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Tonsils & Adenoids
 Tonsil
and adenoid removal is frequently performed to treat
chronic tonsillitis and recurring infection. But
obstructive sleep apnea (OSA) is now the most common
reason children have tonsil and adenoid surgery. This
occurs when swollen tonsils and adenoids interfere with
healthy breathing, particularly during sleep. It can
affect a child's behavior and ability to learn
significantly. In adults, OSA is linked to an increased
rate of auto accidents, hypertension and diminished job
performance.
At this site ,you'll find a wealth of information about
tonsils and adenoids. You can also learn about the PITA
technique a revolutionary yet simple way of performing a
tonsillectomy and adenoidectomy. Clinical studies show
PITA presents most patients with significantly less pain
and a faster recovery.
Many parents whose children have had PITA surgery are
amazed at how quickly their children returned to normal
activities. We encourage you to read their stories, and
we hope this website will help answer many of your
questions about tonsils and adenoids.
Tonsil and adenoid removal is frequently performed to
treat chronic tonsillitis and recurring infection. But
obstructive sleep apnea (OSA) is now the most common
reason children have tonsil and adenoid surgery. This
occurs when swollen tonsils and adenoids interfere with
healthy breathing, particularly during sleep. It can
affect a child's behavior and ability to learn
significantly. In adults, OSA is linked to an increased
rate of auto accidents, hypertension and diminished job
performance.
At this site ,you'll find a wealth of information about
tonsils and adenoids. You can also learn about the PITA
technique a revolutionary yet simple way of performing a
tonsillectomy and adenoidectomy. Clinical studies show
PITA presents most patients with significantly less pain
and a faster recovery.
Many parents whose children have had PITA surgery are
amazed at how quickly their children returned to normal
activities. We encourage you to read their stories, and
we hope this website will help answer many of your
questions about tonsils and adenoids.
Tonsils
Every person has three types of tonsils, located in
different parts of the mouth area.
1. Palatine tonsils – located on
both sides of the back of the throat
2. Lingual tonsils – located at the base of the tongue
3. Pharyngeal tonsils, or adenoids – located high in the
throat, behind the nose .
The palatine tonsils are the tonsils that are often
removed for infection or obstructive sleep apnea. These
tonsils are round masses of lymph tissue that are
believed to assist the body in fighting off infection
during the early years of life.
Adenoids
What people commonly refer to as "the adenoids" is
actually a single clump of tonsillar tissue located high
in the throat, behind the nose. They are composed
primarily of lymph tissue, and serve to trap incoming
germs before they can cause harm. In addition, the
adenoids contain cells that make antibodies to help your
body fight off infection.
Because the adenoids are located so high in the throat,
the only way your doctor can see them is by looking
through a tiny mirror placed in your throat or a tiny
telescope placed in your nose.
Why are tonsils and/or adenoids removed?
While tonsils and adenoids aid in the body's ability to fight infection in the
first few years of life, they sometimes become detrimental to your health and
need to be removed. The most frequent problems associated with adenoids and
tonsils are:
1. Obstructive sleep apnea
2. Chronic,recurring infections of the ear(Otitis Media)
3. Chronic ,recurring infection of the tonsils
4. Chronic ,recurring infection of the tonsils
Occasionally, the tonsils or adenoids may need to be removed because of a benign
or malignant tumor, failure to thrive, bleeding tonsils, abnormal facial growth,
difficulty swallowing, speech impairment, or bad breath (halitosis).
How are tonsils and/or adenoids removed?
Years ago, tonsils were removed primarily to treat recurrent tonsillitis or
chronic strep throat. Now, obstructive sleep apnoea is the number one reason
tonsils are removed in children.
While more tonsillectomies on adults are performed to treat infectious problems,
many tonsillectomies are performed on adults for sleep apnea as well, often in
conjunction with other procedures to open the area in the back of the throat.
The adenoids are removed primarily because they harbor bacteria that can cause
recurring ear/sinus infections, or because they block the airway and contribute
to obstructive sleep apnea.
There are a variety of traditional surgical approaches that may be used to
remove tonsils and adenoids viz Gulletine method(Discarded long ago), Cold steel
or dissection method,radiofrequency, harmonic scalpel, bovie technique,Laser
tonsillectomy or laser assisted serial tonsillectomy. All these methods have
some or more disadvantages. A new technique called PITA (Powered Intracapsular
Tonsillectomy and Adenoidectomy is now being performed that offers most patients
reduced postoperative pain and a faster recovery than traditional methods.
What is the PITA technique?
Historically, a complete removal of the tonsils using traditional methods has
been the most widely accepted treatment for conditions such as obstructive sleep
apnea or chronic infection.
While this is generally effective and comparatively safe, conventional
tonsillectomy techniques routinely cause substantial postoperative pain and a
delayed return to normal diet and activity. This is believed to result from the
complete removal of tonsil tissue, which leaves delicate throat muscles totally
exposed to injury, infection, and inflammation.
But research has found that, in most cases, a near-complete (90 - 95%) removal
of tonsil tissue, along with extensive removal of the adenoids, provides a safe
and effective treatment, with significantly less postoperative pain and a faster
recovery.
Using this theory, researchers have developed the PITA technique (Powered
Intracapsular Tonsillectomy and Adenoidectomy).
How is PITA different?
Traditionally, a combined
tonsillectomy and adenoidectomy (T&A) procedure consists
of a tonsillectomy and a curette adenoidectomy. This is
typically effective and relatively safe, but it is less
precise and involves considerable postoperative pain.
Conventional approaches routinely remove 100% of the
tonsil tissue, which exposes the underlying throat
muscles to bacteria, thermal injury, and inflammation.
This is believed to cause the severe pain, slower
recovery and higher rate of complications associated
with traditional tonsillectomies
The severe pain after a conventional T&A prolongs
recuperation and can cause dehydration. The lack of
precision can lead to a hypernasal voice. The complete
removal of the tonsils can also contribute to delayed
postoperative bleeding following a traditional T&A
procedure.
The PITA technique utilizes a powered instrument called
a microdebrider (pronounced "MI-cro-dib-Ry-der"). The
microdebrider is a soft tissue shaver, has a tiny
rotating tip that offers the surgeon more precision and
control than traditional tonsil/adenoid surgery tools.
This allows the surgeon to remove the maximum amount of
obstructive or disease-causing tonsil and adenoid tissue
to treat the problem, precisely remove 90-95% of the
tonsils while leaving a very small amount of tonsil
tissue intact to protect the delicate throat muscles,
decrease postoperative pain, and shorten the
convalescent period.
The result: less pain, faster recovery, fewer
complications
For most patients, the PITA technique offers: less
postoperative pain, a more rapid recovery and return to
work or school, a faster return to a normal diet, and
fewer postoperative complications. Less postoperative
pain A conventional T&A completely exposes the
vulnerable throat muscles to bacteria, thermal injury
and inflammation, which increases swelling and pain. The
pain may be so severe that it causes dehydration and
inhibits normal drinking and eating. A curette
adenoidectomy may also unintentionally damage the
underlying muscle tissue, contributing to neck pain.
By leaving a thin layer of tonsil tissue intact and
controlling the depth of adenoid tissue removal, the
PITA technique protects the throat muscles, instead of
exposing them. This greatly reduces the pain most
patients experience after surgery.
More rapid recovery
Due to intense pain, a conventional T&A frequently
requires seven to ten days of recuperation. But the
recovery time with PITA surgery is typically less than
four days and may be as little as one or two days. So
children need less pain medicine and can go back to
school more quickly.
Faster return to a normal diet
When the pain is very severe following a traditional
T&A, children may not eat or drink normally until the
pain subsides. Sometimes this can lead to dehydration
that requires readmission to the hospital for
intravenous fluids. Because there is less pain with the
PITA technique, most children can return to normal
eating and drinking soon after PITA surgery.
Fewer postoperative
complications
The PITA technique offers precise control of tissue
removal, which helps protect nearby tissues from
unintended harm and reduces postoperative pain. Since
the throat muscles are protected and there is less pain,
children who have PITA surgery are less likely to
experience postoperative complications such as
dehydration, delayed bleeding and velopharyngeal
insufficiency (VPI)..
CONCLUSIONS
1. Tonsillectomy is a surgical procedure that carries
significant postoperative morbidity
2. To minimize postoperative morbidity various
techniques and adjuvant therapies have been studied
3. There are many options available and it behooves an
otolaryngologist to stay as up to date as possible
4. In PITA -Tonsil capsule is not violated,thereby
avoiding pharyngeal muscle exposure to secretions,injury
and inflammation. As a result postoperative pain and
recovery time is reduced.
5. Intracapsular tonsillectomy is safe and efficacious
in children under 3 years for tonsillar hypertrophy and
sleep disordered breathing without need for admission .
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