Tonsils, Adenoids, and Sleep Problems

The most common reasons for removal of tonsils and/or adenoids are chronic infections and obstructive sleep apnea (OSA). For those with chronic infections, tonsillectomy is still performed in a traditional manner. For those with obstructive sleep apnea, there is a choice. The following is a discussion of some of the key differences between these two techniques. There is no absolute best choice that is the same for all patients. Many different factors need to be taken into account, and what is right for one patient may not be the best choice for another - even within the same family. 

The Traditional Tonsillectomy

There have been very few innovations in the way that tonsils are removed over the course of many years. The recovery period for traditional tonsillectomy remains, unfortunately, a painful experience. While pain medicines such as narcotics, can be helpful, recovery is still quite rough. 

Why is recovery from a tonsillectomy painful?

In a traditional tonsillectomy, the surgeon follows the fibrous capsule which surrounds the tonsil.  After removal of the tonsil, the muscles of the throat are exposed.  It is the exposure of the muscle which is responsible for most of the postoperative pain. Unfortunately, the tonsil resides within an open area called a "fossa" and after removal the area cannot be covered or closed. Until this area heals over on its own there will be significant discomfort.

 What is the recovery period for a traditional tonsillectomy?

Most patients recover in approximately 7-10 days. Some, however, will take up to two weeks. Most find that this recovery period is quite rough, requiring narcotic pain medicine for adequate relief. The diet can be advanced to regular food as soon as the patient is ready. However, most will eat only soft foods in the first days after surgery. 

Are lasers helpful in reducing pain?

When lasers were first introduced into surgical practice, it was hoped that postoperative pain would be dramatically reduced. Unfortunately, this has not been the case. A laser is a very sharp cutting instrument that uses light. It does not, however, solve the basic problem that removal of tonsils exposes raw muscle in the back of the throat. It is this exposed muscle which is responsible for the pain during the recovery period.

When should I decide which method is best?

It is much easier to schedule a PITA procedure and change to a traditional technique then vice a versa. A final decision does not need to be made until just before the patient goes into the operating room. If the decition is initially unclear, it is better to schedule the PITA procedure and then change if necessary. The PITA procedure requires a more extensive set up and equipment that needs to be reserved in advance.

More information about tonsillectomy surgeries can be found at www.itonsil.com

Partial Intracapsular Tonsillectomy and Adenoidectomy (PITA)

The PITA procedure is a newer technique to treat obstructive sleep apnea caused by tonsil and adenoid enlargement. The goal is to remove approximately 90% of the tonsil tissue, leaving a small portion of the tissue behind to act as a biological dressing. This prevents exposure of raw muscle in the back of the throat and provides a dramatically improved postoperative recovery period. The adenoid tissue is removed in identical fashion to traditional techniques.

What are the advantages of the PITA procedure? 

Patients who undergo the PITA procedure have less pain and recover quicker than those who undergo traditional tonsillectomy. They usually are able to eat regular foods sooner as well. 

What is the recovery period for the PITA procedure?

Recovery period for the PITA procedure is typically 3-5 days. Additionally, the pain is typically mild to moderate as compared to the severe pain with a traditional, complete tonsillectomy. Most patients are eating regular food on the first day. Because there is still risk of bleeding, activities should still be limited within the first two weeks.

What are the drawbacks to the PITA procedure?

With a traditional tonsillectomy there is virtually no chance that the tonsils will regrow. The PITA procedure, however, carries a 5% to 15% chance of tonsil regrowth. Only approximately 5% of patients have enough regrowth to merit repeat surgical intervention. The PITA procedure can be repeated at this time or a traditional tonsillectomy can be performed. The PITA procedure is not appropriate for patients who have had a significant number of throat or tonsil infections.

Are some patients more appropriate for PITA?

The PITA procedure can be used in any age group. It works very well for young children with sleep apnea. Children with special needs, behavioral problems, and communication difficulties are excellent candidates for this procedure. The diminished recovery time significantly decreases the risk of dehydration. Additionally, because swallowing is less painful it is easier to administer postoperative medications. The decreased time of recovery can also reduce weight loss that is usually associated with traditional tonsillectomy. For children with speech and and language difficulties the PITA procedure carries a reduced risk of scarring and subsequent limitation of the palatal movement.