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Sleep apnea and difficulty breathing, which are caused by enlarged tonsils or adenoids, are the most common signs that your child may need a tonsillectomy. We talked to Shai Shinhar, M.D., a pediatric ear, nose, and throat specialist at the New York Eye and Ear Infirmary in Manhattan, about the commons signs that someone should have a tonsillectomy, at what age tonsillectomies are usually performed, and the painless tonsillectomy, a procedure he developed.
A tonsillectomy is a surgical procedure to remove the tonsils from the mouth. It’s a very old procedure that has been around since the ancient Greeks, and it is still one of the most common procedures done in the world. In this country alone, there are approximately 600,000 surgeries a year that are done mainly to cure obstructive sleep apnea and breathing problems in children. Since it’s such a common procedure, there are a lot of different instrumentations and techniques that were developed over time to perform tonsillectomies.
There are definitely other indications such as recurring throat infections, but the main indication today for this type of surgery is sleep apnea or breathing issues particularly at night when children have loud snoring, gasping at night, and reduced sleep quality—they’re moving a lot and always breathing with their mouth open while sleeping which causes them to always appear tired. These are the common symptoms of sleep apnea in children and in the vast majority of cases this is caused by enlarged tonsils and in some cases the adenoids, which are a tissue that is located behind the back of the nose.
The age range in which most of these procedures are done is between 2-6 years old since this is the age range in which the manifestation of these problems is most prevalent. We do perform tonsillectomies on adults but that is a little less common since breathing issues or sleep apnea in adults are not usually caused by enlarged tonsils or adenoids, but are mostly related to obesity. But that’s not the case with children. In children the vast majority of tonsillectomies are done because of the adenoid and tonsil enlargement.
There are different machines and instruments used but almost all of the techniques work on the idea that there is some sort of hand piece that produces heat. That heat dissects the tonsils from the tissue in the mouth. The benefit of using these machines is they allow surgeons to remove the tonsil while at the same time avoid bleeding in the mouth, and the procedure becomes very quick and easy for the surgeon. The downside of using all these machines is that the heat that you’re using to dissect the tonsils also produces thermal injury—heat injury—to the surrounding tissues of the mouth, and that is the main reason for very excruciating pain after tonsillectomy. There are a lot of symptoms that are associated with a burn such as developing some sort of scar at the back of the mouth as part of the healing, bad breath, and children don’t want to eat or drink.
I use cold instruments—special knives—to remove the tonsils. There’s no heat involved. Then I use a special chemical that we developed that I paste on the area where the tonsils used to be to stop the bleeding. That procedure is as quick as the others, but unlike the others, I use no heat. So the pain after the procedure is significantly less, and the recovery is very quick. There’s no foul breath, there’s no scabs that form in the mouth, and the child can resume eating very quickly, most of the children by the next day. They feel much better. So the big difference is that I don’t create any thermal injury in the mouth and that creates an almost painless procedure with a much speedier recovery.
The recovery time for a painless tonsillectomy is two to three days. It’s usually about 10 days to two weeks for a regular tonsillectomy.
I’ve been doing this for about 10 years on thousands of patients, and I haven’t seen any adverse side effects. The only thing I can say is the procedure appears to be also safer than a regular tonsillectomy from the standpoint of the most feared complication is bleeding after having the surgery. You can have bleeding from the mouth, and in our studies, we found out that most of the bleeding—and particularly the fatal cases because there are still fatalities after tonsillectomies although not common—happens at home after the surgery. In all of these cases, the tonsils were removed by using some sort of heat energy. In all the years that I’ve been doing the painless tonsillectomy, we’ve never had even one case of post-operative bleeding because there is no thermal injury, scabs, or burning the mouth, and that decreases the chance of post-operative complications.
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