'Less pain' to remove tonsils

A 10-year study from Flinders University has found 'shrinking' tonsils results in far less pain and bleeding than a full tonsillectomy.

The research paper, published this month in the Australian and New Zealand Journal of Surgery, looked at 608 children who underwent tonsil surgery between 2008 and 2018.

Children who had their tonsils reduced with a small portion left intact, returned to normal activities after an average of 4.6 days compared to 11.1 days after a full tonsillectomy.

They were also three times less likely to have any form of bleeding and eight times less likely to have a serious bleed requiring readmission to hospital, says Flinders University lead researcher Professor Simon Carney, who has introduced the procedure at in ENT (ear, nose and throat) practice in South Australia.

"Recurrent tonsillitis is much less common than in the past. By far, the most common reason for tonsil surgery is now obstruction, most commonly causing snoring and sleep issues, as well as speech and eating problems in some cases," says Professor Carney.

"A full tonsillectomy exposes the muscles of the throat, causing pain and a higher risks of bleeding. By removing 90-95% of the tonsil and leaving a small crescent-moon of tissue intact, it leads to much less pain and bleeding, which obviously allows kids to go back to childcare or school so much earlier as well as reassuring parents there is much less risk of a tonsil hemorrhage," says co-lead researcher Sara Attard.

The procedure, often called a "sub-total tonsil reduction" or "tonsillotomy," was pioneered in Scandinavia and is now also commonly performed in the USA and elsewhere in the world.

"It takes longer than a full tonsillectomy but our data have shown the benefits are just so great, we believe parents need to be aware of this option," says Professor Carney.

The 10-year review study, "Pediatric patient bleeding and pain outcomes following subtotal (tonsillotomy) and total tonsillectomy: a 10-year consecutive, single surgeon series' (2020) by S Attard and AS Carney from the College of Medicine and Public Health, Flinders University has been published in ANZJSurg (Royal Australasian College of Surgeons) DOI: 10.111/ans.16306.

Key points

• After a full tonsillectomy, the muscles of the throat are uncovered, exposing nerves and blood vessels which cause pain and a risk of bleeding. With subtotal tonsil reduction or 'tonsillotomy' a rim of tonsil tissue is preserved, reducing pain and with much less risk of bleeding.
• Of the 608 children studied, those left with a small portion of their tonsils left intact returned to normal activities in less than half the time usually taken after a full 'tonsillectomy."
• They were also three times less likely to have any form of bleeding—and eight times less likely to have a serious bleed requiring hospital readmission after a tonsillotomy.
• Tonsillectomy is one of the most commonly performed ear, nose and throat procedures with more 35,000 tonsillectomies performed per year in Australian patients aged 17 and under. The main risks following total tonsillectomy include hemorrhage and a prolonged return to regular activity due to pain.