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Throat

What are tonsils and adenoids?

Tonsils are small glands in the throat, one on each side. They are there to fight germs when you are a young child. After the age of about 3 years, the tonsils become less important in fighting germs and usually shrink. They are lymph-like soft tissue located on both sides of the back of the throat. Along with adenoids (soft tissue behind the nose), tonsils help your body fight infection by producing antibodies to combat bacteria that enter through the mouth and nose.

Approximately 600,000 people have their tonsils removed each year.

Does my child / Do I need them?

Your body can still fight germs without them. We only take them out if they are doing more harm than good.

Why take them out?

We will only take your child’s tonsils out if he or she is getting lots of sore throats, which are making him or her lose time from school. Sometimes small children have tonsils so big that they block their breathing at night.

Before your child’s operation

Arrange for a week off school. Let us know if your child has a sore throat or cold in the week before the operation - it will then be safer to put it off for a week. It is very important to tell us if your child has any unusual bleeding or bruising problems, or if this type of problem might run in your family.

How is the operation done?

Your child will be asleep. We will take his or her tonsils out through the mouth, and then stop the bleeding. This takes about 20 minutes. Your child will then go to a recovery area to be watched carefully as he or she wakes up from the anesthetic. He or she will be away from the ward for about an hour in total.

What is coblation tonsillectomy?

Unlike traditional tonsillectomy procedures, which remove tonsils by burning or cutting, Coblation is an advanced technology that combines gentle radiofrequency energy with natural saline — to quickly, and safely remove tonsils. Because traditional procedures use high levels of heat to remove the tonsils, damage to surrounding healthy tissue is common.

Coblation does not remove the tonsils by heating or burning, leaving the healthy tissue surrounding the tonsils intact. The innovative approach of Coblation results in minimal pain and rapid recovery for patients. Coblation has been used in nearly three million procedures by surgeons in ear, nose, and throat (ENT) and other areas of medical specialty.

How chronic tonsil problems are usually treated?

Depending on symptoms, and the frequency of infection, tonsils are typically treated with antibiotics or removed surgically in a procedure called a tonsillectomy.

How chronic tonsil problems are usually treated?

Depending on symptoms, and the frequency of infection, tonsils are typically treated with antibiotics or removed surgically in a procedure called a tonsillectomy.

How is coblation tonsillectomy performed?

Coblation uses radiofrequency energy and natural saline, not heat, to gently dissolve tonsil tissue and remove the infected or enlarged tonsils. Coblation Tonsillectomy is a quick outpatient procedure that takes less than 30 minutes, and is performed in an operating room with general anesthesia. Most patients stay in the hospital only a few hours.

A coblator machine and wand

Why is coblation tonsillectomy a better choice?

Patients report a better overall experience with Coblation Tonsillectomy after surgery when compared to traditional procedures. Studies show that patient calls and visits to the doctor due to complications after surgery are significantly less with Coblation Tonsillectomy.

Because of tissue damage caused by the heat of traditional tonsillectomy procedures, patients often take up to two weeks to return to a normal diet and to resume normal activity. Coblation Tonsillectomy is the gentle alternative offering a rapid recovery and minimal pain, with most patients resuming a normal diet and activities within just a few days.

Am I a Candidate for Coblation Tonsillectomy?

If your doctor recommends your tonsils and/or adenoids be removed, you are a candidate

Why have your tonsils removed?

Tonsils and adenoids can cause health problems when they become infected or obstruct normal breathing or nasal/sinus drainage. Recurring infections in the tonsils can lead to chronic tonsillitis. Symptoms include fever, persistent sore throat, redness of the tonsil area, yellow discharge on the tonsils, and tender lymph nodes on both sides of the neck.

It is common for patients who have undergone Coblation Tonsillectomy to feel better than expected following their surgery, with most patients resuming a normal diet and activities within just a few days.

In addition to blocking the throat, enlarged tonsils may interfere with normal breathing, nasal sinus drainage, sleeping, swallowing and speaking. They may also aggravate snoring and can even cause an alarming condition called sleep apnea which involves an occasional stoppage of breathing.

After the procedure

Your doctor or nurse will provide postoperative instructions, which may include antibiotics and other medicines for up to 1 week. Some minor pain medication may also be prescribed.

How long will my child be in hospital?

In our hospitals, tonsil surgery is done as a day case, so that he or she can go home on the same day as the operation. Rarely, we may keep children in hospital for one night. It may depend on whether your child has their operation in the morning or the afternoon. Either way, we will only let him or her goes home when he or she is eating and drinking and feels well enough.

Can there be problems?

Tonsil surgery is very safe, but every operation has a small risk.

The most serious problem is bleeding. This may need a second operation to stop it. but only 1 child out of every 100 will need a second operation.

Your child’s throat will be sore

Your child’s throat will get better day-by-day. Give him or her painkillers regularly, half an hour before meals for the first few days. Do not give more than it says on the label. Do not give your child aspirin - it could make your child bleed.

Eat normal food

Eating food will help your child’s throat to heal. It will help the pain too. Always give him or her a drink with every meal. Chewing gum may also help the pain.

Your child may have sore ears

This is normal. It happens because your throat and ears have the same nerves. It does not usually mean that your child has an ear infection. The removal of enlarged tonsils like this can relieve airway obstruction.

Your child’s throat will look white

This is normal while your throat heals.

This is normal while your throat heals. You may also see small threads in your child’s throat – sometimes these are used to help stop the bleeding during the operation, and they will fall out by themselves.

Some children get a throat infection after surgery, usually if they have not been eating properly. If this happens you may notice a fever and a bad smell from your child’s throat. Call your hospital doctor for advice if this happens.

Keep your child off school for 7 days

Make sure he or she rests at home away from crowds and smoky places. Keep him or her away from people with coughs and colds. Your child may also feel tired for the first few days.

Bleeding can be serious

If you notice any bleeding from your child’s throat, you must see a doctor. Go to our hospital casualty department which is 24 hrs.

What are the adenoids?

Adenoids are small glands in the throat, at the back of the nose. In younger children they are there to fight germs. We believe that after the age of about 3 years, the adenoids are no longer needed.

Do we need our adenoids?

Your body can still fight germs without your adenoids. They probably only act to help fight infection during the first three years of life; after then, we only take them out if they are doing more harm than good.

Why do adenoids cause problems?

Sometimes children have adenoids so big that they have a blocked nose, so that they have to breathe through their mouths.

They snore at night.

Some children even stop breathing for a few seconds while they are asleep. The adenoids can also cause ear problems by preventing the tube which joins your nose to your ear, from working properly.

Some benefits of removing adenoids
For children with glue ear

For children over three years of age, removing the adenoid at the same time as putting grommets in the ears seems to help stop the glue ear coming back.

Reduces colds

Removing the adenoid may reduce the problem of a blocked nose when your child has a cold

Is there an age limit for adenoidectomy?

Adenoidectomy is generally avoided in children under 12 kgs, approximately 2 and a half years of age, because of the small risk of blood loss during or after the operation. There is no upper age limit, but the adenoid has usually shrunk to almost nothing by the teens.

How are the adenoids removed in the 21st century?

The traditional technique is to use a curette, which is a special type of surgical cutting device. This is a safe technique, although a consideration for small children having the operation is that the blood loss may be higher at the time of surgery.

Other techniques are becoming more popular.

Electric diathermy and Coblation dissection have the advantage of less blood loss at the time of surgery. At our hospital, we are using coblation and microdebrider.

The laser has fallen out of favor because of the much higher levels of pain after the operation.

Is it true that the adenoid may grow back?

This is possible but uncommon.

Who is suitable for day case surgery and who would require inpatient stay?

Generally, children who are fit and well with no bleeding or bruising disorders are fit for day surgery.

What is the recovery time after surgery?

It is wise to allow a one week convalescence period.

Is there any long-term risk to having your adenoids removed (e.g. reduced immune function)?

There is no good evidence that adenoidectomy reduces immune function or makes people more prone to chest infections. If possible, it is probably wise to avoid adenoidectomy in children less than 2 and a half years of age as the adenoids may be helping develop their ability to fight off infections.

What makes you decide to remove the tonsils at the same time?

If your child gets lots of tonsillitis (sore throats) or has difficulty breathing at night then we may decide to take out the tonsils at the same time as the adenoids.

Preparing for your child’s operation or things to do before your child’s operation

Arrange for a week at home or off school after the operation.

Things we need to know before the operation

Let us know if your child has a sore throat or cold in the week before the operation - it will be safer to put it off for a week. It is very important to tell us if your child has any unusual bleeding or bruising problems, or if this type of problem might run in your family.

How is the operation done?

Your child will be asleep.

We will take his or her adenoids out through the mouth, and then stop the bleeding. This takes about 20 minutes.

Your child will then go to a recovery area to be watched carefully as he or she wakes up from the anesthetic.

He or she will be away from the ward for about an hour or two in total.

How long will my child be in hospital?

In our hospitals, adenoid surgery is done as a day case, so that he or she can go home on the same day as the operation. Some surgeons may prefer to keep children in hospital for one night. Either way, we will only let him or her go home when he or she is eating and drinking and feels well enough.

Most children need no more than a week off nursery or school. They should rest at home away from crowds and smoky places. Stay away from people with coughs and colds.

Can there be problems?

Adenoid surgery is very safe, but every operation has small risks.

The most serious problem is bleeding, which may need a second operation to stop it. However, bleeding after adenoidectomy is very uncommon. It is very important to let us know well before the operation if anyone in the family has a bleeding problem.

During the operation, there is a very small chance that we may chip or knock out a tooth, especially if it is loose, capped or crowned. Please let us know if your child has any teeth like this.

After the operation

Some children feel sick after the operation. This settles quickly.

A small number of children find that their voice sounds different after the surgery. It may sound like they are talking through their nose a little. This usually settles by itself within a few weeks. If not, speech therapy is helpful.

Your child’s nose may seem blocked up after the surgery, but it will clear by itself in a week or so.

Your child’s throat may be a little sore

Give painkillers as needed for the first few days.

Prepare normal food. Eating food will help your child’s throat to heal.

Your child may have sore ears

This is normal. It happens because your throat and ears have the same nerves. It does not usually mean that your child has an ear infection.

Your child may also feel tired for the first few days

This is normal.

Keep your child off school for 2 to 7 days

Make sure he or she rests at home away from crowds and smoky places.

Keep him or her away from people with coughs and colds.

What is Hoarseness?

Hoarseness or Dysphonia means a change in the sound of someone’s voice. People suffering from hoarseness can experience a strained, husky or breathy voice.

They may also notice a difference in loudness and/or changes in how high or low their voice sounds (Pitch).

Changes in voice pitch are common in young children as they grow through puberty (voice ‘breaking’).

A complete loss of voice, resulting in only a whisper, is called Aphonia.

What causes Hoarseness?

Normally when we talk/sing the vocal cords come together and vibrate. This creates a sound which we know as the voice. Hoarseness results from the vocal cords in the voice box (Larynx) not working properly. There are several causes of hoarseness, fortunately most are not serious and tend to go away after a short period of time. Common causes are:

A viral upper respiratory tract infection, causing the voice box lining to swell (Laryngitis)

Stomach acid/enzymes irritating the throat (Laryngopharyngeal Reflux)

A build-up of soft tissue (polyps) or thickenings (nodules) on the vocal cords. These can develop when the voice is used too much or too loudly for long periods of time (Singer’s Nodules). Vocal cord polyps are often related to smoking.

Problems with the strength of the lungs can also lead to a change in voice

Rarely a growth or tumour develops on the vocal cords and or voice box. These may be noncancerous (benign) or cancerous (malignant).

Problems with movement of the vocal cords (paralysed vocal cords). One or both of the vocal cords may be paralysed if it’s nerve is affected by infection or tumour.

How is Hoarseness treated?

A key question here is whether the hoarseness is constant or getting worse or does it come and go with periods of “normal” voice in between.

Intermittent mild episodes of hoarseness: In most cases this will settle by itself. To help relieve the symptoms one can:

rest the voice (but don’t resort to whispering which can make matters worse).

drink plenty of fluids (avoid too many fizzy drinks).

avoid alcohol.

avoid cigarette smoke.

take Antacids if you get a buildup of acid in the throat.

Persistent and / or worsening hoarseness

People suffering from the following symptoms should seek urgent medical advice from a doctor:

Prolonged hoarseness for more than four weeks

repeated spells of hoarseness without reason

Prolonged sore throat or difficulty swallowing for more than two weeks

It is particularly important to see the doctor with these symptoms if the person is a smoker or drinks more than the recommended amount of alcohol.

What will the ENT surgeon do?

The surgeon will examine the throat to help identify the cause of the hoarseness. This is done by passing a flexible telescope through the nose (Fibreoptic Endoscope). This examination is done at the time of your outpatient visit and does not require hospital admission. Depending on the clinical findings, the following treatments may be recommended:

Simple advice:

As described above for intermittent mild hoarseness.

Voice therapy (Speech and Language Therapist):

The majority of patients will have no structural abnormality identified. The problem with their voice will be related to the way they are using their voice i.e. they are ‘straining’ it in some way. In this case a voice therapist will be able to give advice or suggest exercises that might help the quality of the voice. Voice therapy may require more than one visit to the therapist.

Microlaryngoscopy

An operation to remove nodules, polyps and non cancerous (benign) tumors may be recommended if these are identified at the outpatients visit. This type of operation is usually done under general anesthetic using a rigid telescope (Endoscope) and a microscope (to provide magnification). It can remove the problem in the case of polyps, nodules or cysts and will provide a piece of tissue for laboratory analysis (a biopsy). If a malignant (cancerous) tumor of the larynx is diagnosed by biopsy then further treatment will be planned at a cancer team meeting and discussed with the patient.

What is Microlaryngoscopy?

Microlaryngoscopy is the examination of your larynx (voice box) while you are under a general anaesthetic.

Why do you need the operation?

Microlaryngoscopy is done to find and treat problems of the voice box, such as hoarseness. Your surgeon will put a short metal tube (laryngoscope) through your mouth into your voice box. A microscope is then used to look into the voice box to find the problem. If needed, surgery on your voice box can also be done through the laryngoscope with very fine instruments.

If there are any problem areas, a small part of the lining of the voice box is taken away for laboratory examination. This is called a biopsy. Depending on the type of problem a laser might be used. Microlaryngoscopy is quite a short operation and usually takes less than 30 minutes.

How will I feel after the operation?

You may find that your throat hurts. This is because of the metal tubes that are passed through your throat to examine the voice box. Any discomfort settles quickly with simple painkillers and usually only lasts a day or two. Some patients feel their neck is slightly stiff after the operation.

After microlaryngoscopy, you should be able to use your voice as normal after the procedure. If the surgeon has taken a biopsy from your voice box, he may advise you to rest your voice for a short period. Your voice may sound worse, especially if any biopsies have been taken. This should be temporary until the lining of the voice box heals. You can usually eat and drink later the same day

Possible complications

Microlaryngoscopy is very safe. You may have a slightly sore throat afterwards. Very rarely, there is a risk that the metal tubes may chip your teeth. Your surgeon uses a gum guard to help prevent this happening.

Things to think about before your operation

If you have a history of neck problems, you should inform the surgeon about this before your operation. Please also advise your surgeon of any loose or capped teeth before the operation.

When will I know whathappened?

Your surgeon will usually be able to tell you what was found, and what they did to help you, on the same day as your operation. If any biopsies were taken, these normally take a few days to process in a laboratory. Your surgeon will arrange to see you again for your results.

When can I go home?

Usually you can go home the same day as the operation, as long as you have someone with you. Depending on how you feel afterwards, you may need to stay overnight for observation.

When can I go back to work?

You may be advised to stay off work for a few days to rest your throat, depending on your job.

Is there any alternative treatment?

There is no alternative to microlaryngoscopy to achieve a detailed examination of the voice box.

Summary

Hoarseness is very common and usually due to simple problems that get better quickly with simple painkillers, drinking water and rest. Very occasionally however it can be a warning symptom that something more serious is wrong with the throat or voice box. This is especially important to remember in people who smoke and if the hoarseness persists or seems to get worse over a period of several weeks.

About Us

Gajanan Hospital ENT Clinic is one of the leading centers for the treatment of diseases of the ear, nose and throat in the Ahmednagar. Established by Dr. Gajanan Kashid in 2007.The service of humanity with the highest standards of ethics and professionalism. The clinic has many firsts to its credit:

adress

  • Dr.Gajanan Kashid
    Gajanan Hospital & Advanced Endoscopic ENT Surgery Centre & Snoaring Treatment Centre
    Plot no 8, satbhai mala,
    Delhi Gate
    AHMEDNAGAR-414 001.
    Maharashtra, India
  • Tel -: (0241) 2325424 / 2325425
  • Email -: entgajanan@gmail.com entgajanan@rediffmail.com

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