Our Summary

This study looked at how often children had to have a second tonsil surgery (known as a revision tonsillectomy) after having an initial surgery (called an intracapsular tonsillectomy). It was done by looking back at medical records from the Alfred I. duPont Hospital for Children, between 2004 and 2018. The study included 169 children who had to get the surgery a second time and compared them to 169 children who had the same surgery around the same time but didn’t need a second one.

The researchers found that about 1.39% of children needed a second surgery, which usually happened about 3.5 years after the first. The most common reason for needing a second surgery was tonsillitis. A small number of the children who had a second surgery (2.4%) had bleeding from the tonsils after the surgery which needed to be controlled in the operating room.

The study also found that younger children (less than 4 years old) and children with a history of stomach acid reflux were more likely to need a second surgery. The researchers suggest that these factors should be considered when a doctor is deciding to do an intracapsular tonsillectomy on a child.

FAQs

  1. What percentage of children needed a second tonsil surgery according to the study?
  2. What were the most common reasons for needing a second tonsil surgery?
  3. Which factors increased the likelihood of needing a second surgery according to the study?

Doctor’s Tip

One helpful tip a doctor might tell a patient about tonsillectomy is to follow post-operative care instructions carefully. This includes staying hydrated, eating soft foods, avoiding strenuous physical activity, and taking pain medication as prescribed. It is also important to watch for signs of bleeding, such as persistent throat pain, vomiting blood, or coughing up blood, and to contact your doctor immediately if you experience any of these symptoms. Following these guidelines can help prevent complications and promote a smooth recovery after tonsil surgery.

Suitable For

Patients who are typically recommended tonsillectomy include those who have:

  1. Recurrent tonsillitis (inflammation of the tonsils)
  2. Enlarged tonsils causing trouble breathing or swallowing
  3. Sleep-disordered breathing, such as obstructive sleep apnea
  4. Persistent bad breath or taste in the mouth
  5. Peritonsillar abscess (collection of pus behind the tonsils)
  6. Tonsil stones (calcium deposits in the tonsils)
  7. Tonsil cancer (rare, but possible in some cases)

Timeline

Before tonsillectomy:

  • Patient experiences frequent tonsillitis, difficulty breathing/swallowing, sleep apnea, or other tonsil-related issues
  • Patient consults with an ENT specialist who recommends tonsillectomy
  • Patient undergoes pre-operative evaluations and tests to ensure they are a good candidate for surgery
  • Patient schedules surgery and prepares for the procedure, including fasting before surgery and arranging for post-operative care

After tonsillectomy:

  • Patient undergoes surgery, which typically lasts about 30-45 minutes
  • Patient is monitored in the recovery room before being discharged home the same day
  • Patient experiences pain, sore throat, and difficulty swallowing in the days following surgery
  • Patient is advised to rest, stay hydrated, and follow a soft diet to aid in recovery
  • Patient may experience bleeding, infection, or other complications requiring medical attention
  • Patient gradually improves over the next 1-2 weeks, with pain and discomfort decreasing
  • Patient returns for a follow-up appointment with their ENT specialist to ensure proper healing and address any concerns

Overall, the timeline for a patient before and after tonsillectomy involves a series of steps leading up to the surgery, followed by a period of recovery and healing. The success of the surgery and the patient’s overall experience can vary based on individual factors and the expertise of the medical team involved.

What to Ask Your Doctor

  1. Is a tonsillectomy the best option for me or my child’s condition?
  2. What are the potential risks and complications associated with a tonsillectomy?
  3. How long is the recovery process and what can I expect during that time?
  4. Are there any restrictions or special instructions to follow after the surgery?
  5. How likely is it that a second surgery (revision tonsillectomy) may be needed in the future?
  6. What factors may increase the likelihood of needing a second surgery?
  7. How will you monitor for any complications after the surgery?
  8. Are there any alternative treatments or approaches that could be considered instead of a tonsillectomy?
  9. How experienced are you in performing tonsillectomies and what is your success rate?
  10. What should I do if I experience any concerning symptoms after the surgery?

Reference

Authors: Sagheer SH, Kolb CM, Crippen MM, Tawfik A, Vandjelovic ND, Nardone HC, Schmidt RJ. Journal: Otolaryngol Head Neck Surg. 2022 Apr;166(4):772-778. doi: 10.1177/01945998211034454. Epub 2021 Aug 10. PMID: 34372707