of warm liquid.
• Avoid hot baths, which increase the risk of bleeding.

Complete wound healing occurs within a month after surgery. After 14-20 days, scar tissue appears on the surgical wound, which is gradually covered with a healthy mucous membrane.

If you ignore the rules postoperative behavior, then complications are possible: resumption of bleeding during the first days of rehabilitation, prolonged pain.

The floor goes to our expert, the head of the acute care department. chronic pathology ear, nose and throat Research Clinical Institute of Pediatrics named after Academician Yu. E. Veltishchev Federal State Budgetary Educational Institution of Higher Education Russian National Research Medical University named after. N. I. Pirogov, candidate of medical sciences Alan Asmanov.

Wait or clean up?

My son often suffers from sore throat. The doctor advises to remove his tonsils. But I read that those who have had them removed then get colds even more often and more severely. What should I do?

Galina, Perm

—There are clear indications for surgical removal of palatine tonsils. According to today's European standards, this is episodes of tonsillitis (or acute tonsillitis) more than 5-7 times a year.

Previously, it was believed that this operation should not be performed before the age of 14-15, since the palatine tonsils are an important immune organ, a kind of gateway to airborne infection. In addition, thanks to modern antibacterial and other drugs that appeared later, which make it possible to stop the inflammatory process in a timely manner, the tonsils can be preserved.

However, in some cases even the most modern medications are powerless. Practice shows: when sore throats are aggressive, recurrent in nature, when the tonsils cannot cope with their protective role and themselves become a source of chronic infection, which can lead to severe complications(diseases of the heart, kidneys, joints), in this case conservative treatment will have no effect. And the doctor decides on the advisability of a tonsillectomy, which today is much younger. Thanks to new surgical methods, such operations are now performed even on children 2-3 years old, who then forever forget what a sore throat is.

Without pain and complications

They say that tonsil removal is a very dangerous and bloody operation. This is true?

Valentina, Voronezh region

—It depends on how the tonsils are removed. If done the old fashioned way, blindly with the help of sharp surgical instruments (which, unfortunately, is still practiced in a number of Russian clinics), this operation is indeed associated with significant blood loss, severe pain and a long recovery period.

However, in Lately Many leading Russian clinics (including ours) use a low-traumatic approach when removing palatine tonsils. This operation is performed under anesthesia, if necessary, under the control of modern optical equipment, using hemostatic drugs and coagulation equipment. In addition, before each such operation, children are mandatory undergo a thorough examination of all systems and organs, the blood coagulation system, which allows minimizing operational risks.

A real breakthrough in the removal of palatine tonsils was radiofrequency tonsillectomy, thanks to which surgical blood loss was reduced by up to 10 times. The operation in this case is performed using a radiofrequency coagulator, thanks to which it is possible not only to completely remove the tonsils, but also to simultaneously cauterize the wound surface, reducing bleeding to a minimum and accelerating tissue healing. In this case, the structures surrounding the tonsils remain completely intact.

As a result, if after a traditional tonsillectomy children can return to normal eating only on the 7-8th day, after radiofrequency tonsillectomy they can eat normally on the 2-3rd day and be discharged home.

In addition to tonsillectomy surgical hospitals A tonsillotomy is also performed, when the tonsils are only partially removed when they are enlarged and in the absence of any signs of inflammation.

For surgery - with ice cream?

Previously, after surgery to remove tonsils, children were given ice cream. Is this still practiced now?

Margarita, Moscow

— This tradition dates back to the times when ice cream was the only method of reducing postoperative bleeding (cold leads to vasoconstriction), tissue swelling and pain.

Today, when performing tonsillectomy using modern surgical methods, this measure plays rather the role of a pleasant bonus, which we allow our patients to do as well.

() is one of the most common pathologies in children. It is for this reason that surgery to remove the tonsils (tonsillectomy) is considered the most common surgical intervention in childhood.

Contrary to the prevailing stereotype, the causative agent of chronic tonsillitis is not only betahemolytic streptococcus, but also other bacterial pathogens (bacteroides, aureus, moraxella, etc.). In addition, the viral origin of tonsillitis also plays a significant role (, herpes simplex, respiratory syncytial).

Removal of tonsils with chronic tonsillitis required for the development of a toxic-allergic form. The most important difference between this form of the disease and the simple one is the appearance of signs of intoxication and a pathological immune response of the body.

Preoperative period, indications and contraindications

Indications for surgical intervention:

Surgical treatment has the following goals: eliminate symptoms, as well as avoid the development (or progression) of infectious and toxic complications.

Contraindications to surgical method treatment:

Temporary contraindications include:

• Acute period of infectious diseases.
• For females, it is the period of menstruation.
• Third trimester of pregnancy (after 26 weeks). All surgical interventions in the nasopharyngeal area are contraindicated in women in the last months of pregnancy, since the risk of premature birth cannot be excluded.

How to prepare for surgery?

Before the operation, you must undergo tests and undergo preparation:

1. Blood examination for HIV, hepatitis B, C, syphilis - RW.
2. Mandatory fluorography.
3. General blood analysis.
4. Study of blood biochemical parameters (glucose, total bilirubin, its fractions, urea, creatinine).
5. Coagulogram (determination of prothrombin index, APTT, APTT, INR, fibrinogen).
6. Determination of blood clotting according to Sukharev.
7. An examination by a therapist is necessary to identify possible somatic pathologies or contraindications to surgery.
8. Registration and interpretation of ECG.
9. Tank. culture from tonsils to determine microflora.
10. Considering the possible risk of bleeding, 3-5 days before surgery it is necessary to take drugs that reduce tissue bleeding: Vikasol, Ascorutin.
11. The night before surgery, sedatives must be prescribed.
12. On the day of surgery, you should not eat or drink.

When a corresponding somatic pathology is identified, compensation for certain conditions is necessary. For example, if grade 2-3 hypertension is detected, it is necessary to achieve the target numbers blood pressure. In the presence of diabetes mellitus it is necessary to achieve normoglycemia numbers.

At what age is it best to have surgery?

Indications for surgery can be in patients of any age group. However, children under 3 years of age are at high risk of developing postoperative complications. It is for this reason that surgery must be performed in children over 3 years of age.

How to perform the operation: outpatient with hospitalization?

Tonsillectomy is not a simple operation. Despite the fact that most of these surgical interventions are performed on an outpatient basis, the risk of complications is present, and the patient is still required to be closely monitored. postoperative period. For this reason, it is recommended that tonsil removal be performed in a hospital setting, with appropriate preoperative examination and postoperative monitoring.

Anesthesia for tonsillectomy

Local anesthesia

Local anesthesia is used in most cases. First, the mucous membrane is irrigated with a 10% lidocaine solution or a 1% dicaine solution.

It is imperative to apply an anesthetic to the root of the tongue to eliminate vomiting reflex during the operation. Then it is necessary to carry out infiltration anesthesia with the introduction of an anesthetic into the submucosal space. The most commonly used solution is 1% novocaine, 2% lidocaine solution. Sometimes used together with anesthetic 0.1% solution of adrenaline in order to narrow blood vessels and reduce blood loss. However, the administration of adrenaline is not always justified due to its manifestation general effects on the body (increased heart rate, increased blood pressure).

For proper pain relief, certain injection sites are used:

• The point where the anterior and posterior palatine arches meet.
• In the middle section of the tonsil.
• At the base of the anterior palatine arch.
• Into the back arm fabric.

When conducting infiltration anesthesia the following rules must be followed:

1. The needle should be immersed 1 cm deep into the tissue.
2. It is necessary to inject 2-3 ml into each injection site.
3. Start the operation no earlier than 5 minutes after anesthesia.

General anesthesia

The use of local anesthesia can be very difficult in children, since its implementation requires a full understanding of the importance of the process by the patient himself. A good alternative in such cases is surgery under general anesthesia. Before the operation, the patient is given premedication drugs (sedatives). Next, the patient is injected intravenously with drugs that make it possible to turn off the patient’s consciousness. At this time, the anesthesiologist performs tracheal intubation and connects the patient to the machine artificial respiration. After these manipulations, surgery begins.

Progress of the operation

• When using local anesthesia, the patient is in a sitting position; when performing the operation under general anesthesia, the patient lies on the table with his head tilted back.
• An incision is made only in the mucous membrane in the area of ​​the upper third of the palatine arch. It is important to control the depth of the incision; it should not be superficial and not extend beyond the mucous membrane.
• Through the incision, it is necessary to insert a narrow rasp between the tonsil and the palatine arch directly behind the tonsil capsule.
• Then it is necessary to dissect (separate) the upper pole of the tonsil.
• The next step is to fix the free edge of the tonsil with a clamp.

• To further separate the middle section of the tonsil, you need to slightly (without force) tighten the free edge of the tonsil, fixed with a clamp, to ensure convenient access and the necessary visualization.
• The tonsil is cut off from the palatoglossus and velopharyngeal arches.
• Separation of the middle part of the tonsil. It is important to remember that when separating the tonsil from the underlying tissue, it is necessary to constantly intercept the free tonsil tissue with a clamp closer to the cutting edge. This is necessary according to easy reason tissue vulnerability, and high probability her breakup. In order to maximize the separation of the tonsil along with the capsule, you need to fix the tissue in a clamp.
• When separating the lower pole of the tonsil, it is important to remember that this part of the tonsil does not have a capsule and is cut off using a loop. To do this, it is necessary to retract the tonsil tissue as much as possible by passing it through the loop. Thus, the tonsils are cut off as a single block, together with the capsule.
• The next stage of the operation is to examine the bed at the site of the removed tonsils. It is necessary to determine whether there are any remaining areas of the tonsils. It is very important to remove all the tissue to avoid relapse of the disease. You also need to determine if there are any bleeding, gaping vessels. If necessary, it is important to perform thorough hemostasis (stop bleeding).
• Completion of the operation is possible only when bleeding has completely stopped.

Postoperative period

Postoperative management and necessary recommendations:

1. The patient is transferred to the ward after surgery on a gurney (sitting - with local anesthesia).
2. The patient must be placed on the right side.
3. An ice pack is placed on the patient’s neck every 2 hours for 5-6 minutes (2-3 minutes on the right and left surface of the neck).
4. The first day it is forbidden to swallow saliva. The patient is advised to keep his mouth slightly open so that saliva can flow onto the diaper on its own. Do not spit or cough up saliva.
5. For severe pain, you can use narcotic analgesics on the day of surgery. In the following days, it is recommended to use non-steroidal anti-inflammatory drugs.
6. You can't talk for the first day.
7. Diet: eating liquid food in the first few days with a gradual transition to soft food (in the form of purees).
8. Due to the risk of bleeding, patients are prescribed drugs that increase blood clotting. The drugs “Tranexam” and “Etamzilat” in injection form are effective.
9. For prevention infectious complications appointment required antibacterial drugs wide range actions: “Amoxiclav”, “Flemoclav solutab”, “Cefotaxime”, “Ceftriaxone”, etc.
10. It is forbidden to gargle for 2-3 days after surgery, as this can cause bleeding.
11. Release from work for 2 weeks.

Possible complications of the operation

Bleeding is one of the most common and dangerous complications tonsillectomy. The pharyngeal tonsils are well supplied with blood from the branches of the external carotid artery. It is for this reason that very heavy bleeding is possible during surgery and in the postoperative period. The most dangerous period is considered to be 7-10 days after surgery. The cause of this complication is the peeling of crusts from the tonsil fossa (at the site of the removed tonsil).

photo on the left - before surgery, photo on the right - after tonsillectomy

As a rule, bleeding is characteristic of the branches of the superior descending palatine artery passing through the top corner anterior and posterior palatine arches. Also often, bleeding opens in the lower corner of the tonsil fossa, where the branches of the lingual artery pass.

• With slight bleeding from small vessels It is necessary to thoroughly dry the field and inject the wound with an anesthetic solution. Sometimes this is enough.
• For more severe bleeding, it is important to identify the source. A clamp must be applied to the bleeding vessel and sutured.
• In case of massive bleeding, it is necessary to insert a large gauze swab into the oral cavity and press it tightly to the site of the removed tonsil. Then take it away for a few seconds to see the source of the bleeding, and quickly bandage the vessel.
• In severe cases, if it is impossible to stop the bleeding, the external carotid artery must be ligated.

It is very important to administer drugs that promote blood clotting. These drugs include: “Tranexamic acid”, “Dicinone”, “Aminocaproic acid”, 10% calcium chloride solution, fresh frozen plasma. These drugs must be administered intravenously.

Relapse of the disease. In rare cases, tonsil tissue may grow. This situation is possible if small tissue was left behind when removing the tonsils. With severe hypertrophy of the remaining tissue, a relapse of the disease is possible.

Expressed pain syndrome most often characteristic of adult patients, since the pain is already emotionally charged. For pain relief, you can use drugs from the group of non-steroidal anti-inflammatory drugs in injection form (“Ketorol”, “Ketoprofen”, “Dolak”, “Flamax”, etc.). However, these drugs have many contraindications (erosive and ulcerative processes gastrointestinal tract, blood diseases, kidney and liver failure).

Loss of body weight. Given the pain, which intensifies during the act of swallowing, the patient often refuses to eat. For this reason, weight loss is possible. In the postoperative period, on the first day, patients are allowed only liquid food.

Velopharyngeal insufficiency. After surgery, velum closure may be impaired. This complication manifested by the appearance of a nasal voice in the patient, appearance during sleep, disruption of the processes of speech and swallowing food. The incidence of velopharyngeal insufficiency according to various authors ranges from 1:1500 to 1:10000. More often, this complication appears in patients with a hidden cleft of the hard palate that was not diagnosed before surgery. To exclude such a condition, it is necessary to carefully examine the patient. One of the signs of the presence of a submucosal cleft of the hard palate is the splitting of the uvula.

Alternatives to Traditional Tonsillectomy

Cryosurgery

There is also a method of cryosurgical treatment of chronic tonsillitis. The essence of this technique is the local effect on the pharyngeal tonsils with nitrogen in the temperature range from (-185) to (-195) C. Such low temperatures lead to tissue necrosis of the affected tonsils. Immediately after exposure to the cryoapplicator, you can see that the tonsil tissue becomes pale, flat and hardens. 1 day after the operation, the tonsils acquire a bluish tint, and the line of necrosis is well contoured. Over the next few days, the tissue is gradually sloughed off, which may be accompanied by slight bleeding, which usually does not require intervention. This method can be used in patients with increased risk bleeding (with certain diseases blood), with severe heart failure, endocrine pathology.

When exposed to cold temperatures in the tonsil area, 4 levels of tissue damage are possible:

• Level 1 – superficial damage.
• Level 2 – destruction of 50% of the tonsil tissue.
• Level 3 – necrosis of 70% of tissues.
• Level 4 – complete destruction tonsils.

However, you need to know that the cryosurgical method is used in the form of courses of procedures up to 1.5 months. Also, a significant disadvantage of this procedure is the possible relapse of the disease (if the tonsil tissue was not completely necrotic low temperatures). Generally, this method is used only in cases where surgical intervention is impossible due to certain contraindications.

Removing tonsils using laser

The use of laser energy has been successfully used in tonsillectomy. The contraindications for this procedure are the same as for the classical surgical method.

Operation stages:

1. Local anesthesia with an anesthetic solution.
2. Fixation of the tonsil with a clamp.
3. Direction of the laser beam to the area where the tonsil connects with the underlying tissues.
4. Laser tonsil removal.

Stages of tonsillectomy using laser

The advantages of this technique are:

• Simultaneous separation of the tonsil from the underlying tissues and coagulation of blood vessels. All vessels falling into the area of ​​influence of the laser beam are “soldered together”. For this reason, this operation significantly reduces the risk of bleeding.
• Faster recovery (compared to classical surgery).
• The risk of tissue infection is reduced (due to the instant formation of a scab in the area of ​​the removed tissue).
• Reduced operation time.

Disadvantages of the procedure:

1. Possible relapse (with incomplete tissue removal).
2. More expensive procedure.
3. Burn of nearby tissues (these consequences of the operation are possible when the laser beam hits tissues adjacent to the tonsil).

Alternative Methods

Less commonly used methods:

conclusions

Removal of tonsils for chronic tonsillitis is carried out if there are strict indications. This operation is not simple, and has a number of possible contraindications and complications. However, the development of surgical technologies has led to the emergence of alternative methods for performing tonsillectomy. In addition to classical surgical techniques, it has become possible to remove tonsils using cryosurgery, a laser scalpel, cold plasma energy, radioknife, etc. These techniques are successfully used when classical surgery is contraindicated (in case of serious disorders of the blood coagulation system, complications somatic diseases). It is important to know that only a qualified specialist can determine whether or not to remove the tonsils, as well as choose the necessary surgical tactics.

Video: tonsillectomy - medical animation

Tonsils and adenoids

Those who are no longer able to fight the chronic form of tonsillitis make a confident decision - to undergo surgery. Tonsil removal in adults occurs a little differently than in infants. It is necessary to weigh the pros and cons. Repeatedly go through various laboratory research. Check for the presence or absence of contraindications. As practice shows, surgical intervention is used only when it is impossible to fully restore the immune process. Let's look at how the process works and what its consequences are below.

Indications for tonsillectomy

• An aggravated form of chronic streptococcal tonsillitis. The presence of the latter in the blood will only indicate the result general analysis blood. Exceeding the permissible levels of antistreptolysin indicates a positive result. Comprehensive use of a group of antibiotics may not always give the expected positive effect. In such cases, there is only one solution - surgery;
• for a long time, the volume of the tonsils is increased, which leads to complete or partial overlap respiratory tract, causing pain when swallowing food, especially solid foods. During sleep, breathing is held for a short time;
• intoxication of the body as a whole and, as a consequence, affected soft fabrics heart, kidney. To confirm or refute, it is necessary to pass a comprehensive test for rheumatic tests, C-reactive protein;
• peritonsillar exacerbation: this is when inflammatory processes spread to neighboring organs and affects soft tissues. The expansion can be muted by a group medications, but, as a last resort, they involve an operation;
• complete ineffectiveness medicinal methods treatment.

Preparatory stage

Removal of palatine tonsils in adults is performed in a hospital setting. Tests are taken:

• blood, urine;
• platelet count;
• coagulation index.

In addition, preoperative reports from primary doctors are required; the list is attached in addition to outpatient card. If any pathologies or changes are detected, it is required operational diagnostics and consultation. If a patient has poor blood clotting, he is prescribed a set of medications within a few weeks to increase the rate. At least a month before the date of intervention, be sure to stop using aspirin.

The operation itself

The time and place are determined by the specialized doctor. entirely. Although, there are frequent cases when one tonsil is cut out. This is typical for severe tissue hypertrophy.

As with infants, the operation is performed under local anesthesia. Forty minutes later, an injection is administered intramuscularly. The patient sits comfortably in a chair. The tonsils are cut out through the mouth. Myths about incisions in the neck and chin are not true.

Methods of performing the operation

The patient can be discharged home on days 3–9, depending on the type of surgery and the recovery process. The pain in the throat area persists for half a month, this is normal. Afterwards everything calms down. In order to reduce pain, it is possible to administer painkillers. Apply several warm compresses.

Home care

As the surgical consequences heal, a yellowish coating forms on the surface. Until the plaque disappears, it is strictly forbidden to rinse the mouth. During the month after the intervention, it is not advisable to talk a lot, give the body strong physical exercise, eat solid food. You can forget about saunas and solariums for a while. Rinse your mouth extremely carefully. Do not take ibuprofen. Taste buds will be somewhat upset, after a month they will resume their activities. In some cases, there is a decrease in appetite and intolerance to certain foods; this is also temporary.

Possible complications:

• open up profuse bleeding in the first two weeks. If bleeding begins, lie on your side, apply ice to your neck, call an ambulance;
• change in a person's voice;
• when an infection occurs on open wound, the development of aggravating forms is possible.

Against the background of the described possible negative manifestations, many patients refuse to undergo the procedure.

Contraindications

• Dysfunction of the cardiovascular system, which is accompanied by frequent bleeding;
• severe diabetes mellitus;
• tuberculosis of all forms;
• hypertension.

In such cases, lacunotomy is prescribed as an analogue laser surgery. An incision is made in the tonsil with a laser and a purulent formation flows out through it. The method is not very effective due to the fact that the hole often becomes clogged and has to be repeated again and again. Many people do not like such interference. Official data states that removal of tonsils in adults occurs 45% less than in adolescence. Basically, patients are limited to drug treatment.

Time limit for holding:

Amazing fact. After the operation, the activity of the tongue and sublingual tonsil are activated, which take on the function of guarding the “gate” and minimize the entry of microbes into the body.

Regarding the removal of tonsils, there are both supporters and opponents. Of course, the tonsils, like any other organ, perform their functions, but if they are affected by infection and are a focus inflammatory process, it is better to remove them. Often chronic form is a neglected process and removal becomes the only way to get rid of a constant infection in the mouth, which not only brings discomfort with unpleasant symptoms, but also causes intoxication of the entire body.

Refusal of surgery can lead to serious consequences serious consequences rather than carrying it out. Affected tissues have an even worse negative effect. So, you need to weigh everything several times before giving a final answer. What to do and how to decide is up to you to decide. But saving on your own health is not acceptable. Be reasonable. Take care of your body from an early age.