by: Dr Johan Grobbelaar
The first recorded tonsillectomy is believed to have been performed by the Roman physician Aulus Cornelius Celsus, who lived around 25 BC to 50 AD. He described the procedure in his work “De Medicina,” where he detailed the removal of tonsils using a technique similar to what we now know as a tonsillectomy. Since then, a tonsillectomy with or without an adenoidectomy, has remained one of the most frequent surgical procedures throughout the world. It is quite often a patient’s first and only operation for many years. For practical purposes, a tonsillectomy referred to below, can include removing the adenoids.
In many cases, a tonsillectomy can significantly improve the quality of life for individuals who have been experiencing chronic or recurrent tonsillitis or other tonsil-related issues. Here are some reasons:
- Reduced frequency of infections: Tonsillectomy can be particularly beneficial for those who suffer from frequent tonsillitis or throat infections. After the procedure, the risk of experiencing these infections is significantly reduced, which can lead to improved overall health and well-being. It has also been proven that removing the tonsils does not impair your ability to fight infections. It is in fact exactly the opposite, whereby diseased tonsils lead to an impaired immune response in the upper airway lymphoid tissue.
- Improved sleep: Enlarged tonsils can obstruct the airway during sleep, leading to sleep disturbances and sleep-disordered breathing conditions like sleep apnea. Removing the tonsils can improve breathing during sleep, resulting in better sleep quality and daytime alertness. This is especially important in children, were the link between poor sleeping patterns and daytime performance are becoming stronger by the year. This corelates with the evidence that the most common indication to remove tonsils are due to obstruction.
- Enhanced ability to swallow and eat: In some cases, enlarged or inflamed tonsils can make swallowing difficult and may interfere with eating. After the tonsillectomy, these difficulties may be alleviated, allowing individuals to eat and swallow more comfortably. Typically, children with enlarge tonsils will prefer to eat soft foods and spit out solids like meat.
- Fewer missed school or work days: Chronic tonsil infections can lead to frequent absences from school or work due to illness. After a successful tonsillectomy, individuals are less likely to miss days due to tonsil-related problems.
Coblation tonsillectomy is a surgical technique used to remove the tonsils. It is a relatively newer approach compared to traditional methods like cold knife (steel scalpel) tonsillectomy or electrocautery tonsillectomy. Coblation stands for “controlled ablation,” which is a process that uses radiofrequency energy to remove tissue while minimizing damage to surrounding structures. A specialized coblation device is used by the surgeon. This device consists of a wand with a small electrode tip. The surgeon inserts the coblation wand into the mouth and directs it toward the tonsils. The electrode tip emits radiofrequency energy, which turns the saltwater solution in the tissue into charged particles (ions). These ions are then accelerated and directed toward the tonsils, removing the tissue in a controlled and precise manner. Coblation not only removes tissue but also has coagulation properties. It helps seal blood vessels during the procedure, reducing bleeding and promoting a smoother recovery. There are various techniques how to remove the tonsils and adenoids using the coblator.
Potential benefits of coblation tonsillectomy include less post-operative pain, reduced risk of bleeding, and potentially faster recovery times compared to some traditional techniques. However, like any surgical procedure, it also has its own set of risks and possible complications, which the surgeon will discuss with the patient before the operation. It’s essential to consult with an experienced ear, nose, and throat (ENT) surgeon to determine if coblation tonsillectomy is the right option for each individual case, as the most appropriate method may vary depending on factors such as the patient’s medical history, age, and the severity of tonsil-related issues.
DR JOHAN GROBBELAAR
DEPARTMENT HEAD OF EAR, NOSE AND THROAT
STELLENBOSCH UNIVERSITY/TYGERBERG HOSPITAL