Tonsillectomy: indications and contraindications. Removal of tonsils: indications, methods of removal Tonsillectomy postoperative period pain relief

Recovery after removal of the tonsils lasts several weeks and requires strict adherence to the recommendations of the doctor. During this period, due to swelling of the tissues of the pharynx, pain and a feeling of a foreign body in the throat occur.

Caring for a person after surgery for the removal of the tonsils is proper nutrition. Restriction of physical activity and the correct mode of the day accelerate recovery.

First hours after tonsillectomy

Immediately after the removal of lymphoid tissue, there are wounds in the throat. To prevent bleeding, the patient is laid on their side and a paper towel is offered to spit out the sputum. The entire first day, the patient observes several important rules:

1. You can't talk for 24 hours. Voice rest helps to quickly restore the ligaments of the larynx.
2. The lying position prevents bleeding.
3. You can't take food.
4. Adults are allowed to drink sweetened tea at room temperature.
5. It is recommended to drink plenty of fluids.
6. Small children can eat liquid porridge and milk jelly.
7. An anesthetic injection is given to relieve sore throat after tonsil surgery.
8. On the first day, the patient should not swallow saliva, they should be spit out.
9. Oral hygiene must be observed very carefully, trying not to damage the mucous membranes.

Advice! On the first day you can not go to the bath, sauna, solarium, take a hot shower. Alcoholic drinks and smoking are prohibited. Tobacco smoke strongly irritates the operated area. Air travel is prohibited on the day of the operation.

Second day

The next day after the operation, the patient needs to talk a lot so that adhesions do not form.

For several days after surgery on the tonsils, the risk of bleeding remains. For the prevention and disinfection of the oral cavity, it is allowed to gargle with 3% hydrogen peroxide, diluted in a proportion of 1 tbsp. l. pharmaceutical agent in half a glass of warm water.

• a variety of fruit non-acidic juices;
• puree;
• sour cream and milk;
• mucous soups;
• soaked bread and cookies;
• mashed vegetables and fruits in a blender.

The main rules of the second day are frequent, but fractional meals with salt restriction. Each serving should not exceed 400 grams at 6 meals.

Third - fifth day after removal

On the third day after the operation, the sore throat intensifies in all patients. This is due to the process of regeneration, the formation of granulation tissues. Therefore, nutrition after the removal of the tonsils in this period remains sparing. Meals included in the diet:

• cottage cheese, mashed with milk, cream;
• boiled cereals in water, meat broth or milk;
• soup with semolina;
• meat broth;
• fish puree;
• eggs in a bag or for a couple;
• steamed meat, chicken and fish;
• baked vegetables.

After removal of the tonsils, it is important not only to prevent infection of the postoperative wound, but also to provide the body with the necessary nutrients. The rate of regeneration depends on the state of immunity and the method of operation.

What can you eat after the removal of the tonsils in a week

Although the sore throat subsided during this period, the wound surface is still irritated and the risk of bleeding remains. The diet after removal of the tonsils in adults and children includes a variety of but sparing dishes.

The diet after the removal of the tonsils has a number of features. Until the complete disappearance of pain and discomfort in the throat, patients must adhere to the rules:

• dishes are recommended to be taken cold;
• food intake should be fractional - in small portions, but more often than usual;
• before lunch and dinner, it is allowed to take anesthetics to relieve pain;
• food should be soft, without hard lumps;
• dishes need to be cooked only for a couple;
• after removing the tonsils, it is recommended to eat ice cream to reduce pain and stop bleeding.

Excluded from the diet are drinks and foods that irritate the throat - sauces, marinades, spicy cheeses. It is necessary to refuse fatty, canned food. The menu should be balanced so that the patient receives nutrients without weakening the body.

How much sore throat after tonsil removal

The postoperative period on the third day after removal is characterized by increased pain at the site of the tonsils. This is due to the deposition of fibrin.

Over the next 6 days, epithelial cells form in the place where the tonsils were. The process of tissue healing is accompanied by the deposition of white plaque, which disappears by the end of the week.

The patient is discharged home on the second to tenth day, depending on the method of the operation to remove the tonsils. The longest rehabilitation is noted after the classical method of tonsil removal, the shortest - after coblation.

Important! After any type of surgery, the pain syndrome persists for 2 weeks. Throughout this period, the patient must carefully monitor the throat, following the recommendations for the use of drugs. It is just as important to follow a diet.

Full recovery after removal of the tonsils lasts 22–23 days. By this time, the wound heals, acquiring a homogeneous structure. In the place where the palatine tonsils were, new mucous membranes are formed. Children recover faster. In addition, they are easier to tolerate surgery.

Medical treatment after tonsil surgery

In addition to proper nutrition, the operated patient undergoes a full course of drug therapy. Complex treatment includes the following drugs:

• Antibiotics prevent the growth of pathogenic bacteria.
• Immunostimulants accelerate the production of natural protective substances, increase the body's resistance to bacteria and viruses.
• Coagulants promote blood clotting, which is necessary to prevent bleeding.
• Non-steroidal anti-inflammatory drugs reduce sore throat, eliminate swelling of the tissues of the pharynx.
• Vitamins stimulate cell regeneration of the operated area, accelerate metabolic processes.

Antibiotics are prescribed only by a doctor for 7-10 days. Do not interrupt the course of treatment or change the dosage. Drugs are selected depending on the patient's condition and contraindications.

Removal of the tonsils during the rehabilitation period is accompanied by an increase in temperature to 37.0–37.5 °C, an increase in the cervical and submandibular lymph nodes. Such a reaction of the body indicates recovery processes.

Proper nutrition helps restore strength and speed up healing after tonsil removal surgery. The diet should be complete, but sparing.

Steamed dishes prevent irritation of wounds, do not allow increased pain. Recovery comes much faster if you follow the doctor's recommendations, give up bad habits.

A tonsillectomy is a medical term used to remove the tonsils. This is the oldest surgical intervention, which was actively used by doctors 2000 years ago. However, this procedure is very relevant today. In order for a tonsillectomy to be carried out correctly, it is necessary to competently approach it not only to the doctor, but also to the patient. In this article, we will tell you what this throat surgery is, how to prepare for it, for what indications this procedure is prescribed, and what it is fraught with for children and adults.

Tonsillectomy, despite being a fairly common procedure, remains controversial in the field of otolaryngology. In the second half of the 20th century, almost all children underwent tonsillectomy; now this operation is performed only when indicated.

In modern otolaryngology, there are several methods by which this operation is performed to remove the tonsils. Each of them is designed to fulfill the basic requirements:

• there should be the safest way to influence the tonsils;
• there should not be a large blood loss either during the operation or after it;
• postoperative pain syndrome should not be pronounced;
• the recovery period should be as fast as possible.

Now let's take a closer look at the existing methods of performing tonsillectomy:

1. Extracapsular. With it, the tissues of the tonsils are excised with scissors or a special loop. This tonsillectomy is performed under anesthesia. Both local and general anesthesia can be used. This procedure is very common, because by applying it, you can remove not only the tonsils, but also their capsule.
2. Electrocoagulation. With it, the tissues of the tonsils are excised due to the electric current of the highest frequency. The advantage of this operation is that it prevents bleeding. The main disadvantage of electrocoagulation is that complications can occur after it.
3. Laser tonsillectomy. This is the safest and most popular way to remove tonsils in modern clinics, but it is quite expensive, but absolutely safe. It is done under local anesthesia. The laser during the operation can be used either infrared or carbon.
4. Radio wave. The energy of radio waves is used, which excise the tissues of the tonsils. Such a tonsillectomy is also performed under anesthesia, most often under local anesthesia. However, doctors resort to this method of surgical intervention most often when it is required not to completely remove the tonsils, but only partially.
5. Coblation. Excision of tonsil tissue occurs with the help of radio frequency energy (thermal energy is not used). For such a surgical procedure, general anesthesia is required, but the tissues are minimally injured, and complications almost never occur after the operation. This method of tonsillectomy is often used in adults, because they need to recover as quickly as possible and return to work.

What is the process of tonsillectomy:

1. Before the operation, the patient must first be examined by a specialist. He appoints him to undergo clinical studies, because before the operation he needs to know information regarding the patient's blood clotting, chronic diseases. Based on this data, he will select the type of operation and plan its course.
2. A few days before the operation, the doctor often prescribes the use of hemostatics or coagulants to the patient. This is necessary in order to reduce the risk of large blood loss during and after surgery. As a rule, it is necessary for children in preparation for surgery.
3. Before excising the tissues of the tonsils, the doctor sanitizes them. He treats the pharyngeal mucosa with a special solution so that all harmful bacteria are destroyed.
4. The patient is then given an anesthetic.
5. Next, the excision of the tissues of the tonsils is carried out according to the chosen scheme.

Indications and contraindications for tonsillectomy

As we mentioned above, tonsillectomy is not done for everyone, but only for those who have indications for this procedure. The main indications include:

1. Tonsillitis, which constantly worries a person. If within 1 year tonsillitis occurs more than 7 times or within 2 years it worsens about 3-5 times.
2. If tonsillitis has already developed into a chronic form.
3. If there is a risk of complications due to tonsillitis on the heart or kidneys.
4. If a patient has frequent sleep apnea, he cannot swallow or breathe normally because his tonsils increase in size.
5. If the tonsils are constantly covered with purulent plaque.
6. If bronchopulmonary diseases constantly recur. This indication, as a rule, concerns children of childhood (children who have not yet turned 2 years old are not subjected to tonsillectomy).

The main contraindications to the removal of the tonsils include:

1. Pathologies that are associated with the human circulatory system. It could be leukemia or diathesis.
2. Diseases of the vessels located on the pharynx.
3. If the patient has severe neuropsychiatric diseases, the operation to remove the tonsils is not performed, because the course of the operation cannot be a priori safe.
4. Tuberculosis cannot be treated with tonsillectomy.
5. Pathologies of the heart muscle, kidneys, respiratory system and digestive system, especially if they are in the active stage, are direct contraindications to surgery on the tonsils.
6. In both adults and children with diabetes, tonsillectomy is contraindicated.

• if they have infectious diseases (this includes even SARS);
• girls and women should not have surgery during menstrual bleeding;
• if there is caries, other dental diseases that require treatment, tonsillectomy can be harmful;
• if there are skin diseases, tonsils should not be removed.

Advantages and disadvantages of tonsillectomy

Modern experts refer to the procedure for removing tonsils rather ambiguously. Many doctors are of the opinion that the tonsils are a very important organ that is needed to protect the human immune system. If the tonsils are removed, the respiratory organs will automatically lose their barrier, and the frequency of colds will increase significantly. This point of view is not unfounded. Most of the time, this is exactly what happens to children. This is the undoubted minus of such an operation.

The advantage of tonsillectomy is that it prevents the development of a large number of diseases and the spread of infection. It is better to remove the main focus of the inflammatory process than to allow it to develop throughout the human body.

Important! If an adult woman is diagnosed with chronic tonsillitis, then she definitely needs to have an operation to remove the tonsils, otherwise her reproductive function will be impaired. It may even lead to infertility.

For adults, the negative consequences of tonsillectomy, which we mentioned above, do not apply. The functions of the tonsils in adults are performed, if necessary, by the hyoid and pharyngeal tonsils.

How should I prepare for a tonsil removal surgery?

According to reviews, tonsillectomy is an operation that requires careful preparation from the patient:

1. To begin with, on an outpatient basis, it is necessary to donate blood and urine for analysis so that the doctor can plan the operation.
2. After that, it will be useful to visit the offices of a dentist, a cardiologist and a therapist in order to exclude diseases associated with the organs and systems that these specialists treat.
3. A month before the operation, the patient will have to give up the use of aspirin and ibuprofen without fail. 14 days before a tonsillectomy, you should take a course of drugs that increase blood clotting.
4. Do not eat or drink anything 5-6 hours before the operation. Even ordinary water is strictly prohibited.

The essence of the postoperative period after tonsillectomy

A responsible approach from a person who has undergone an operation to remove the tonsils requires a postoperative period. It should include the following recommendations:

1. As long as there is plaque on the wounds after the removal of the tonsils (it can be white or yellowish), you can’t gargle with anything.
2. The next 12 days after the removal of the tonsils, the patient should not talk a lot, lift any heavy things, objects, children.
3. It is unacceptable to eat something solid, hot. You need to give preference to vegetable and meat purees, soups, yogurts and cereals.
4. Be sure to drink as much liquid as possible.
5. It should be abandoned in the first 2 weeks after tonsillectomy from flights, trips to the sauna.
6. You can clean your mouth very carefully.
7. Only cool showers are allowed after the operation.
8. Of the painkillers, you can only take paracetamol or other drugs that are based on it. Ibuprofen, aspirin are excluded because they can cause bleeding.

Keep in mind that after the operation, taste sensations may disappear for a while. As a rule, after 3 weeks a person fully returns to a full life. In places where the tonsils were cut out, scars appear, which are covered with a mucous membrane.

Possible complications of tonsillectomy

Tonsils are an organ that protects the human immune system. Therefore, after their removal, the body can react very violently to what happened. The respiratory organs will be deprived of a barrier, so they will most often suffer from infections. The immune system will have to adjust to a new mode of operation for some time in order for the human body to fully function.

Today, tonsillectomy is performed quickly and with virtually no complications, but in some cases they can still occur. What are these complications?

1. May occur after tonsillectomy bleeding. If this happened at home, then in this case, you should immediately call the doctors. This is a rare consequence that occurs in 5% of adults and 3% of children.
2. The throat after a tonsillectomy can be very sore. He will need to be constantly anesthetized.
3. Often the temperature rises after tonsillectomy. It may be slightly elevated for 2 weeks after surgery. Only if the temperature has risen above 38-39ºC, you need to call the doctors, because, most likely, in this case it will be necessary to treat the infection that provokes such a high temperature.
4. If the patient underwent laser tonsillectomy, then there may be a burn of the throat mucosa. But this complication arises only because the operation was performed by an inexperienced doctor.
5. In children, the voice may change after the operation, even the neck may hurt, and in adults, a not very pleasant aftertaste in the mouth persists for a long time.

The cost of tonsillectomy varies. It all depends on the conditions in which it will be carried out, the chosen method of excision of the tissues of the tonsils, the age of the patient. The cost of the procedure must be specified in each individual case.

If you or your child is scheduled for such an operation, you should not listen to the prejudices and believe the myths that have developed around tonsillectomy. This is an ordinary medical procedure, which in most cases is necessary for a person to have the opportunity to live a full life. If for some reason a tonsillectomy can harm a person, the doctor will immediately warn about this or not prescribe an operation to remove the tonsils at all.

Video: "Tonsillectomy"

Inflamed and hypertrophied tonsils require conservative treatment. But if the desired effect does not occur, and (the tonsils) cause significant discomfort, a decision is made to remove them by surgical intervention.

Removal of the tonsils - tonsillectomy - was used in ancient times (more than two thousand years ago). At that time, the task of the doctor was to get rid of the disease. The patient did not go through a certain preparatory stage, and the doctors "operated" without observing the rules of antisepsis and without anesthesia.

At present, the procedure for the removal of tonsils is a common surgical intervention, carried out in aseptic hospital conditions, or in private offices of ENT doctors, in compliance with safety and sanitary standards.

What is a tonsillectomy and what are its types?

As mentioned above, tonsillectomy is the surgical removal of inflamed and hypertrophied tonsils. Most often, those tonsils that were found in the late period and if the 2nd or 3rd stage of adenoiditis are diagnosed (usually 3rd degree) are surgically removed.

In otolaryngology, there are 5 types of tonsillectomy:

1. radio wave view. Manipulation is carried out under local anesthesia by excision of the lymphatic tissue of the organ. This method is advisable to use for partial removal of the tonsils.
2. laser view. One of the most expensive procedures in otolaryngology. The method of tonsil removal is based on the “burning out” of the inflamed tissue of the nasal cavity with a laser beam. Laser tonsillectomy is absolutely safe and is performed under local anesthesia. The laser beam with this method of removing tonsils is selected individually: it can be carbon (cold plasma tonsillectomy) or infrared laser.
3. Coblatory tonsillectomy. Coblation involves the application of radio frequency energy without thermal accompaniment. This type of surgery is performed under general anesthesia and is characterized by minimal complications. Despite the fact that the traumatization of the surrounding tissues is minimal, the coblation method is used only among the adult population of mankind.
4. Extracapsular view. Surgery is performed under general or local anesthesia, depending on the wishes of the patient. This procedure is performed in all children's hospitals and clinics, and is included in the list of services provided under the compulsory medical insurance policy. Removal of the tonsils is carried out with a loop or scissors, and the advantage is to eliminate not only the atrophied tissue, but also the capsule in which they were located.
5. Electrocoagulation type. A kind of surgical procedure, because high-frequency current is used. Excised tonsils do not bleed, which reduces the risk of unforeseen situations, but the disadvantage of the procedure is a long recovery period and possible complications.

When performing a tonsillectomy, doctors follow the basic requirements:

• The choice of the safest method, taking into account the age and degree of the inflammatory process;
• Prevention of the development of DIC and limitation of minimal blood loss;
• Erased clinical manifestations of the postoperative recovery period;
• Rapid healing of postoperative wounds;
• Preventive measures for the development of complications.

Indications and contraindications for tonsillectomy

Taking into account the presence of indications and contraindications for the operation, the specialist selects treatment options (if necessary), and also advises when choosing a method of tonsillectomy.

Contraindications include:

• menstrual bleeding in women;
• infectious or viral diseases of a respiratory nature (colds, acute respiratory viral infections, acute respiratory infections);
• infectious pathological processes of the skin (including diathesis);
• pulpitis, gingivitis, stomatitis and dental caries in the oral cavity;
• insulin-dependent and non-insulin-dependent diabetes mellitus (both in adults and children);
• blood cancer (leukemia);
• diseases associated with impaired blood formation;
• tuberculosis;
• vascular dystonia or atony (provided that the disease occurs in the pharynx);
• disruption of the pericardium, myocardium and endocardium;
• acute kidney disease at the time of surgery;
• neurological diseases.

Indications for manipulation:

1. If tonsillitis has passed into the stage of chronicity;
2. During one year, the patient had to treat the tonsils at least 7 times;
3. If the affected tissues of the tonsils "grow" with purulent plaque and plugs form;
4. If bronchopulmonary diseases are often diagnosed (in children);
5. Enlarged tonsils cause discomfort to the patient (apnea, snoring, pain when swallowing, difficulty in breathing);
6. If there is a risk of complications in nearby organs (heart, kidneys, lungs).

Advantages and disadvantages of tonsillectomy

According to some people, tonsils are an unnecessary organ that should be removed at the slightest inflammation. However, the main role of the tonsils is to prevent the entry of substances foreign to the body that can lead to inflammatory or infectious processes.

The opinion of experts on this matter is unequivocal - for a start it is necessary to carry out all methods of conservative treatment, and if it is ineffective, seek help from surgeons.

The disadvantage of the procedure is the loss of an organ that performs the immune defense of the body.

The advantage (or advantage) of the procedure is the elimination of the cause of the inflammatory process. Tonsils that have been attacked by pathogenic microorganisms become a source of infection, poisoning the host organism first of all. - the only justified measure that leads to a positive effect in the treatment of tonsillitis. In addition, untreated or unremoved hypertrophied tonsils diagnosed in a woman in time can cause an imbalance in the reproductive system.

How is a tonsillectomy performed?

Operational procedures should be accompanied by a pre-analytical step. Preparation for tonsillectomy includes laboratory research methods and expert opinions.

• detailed blood test;
• general analysis of urine and urine according to Nechiporenko;
• platelet count and their qualitative characteristics in a blood smear according to Fonio;
• blood glucose;
• basic biochemical parameters of blood;
• C-reactive protein;
• acid-base composition of venous blood;
• coagulogram;
• determination of the clotting time and the duration of bleeding of capillary blood according to Sukharev;
• blood for markers of viral hepatitis B and C;
• blood for the detection of antibodies to the human immunodeficiency virus (HIV status).

Expert advice:

• chest X-ray;
• Electrocardiography with description;
• Gynecologist and mammologist (for women);
• Dental consultation;
• The conclusion of the therapist about the possibility (or impossibility) of performing tonsillectomy.

25 days before the operation, you must adhere to a diet: exclude foods that cause allergies from the diet, as well as limit the intake of carbohydrates. Avoid taking painkillers such as ibuprofen and aspirin. However, it will not be superfluous to take drugs that increase blood viscosity 2 weeks before the operation.

On the day of the operation, 6 hours before it starts, it is strictly forbidden to eat:

• First, a gag reflex may develop;
• Secondly, anesthetic drugs are better perceived by the "hungry" body.

Stages of tonsillectomy and adenoidectomy:

• The patient is comfortably positioned in a chair or on the operating table (depending on the situation and the chosen method of anesthesia);
• Half an hour before the manipulation, the patient is given a sedative drug, for example, promedol.
• At the present time, non-injection methods of anesthesia are often used, but "inhalation". A person breathing in intubation anesthesia turns off.
• With the help of a mouth expander, the position of the wide-open mouth is fixed in a state convenient for the doctor.
• At the beginning, adhesions are to be removed. They are dissected with a sharp surgical scalpel or loop.
• Further removal depends on the type of tonsillectomy chosen: this is laser excision of inflamed tissue, or exposure to cold plasma components.

Postoperative period after tonsillectomy

The result of the operation and the recovery period depend on two sides: the efforts of the doctor and the responsibility, after the performed manipulations, of the patient.

The first week after the operation, the patient needs to listen to the body, since an elevated or subfebrile temperature is possible after tonsillectomy.

During the period you need:

• Give up bad habits;
• Do not gargle;
• Reduce physical activity for the next two weeks;
• Diet after tonsillectomy: do not eat hot, cold, spicy and hard;
• Drink more fluids;
• Refuse to go to public bathing places;
• For unbearable pain, take panadol or paracetamol as an anesthetic.

The recovery postoperative stage in most cases takes 20-25 days. With the development of any pain symptoms or hyperthermia of more than 39 °, seek qualified help.

During the time that has passed since the first tonsillectomy, surgical tactics have changed significantly, new methods for removing tonsils using electric current, ultrasound, laser, radio frequency oscillations and other physical methods of influence have appeared. Also, over the years, the strategic approach to the operation has changed - from the extremely rare use of the possibilities of tonsillectomy, through the craze for the removal of tonsils (including for preventive purposes), to modern ideas about the need for an individual approach to each patient with chronic tonsillitis and performing surgery only if there is clear indications.

Most often, the need for tonsillectomy is dictated by the need to eliminate the focus of chronic infection from the body, which is the palatine tonsils affected by the inflammatory process (treatment of chronic tonsillitis). At the initial stages, chronic tonsillitis is subject to conservative treatment, which often gives a positive result. However, even a comprehensive and very competent approach to the treatment of the disease does not always lead to recovery, in this case, surgical intervention comes to the rescue - tonsillectomy.

Tonsillectomy: indications for surgery

Indications for surgical treatment of chronic inflammation of the tonsils are:

1. Frequently recurrent tonsillitis (7 documented exacerbations during the year, or 5 exacerbations per year for 2 years, or 3 exacerbations per year for 3 years);
2. Decompensated form of chronic tonsillitis;
3. Chronic tonsillitis with toxic-allergic phenomena that increase the risk of developing cardiovascular and / or renal complications, as well as already developed diseases of an infectious-toxic-allergic nature (rheumatism, infectious nonspecific polyarthritis, diseases of the heart, biliary tract, kidneys, thyroid gland, some diseases of the nervous systems, skin);
4. Sleep apnea syndrome, impaired swallowing and breathing due to an increase in the size of the palatine tonsils;
5. Purulent complications (intra-, paratonsillar abscess, parapharyngeal phlegmon).

In the first four cases, the operation is performed in the period of remission, after the exacerbation subsides, in the absence of signs of an acute inflammatory process in the tonsils. In the latter case (purulent complications), tonsillectomy is performed in the acute period of the disease under the cover of high doses of antibiotics.

In children, indications for the removal of the tonsils most often become a decompensated form of chronic tonsillitis, resistant to adequate drug therapy, or any form of chronic tonsillitis, accompanied by breathing disorders during sleep. Also, surgical treatment of chronic tonsillitis in pediatrics is carried out with recurrent diseases of the bronchopulmonary system (recurrent pneumonia, bronchiectasis), the presence of tonsillogenic intoxication, metatonsillar diseases (rheumatism, diffuse glomerulonephritis, tonsillogenic chroniosepsis, hemorrhagic vasculitis, capillary toxicosis, immune hemopathy in remission, recurrent ear diseases , larynx, paranasal sinuses, paratonsillar abscess that developed against the background of chronic tonsillitis, and parapharyngeal phlegmon of tonsillar origin, thyrotoxicosis in patients with chronic tonsillitis).

Thanks to the achievements of modern medicine, age is gradually ceasing to be an independent contraindication to surgery: tonsillectomy can now be performed in children aged 2 years and over, as well as in the elderly and old people (if there are absolute indications for surgery).

Tonsillectomy: contraindications

Contraindications to tonsillectomy are divided into absolute and relative (temporary). Absolute contraindications include:

• blood diseases (acute and chronic leukemia, hemorrhagic diathesis);
• anomalies of the vessels of the pharynx (aneurysm, submucosal pulsation of the vessel);
• severe neuropsychiatric diseases that impede the safe course of the operation;
• active form of pulmonary tuberculosis;
• diseases of the heart, kidneys, lungs and liver in the stage of decompensation;
• severe form of diabetes.

Temporary (relative) contraindications to tonsillectomy are:

• acute infectious diseases or prodromal signs of childhood infections;
• acute inflammatory diseases and exacerbation of chronic inflammatory diseases of internal organs (including ENT organs);
• tuberculous intoxication and tuberculous bronchoadenitis;
• menstruation;
• dental caries;
• pustular skin diseases;
• acute dermatitis or chronic dermatitis in the acute stage;
• severe ketonuria in patients with diabetes mellitus;
• epidemic outbreaks of influenza and poliomyelitis.

The decision to perform a tonsillectomy is made by an ENT doctor together with a pediatrician (therapist) after assessing local changes and the patient's medical history. In preparation for surgery, a patient with tonsillitis must undergo an examination, including a general and biochemical blood test, a coagulogram, determination of blood clotting time, and a general urine test.

Tonsillectomy: types of surgical interventions on the palatine tonsils

Modern otolaryngology has a wide choice of tonsillectomy techniques, which differ in the way they affect the tonsils, the volume of blood loss, the severity of postoperative pain syndrome and the duration of the recovery period.

Tonsillectomy can be performed using one of the following types of surgical interventions on the palatine tonsils:

1. Excision of the tonsil tissue with scissors and a wire loop (extracapsular tonsillectomy) is the most widely used technique, which is performed under both local and general anesthesia. Allows you to remove the tonsils together with their capsule and open paratonsillar purulent foci (infiltrates, abscesses).
2. Electrocoagulation - excision of tonsil tissue using a high-frequency electric current. Small blood loss is typical, however, in the postoperative period, complications may arise associated with the thermal effect of the current on the tissues surrounding the tonsils.
3. Excision of the tissues of the tonsils with the help of an ultrasonic scalpel is characterized by minimal damage to the tissues surrounding the tonsils and low blood loss.
4. Radiofrequency ablation - removal of the tonsils with the help of radio wave energy. The operation is performed under local anesthesia, causing minimal pain in the postoperative period. It is more often used to reduce the volume of the tonsils than to completely remove them.
5. The use of an infrared laser (thermal welding method) is characterized by minimal tissue swelling and bleeding, almost complete absence of pain in the postoperative period. It is performed under local anesthesia.
6. The use of a carbon laser (evaporation, vaporization of the tonsils) has the same advantages as an infrared laser. Often the procedure is performed on an outpatient basis, under local anesthesia. The patient quickly returns to his usual way of life.
7. Bipolar radiofrequency ablation (coblation) - the use of radiofrequency energy converted into ionic dissociation. This technique allows you to "dissect" tissue by separating molecular bonds without the use of thermal energy. General anesthesia is required, but the operation is accompanied by minimal tissue trauma, is characterized by a short recovery period and a minimal number of complications. Currently considered the most promising method of intervention on the tonsils.

Tonsillectomy: features of the course of the postoperative period

With a favorable course of the postoperative period, on 2-3 days after tonsillectomy, the tonsil niches are covered with a whitish-yellow coating, there is an increase in pain when swallowing, an increase and soreness of the regional lymph nodes of the neck, and (often) subfebrile temperature. Raids (scabs) begin to disappear on the 5th-6th day of the postoperative period, complete cleansing of the niches is noted by the 10th-12th day, wound epithelialization is completed on the 17th-21st day.

Complications of tonsillectomy

In general, performed according to all the rules (including after adequate preoperative preparation), tonsillectomy is one of the operations with a low level of postoperative complications, the spectrum of which includes postoperative bleeding, infectious and inflammatory processes, and a large group of rare unclassified complications. The latter include hyperthermic syndrome, transient diabetes insipidus, agranulocytosis, acetonemia, hypersalivation, subatrophic, cicatricial changes in the palatine arches and soft palate, hyperplasia of the lymphoid formations of the posterior pharyngeal wall and lingual tonsil, paresthesia, pain in the pharynx, difficulty swallowing. The management of patients with these complications requires an individual and integrated approach to solving the problem.

Complications of tonsillectomy: bleeding after tonsil removal

The overall frequency of bleeding after tonsillectomy is, according to various sources, from 0.1 to 8-10%, in children - 3.4-6.3%. Most often, bleeding, as a complication of the operation on the palatine tonsils, occurs during the first day after the intervention. Operated children who, due to their age, are unable to adhere to medical recommendations, require special attention. The danger associated with bleeding is due not only to blood loss, but also to the aspiration of blood during sleep with the development of asphyxia. Blood loss is assessed by the amount of blood lost and the severity of the patient's condition. The provision of emergency care for blood loss consists in the transfusion of blood components and blood-substituting fluids, the introduction of drugs that stimulate the activity of the respiratory and vasomotor centers, anti-shock drugs, systemic hemostatic agents (adroxon, antihemophilic globulin, vikasol, temophobin, prothrombin complex, fibrinogen, etamsylate) and local ( hemostatic sponges, fibrin isogenic film, adrenaline) actions. It must be borne in mind that the deterioration of the patient's condition after tonsillectomy can also occur with a small blood loss due to reflex spasm of cerebral vessels associated with intraoperative irritation and traumatization of the reflexogenic zone, which is the tonsils.

A repeated increase in the risk of bleeding is observed on the 5-8th day of the postoperative period. This, as a rule, is not abundant bleeding from the niche of the tonsil, associated with a violation of the diet during the discharge of the scab.

Infectious and inflammatory complications of tonsillectomy

Infectious-inflammatory complications of tonsillectomy significantly aggravate the course of the postoperative period and in some cases may pose a danger to the patient's life. The incidence of complications in this group varies over a very wide range, directly depends on the characteristics of the studied populations, and is significantly reduced by the prophylactic and therapeutic use of antibacterial drugs. An increased risk of infectious complications is observed in weakened patients, after inadequate preparation for surgery, in violation of the doctor's recommendations regarding the patient's behavior in the postoperative period, with the addition of superinfection (ARVI, influenza). Depending on the nature and localization, local-regional, distant and generalized infectious complications are distinguished.

Generalized infectious complications of tonsillectomy include septicemia, which occurs 4-5 hours after the operation, the manifestations of which are septic fever, accompanied by tremendous chills.

Long-term infectious and inflammatory complications of tonsillectomy include bronchopneumonia, secondary pleurisy, lung abscess resulting from aspiration of blood and infected contents of the palatine tonsil.

Local-regional complications include postoperative angina or acute febrile pharyngitis (inflammation and hyperemia of the posterior pharyngeal wall, soft palate, regional lymphadenitis against the background of fever), abscess of the lateral pharyngeal wall (usually occurs on the 3rd day after surgery as a result of a violation of surgical technique with a wound side wall of the pharynx or incomplete removal of tonsil tissue).

The postoperative inflammatory process contributes to an increase in body temperature, the appearance and persistence of pain in the throat, lengthens the period of postoperative recovery and therefore requires the use of active therapeutic tactics using antibacterial and antiseptic drugs. In patients at risk for the development of postoperative infectious and inflammatory complications, prophylactic perioperative use of antimicrobials is indicated. A number of studies have shown that the use of antibiotics perioperatively contributes to a significant reduction in the frequency of postoperative fever and the duration of the presence of bad breath, and also shortens the recovery time of normal activity after tonsillectomy.

To prevent the development of systemic side effects (allergic reactions, intestinal dysbacteriosis, the development of antibiotic resistance), antibiotic therapy should be carried out with locally acting drugs. An example of an agent that meets this requirement is Grammidin® Neo with an anesthetic.

Tonsillectomy: prevention of infectious and inflammatory complications using the local antimicrobial drug Grammidin® Neo with anesthetic

Grammidin® Neo with an anesthetic is a combined drug consisting of three active ingredients: the topical antibiotic gramicidin C, the antiseptic cetylpyridinium chloride, and the local anesthetic oxybuprocaine. Gramicidin C belongs to cyclodecapeptide antibiotics and is characterized, in addition to a wide antibacterial spectrum of action, by antiviral and (in combination with other drugs) antiprotozoal activity. The bacteriostatic effect of gramicidin C extends to both gram-positive and gram-negative bacteria, and the strength of the effect is 150-200 times greater than the effect of most sulfanilamide preparations and synthetic antiseptics. A feature of gramicidin C is the ability not to provoke the development of addiction in microorganisms sensitive to the drug.

The antiseptic cetylpyridinium chloride has antimicrobial activity against gram-positive and (to a lesser extent) gram-negative microorganisms, and proven antiviral efficacy.

The anesthetic oxybuprocaine causes a reversible blockade of the propagation and conduction of nerve impulses through the axons of nerve cells. The advantages of oxybuprocaine are the rapid development of anesthesia (after 30 seconds), high efficiency, the presence of its own bacteriostatic and bactericidal action against a number of pathogenic and opportunistic microorganisms, the absence of pronounced systemic effects, low toxicity and high safety.

The pharmacokinetic features of the Grammidin components provide an exclusively local effect of the drug and the absence of undesirable systemic effects, in connection with which Grammidin® Neo with an anesthetic is allowed to be taken by children from 12 years of age and the elderly. The absence of dyes and flavors in the preparation makes it possible to use it by people suffering from allergies.

Associated with the effects of the drug, the suppression of the growth and reproduction of pathogens of infectious diseases helps to reduce the intensity of postoperative inflammation and, as a result, alleviate discomfort in the throat and facilitate swallowing. During resorption, salivation increases, which helps to cleanse the mucous membrane of the oropharynx from microorganisms and inflammatory exudate. Grammidin® Neo with an anesthetic is used after meals, completely dissolving the tablet. After using the drug, you should refrain from eating or drinking for 1-2 hours. Adults and children over the age of 12 Grammidin® Neo are prescribed 1 tablet (one after the other, dissolve within 20-30 minutes) 4 times a day. The course of treatment is 5-7 days.

Tonsillectomy: summary

Thus, to date, tonsillectomy remains one of the main methods of treating chronic tonsillitis in adults and children in cases where the inflammatory process is resistant to conservative therapy, accompanied by the development of complications and toxic-allergic reactions.

The frequency of postoperative complications of tonsillectomy is relatively low, the risk of complications is reduced through proper preparation of the patient for surgery, the use of the most justified surgical tactics and rational management of the postoperative period.

Literature:

1. Baugh R., Archer S., Mitchell R. et all. Clinical Practice Guideline: Tonsillectomy in Children. Otolaryngology - Head and Neck Surgery 2011;144: S1
2. Yulish E.I. Chronic tonsillitis in children. Child Health 2009;6(21):15-18
3. Mangaberia-Albernaz P. The problem of hemorrhages following tonsillectomy. Arch Otolaryngol. 1956 Dec;64(6):466-77
4. Vulfson S., Malysheva I. Immediate and remote results of tonsillectomy in children. Vestn Otorhinolaryngol. 1951 Nov-Dec;13(6):43-6.
5. Dhiwakar M., Eng C., Selvaraj S., McKerrow W.. Antibiotics to improve recovery following tonsillectomy: a systematic review. Otolaryngol Head Neck Surg 2006; 134(3): 357-64.
6. Kleinfeeld J., Ellis P. Inhibition of microorganisms by topical anesthetics. Applied Microbiology, 1967;11:1296-1298.
7. Van G. Effect of oxybuprocaine 0.4% in preventing surgically induced miosis. British journal of Ophthalmology 1984;68:248-251.
8. Pitten F., Kramer A. Efficacy of cetylpyridinium chloride used as oropharyngeal antiseptic. Arzneimittelforschung. 2001;51(7):588-95.

() is one of the most common pathologies in children. It is for this reason that the operation 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 beta-hemolytic streptococcus, but also other bacterial pathogens (bacteroids, aureus, moraxella, etc.). In addition, the viral origin of tonsillitis (herpes simplex, respiratory syncytial) also plays a significant role.

Removal of the tonsils in chronic tonsillitis is required with 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 an abnormal immune response of the body.

Preoperative period, indications and contraindications

Indications for surgery:

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

Contraindications to the surgical method of treatment:

Temporary contraindications include:

• Acute period of infectious diseases.
• In females - the period of menstruation.
• Third trimester of pregnancy (after 26 weeks). All surgical interventions in the nasopharyngeal region are contraindicated in women in the last months of pregnancy, since the risk of preterm birth is not excluded.

How to prepare for the operation?

Before the operation, it is necessary to pass tests and undergo training:

1. Blood tests for HIV, hepatitis B, C, syphilis - RW.
2. Mandatory fluoroscopy.
3. General blood analysis.
4. Study of biochemical parameters of blood (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 pathology or contraindications to surgery.
8. Registration and interpretation of ECG.
9. Tank. sowing from the tonsils to determine the microflora.
10. Given the possible risk of bleeding, 3-5 days before surgery, it is necessary to take drugs that reduce tissue bleeding: Vikasol, Ascorutin.
11. On the night before the operation, it is necessary to prescribe sedatives.
12. On the day of the operation, you can not eat or drink.

When an appropriate somatic pathology is identified, compensation for certain conditions is necessary. For example, when hypertension of 2-3 degrees is detected, it is necessary to achieve the target blood pressure figures. In the presence of diabetes, it is necessary to achieve normoglycemia numbers.

At what age is it best to have surgery?

Indications for surgery may 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 should be performed in children older than 3 years.

How to carry out the operation: on an outpatient basis 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 it is still necessary to monitor the patient in the postoperative period. For this reason, it is recommended to carry out the removal of the tonsils 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% solution of lidocaine, or a 1% solution of dicaine.

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

For proper anesthesia, certain injection sites are used:

• At 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.
• In the fabric of the back arch.

When conducting infiltration anesthesia, the following rules must be followed:

1. Immersion of the needle should be 1 cm deep into the tissues.
2. It is necessary to inject 2-3 ml at 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 ongoing process by the patient himself. A good alternative in such cases is surgery under general anesthesia. Before the operation, the patient is given drugs for premedication (sedatives). Next, the patient is intravenously injected with drugs that allow you to turn off the patient's consciousness. At this time, the anesthesiologist performs tracheal intubation, and connects the patient to the artificial respiration apparatus. After these manipulations, surgery begins.

Operation progress

• 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 thrown back.
• An incision is made only in the mucous membrane in the region 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 go beyond the mucous membrane.
• Through the incision, it is necessary to introduce a narrow raspator between the tonsil and the palatine arch directly behind the tonsil capsule.
• Then it is necessary to separate (separate) the upper pole of the tonsil.
• The next step is fixing the free edge of the tonsil with a clamp.

• For further separation of the middle section of the tonsil, it is necessary to slightly (without effort) tighten the free edge of the tonsil, fixed with a clamp, to provide convenient access and the necessary visualization.
• The tonsil is cut off from the palatoglossal and palatopharyngeal arches.
• Separation of the middle part of the tonsil. It is important to remember that when separating the tonsil from the underlying tissues, it is necessary to constantly intercept the free tonsil tissue closer to the cut-off edge with a clamp. This is necessary because of the slight vulnerability of the tissues, and the high probability of its rupture. In order to maximize the separation of the tonsil together with the capsule, it is necessary to fix the tissue in the 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 with a loop. To do this, it is necessary to retract the tonsil tissue as much as possible, passing it through the loop. Thus, the clipping of the tonsils is carried out as a single block, together with the capsule.
• The next stage of the operation is an examination of the bed at the site of the removed tonsils. It is necessary to determine if there are any remaining areas of the tonsils. It is very important to remove exactly all the tissue in order to avoid a recurrence of the disease. You also need to determine if there are any bleeding, gaping vessels. If necessary, it is important to conduct a thorough hemostasis (stop bleeding).
• Completion of the operation is possible only with a complete stop of bleeding.

Postoperative period

Management of the postoperative period and necessary recommendations:

1. The transfer of the patient to the ward after the operation is carried out on a stretcher (sitting - with local anesthesia).
2. The patient must be laid 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 each on the right and left surfaces of the neck).
4. The first day it is forbidden to swallow saliva. The patient is advised to keep his mouth ajar so that saliva flows on its own onto the lined diaper. You can not spit or expectorate saliva.
5. With severe pain, narcotic analgesics can be used on the day of surgery. In the following days, it is recommended to use non-steroidal anti-inflammatory drugs.
6. The first day you can not talk.
7. Dieting: Eat liquid food for the first few days, gradually moving to soft food (in the form of puree).
8. Due to the risk of bleeding, patients are prescribed drugs that increase blood clotting. Effective preparations "Tranexam", "Etamzilat" in injectable form.
9. To prevent infectious complications, it is necessary to prescribe broad-spectrum antibacterial drugs: Amoxiclav, Flemoclav Solutab, Cefotaxime, Ceftriaxone, etc.
10. It is forbidden to gargle for 2-3 days after the operation, as bleeding can be provoked.
11. Release from work for 2 weeks.

Possible complications of the operation

Bleeding is one of the most frequent and dangerous complications of tonsillectomy. The pharyngeal tonsils are well supplied with blood by 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 is the period of 7-10 days after the operation. The cause of this complication is the exfoliation 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 in the upper corner of the anterior and posterior palatine arch. Also, bleeding often opens in the lower corner of the tonsil fossa, where the branches of the lingual artery pass.

• In case of slight bleeding from small vessels, it is necessary to thoroughly dry the field and puncture the wound with an anesthetic solution. Sometimes this is enough.
• With more severe bleeding, it is important to identify the source. A clamp must be applied to the bleeding vessel and stitched.
• In case of massive bleeding, it is necessary to introduce a large gauze swab into the oral cavity and press it tightly against the site of the removed tonsil. Then take it away for a few seconds to see the source of bleeding, and quickly tie off the vessel.
• In severe cases, if the bleeding cannot be stopped, the external carotid artery must be ligated.

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

Disease relapse. In rare cases, proliferation of tonsil tissue is possible. This situation is possible if a small tissue was left during the removal of the palatine tonsils. With severe hypertrophy of the remaining tissue, a relapse of the disease is possible.

A pronounced pain syndrome is most often characteristic of adult patients, since the pain is already emotionally colored. As pain relief, you can use drugs from the group of non-steroidal anti-inflammatory drugs in injectable form (Ketorol, Ketoprofen, Dolac, Flamax, etc.). However, these drugs have many contraindications (erosive and ulcerative processes of the gastrointestinal tract, blood diseases, kidney and liver failure).

Loss of body weight. Given the pain, which increases with 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.

Palato-pharyngeal insufficiency. After surgery, there may be violations of the closure of the palatine curtain. This complication is manifested by the appearance of a nasal voice in the patient, the appearance during sleep, a violation of the processes of speech and swallowing of food. The incidence of palatopharyngeal insufficiency, according to various authors, ranges from 1:1500 to 1:10000. More often, this complication occurs in patients with a latent cleft 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 fissure of the hard palate is the splitting of the palatine uvula.

Alternatives to Traditional Tonsillectomy

Cryosurgery

There is also a method of cryosurgical treatment of chronic tonsillitis. The essence of this technique lies in 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, it can be seen that the tonsil tissue becomes pale, flat and hard. One day after the operation, the tonsils acquire a bluish tint, the line of necrosis is well contoured. Over the following days, there is a gradual rejection of the tissue, which may be accompanied by a slight bleeding, which, as a rule, does not require intervention. This method can be used in patients with an increased risk of bleeding (with certain blood diseases), with severe heart failure, endocrine pathology.

When exposed to cold temperatures on 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 of the amygdala.

However, it is necessary 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 recurrence of the disease (if the tonsil tissue was not completely necrotic by low temperatures). In general, this method is used only in cases where surgical intervention is not possible due to certain contraindications.

Removal of tonsils with a laser

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

Operation steps:

1. Local anesthesia with an anesthetic solution.
2. Fixation of the tonsil with a clamp.
3. Direction of the laser beam to the junction of the tonsil with the underlying tissues.
4. Removal of tonsils by laser.

Stages of tonsillectomy using a laser

The advantages of this technique are:

• Simultaneous separation of the tonsil from the underlying tissues and coagulation of the vessels. All vessels that fall into the area of ​​the laser beam are “soldered”. For this reason, during this operation, the risk of bleeding is significantly reduced.
• Faster recovery (compared to classic surgery).
• The risk of tissue infection is reduced (due to the instantaneous formation of a scab in the area of ​​​​removed tissues).
• Reducing the operation time.

Disadvantages of the procedure:

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

Alternative Methods

Less common methods are:

conclusions

Removal of the tonsils in chronic tonsillitis is carried out in the presence of 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 of tonsillectomy. In addition to the classical surgical technique, it became possible to remove the tonsils using cryosurgery, a laser scalpel, cold plasma energy, a radio knife, etc. These techniques are successfully used when classical surgery is contraindicated (with serious disorders of the blood coagulation system, complications of 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 tactics for surgical intervention.

Video: tonsillectomy - medical animation