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This letter originally appeared in Dr. Hoffman's column on allHealth.com. |
Q: I am XX years old and I suffer from chronic acute tonsilitis. I am being referred to a specialist to have my tonsils removed. I am wondering what I can expect the recovery time to be, the amount of time I should take off work and when I will be able to go back to day-to-day activities. Also will I have swelling, bruising, etc.?
A: I am not sure what you mean by "chronic acute tonsillitis." You may have "recurrent acute tonsillitis," in which you have frequent bouts of tonsillitis, but are well between bouts. Or, you may have "chronic tonsillitis," in which your tonsils are always painful. Some unfortunate folks actually have both problems; their tonsils are always bothersome, but are at times acutely worse. The treatment options for these problems are essentially the same:
– Do nothing. Just live with it.
– Treat each acute exacerbation with a short course of antibiotics (7 to 10 days.)
– Try to "clear it up" with a longer course of antibiotics (20 to 30 days.)
– Try to prevent exacerbations by taking a low dose of antibiotics on a daily basis (this is known as "prophylaxis.")
– Tonsillectomy.
Tonsillectomy tends to be a very painful operation in adults; children fare much better. In my experience, children will usually "bounce back" in 4 or 5 days (sometimes sooner), teenagers in 7 to 10 days, and adults in 10 to 20 days. Some adults continue to have significant throat pain (such that they limit their diet) for a month or more. Some fortunate adults behave more like children, however. It is not clear why this age variation exists; it may be due to a change in innervation of the throat as we age.
The main risks of tonsillectomy are bleeding, pain, and dehydration. Dehydration is due to poor oral intake, which in turn is due to pain. It is, of course, preventable. In fact, dehydration INCREASES pain, and so it is possible to fall into a vicious circle of pain, poor oral intake, dehydration, MORE pain, POORER oral intake, MORE dehydration, and so forth. Bleeding seems to be more common in dehydrated patients, in my experience.
Bleeding deserves special mention. Bleeding can certainly occur during the operation, but this is usually not too worrisome; the surgeon takes care of it immediately. Bleeding can also occur as you are waking up from the anesthetic. This is unfortunate when it occurs, but it is usually only an inconvenience; you will be placed under a second general anesthetic, and your surgeon will promptly control the bleeding.
No, the really nasty bleeding is that which most commonly occurs 7 to 11 days AFTER surgery. We think this is the time when the "scab" first begins to slough. Approximately 1 in 20 patients will experience a significant degree of bleeding at this time. (By the way, "7 to 11 days" is only the most common interval; I have heard of folks who bled 20 to 30 days after surgery! This, fortunately, is very rare.) What is "a significant degree of bleeding"? Enough that you will feel compelled to call your doctor, or come in to the emergency room.
Late bleeding is worrisome. If it does not stop spontaneously, or if it is not easily treated in the emergency room, you will have to undergo another general anesthetic so that your surgeon may stop the bleeding. In contrast to the tonsillectomy, this time you will probably NOT have an empty stomach. At the very least, you will probably have swallowed some blood. This is hazardous, since you could vomit and aspirate (choke on) this blood while you are being placed under anesthesia. Anesthesiologists have ways of coping with this situation, but I have never met one who did not dread these cases to some degree.
This is just a brief discussion of the surgical risks; I recommend that you discuss this thoroughly with your surgeon.
How long should you take off work? If you have a desk job, you may be ready to go back after a week to 10 days. If physical exertion is part of your work, I would be much more cautious than this. This also applies to resumption of daily activities. Anything that might tend to increase your blood pressure (exercise, strenuous chores, sex, and so forth) could cause a hemorrhage. Once again, discuss these issues in detail with your surgeon.
You will have some swelling within your mouth. The tongue and uvula occasionally swell following a tonsillectomy. Bruising is very uncommon. (If you bruise or bleed easily, you must share this with your doctor! Also, if you are taking aspirin or nonsteroidal antiinflammatory drugs (such as ibuprofen), you must tell your doctor. Give your doctor a very complete list of all of your medications, including vitamins and herbal remedies. You would be surprised how many different things can decrease one’s ability to clot.)
These are my opinions regarding the risks of tonsillectomy and what to expect after tonsillectomy. It is essential that you have this discussion with your surgeon. Only then can you weigh the discomfort of having to live with your bothersome tonsils against the risks and discomfort of tonsillectomy, and then decide whether to proceed with surgery or investigate nonsurgical options.
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More information available on other diseases of the ears, nose and throat! |
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