Tonsil removal (tonsillectomy) using COBLATION™ Plasma Technology at Warwickshire Hospital

Tonsillectomy is an operation to remove your tonsils, the two small lumps of tissue at the back of your throat that help fight infection. Coblation is one way surgeons do this: it uses radiofrequency energy and a plasma field, rather than a blade, to remove some or all of the tonsil tissue.

What conditions does it treat?

Tonsillectomy is used for a number of tonsil-related problems, including:

• Frequent or long-lasting bouts of tonsillitis, causing sore throats, fever and difficulty swallowing
• Breathing problems during sleep caused by swollen tonsils, such as snoring or obstructive sleep apnoea
• A repeated or persistent abscess around the tonsil, sometimes called quinsy
• Rarely, cancer affecting the tonsil.

It's more often needed in children, since tonsils are naturally larger in childhood and tend to shrink with age, though adults can need the operation too.

What are the benefits of having a tonsillectomy?

The main benefits reported are better sleep quality, fewer throat infections, and an improved quality of life day to day. General health often improves too, since removing the tonsils stops the repeated cycle of infection.

You may still get the occasional sore throat afterwards, but episodes tend to be far less frequent. Where swollen tonsils were narrowing your airway, removing them can also ease breathing problems such as snoring.

Are there different types of surgical approach?

There are two broad approaches, based on how much tonsil tissue is removed.

A traditional tonsillectomy removes the whole tonsil, while an intracapsular tonsillectomy removes the affected tissue but leaves a thin layer, called the capsule, in place to protect the throat muscles underneath.

Intracapsular surgery carries a small risk of the tonsil tissue regrowing and causing further tonsillitis, which occasionally needs further surgery.

Surgeons can use different instruments to do this. Coblation uses radiofrequency energy passed through a saline solution to create a small plasma field, which can remove some or all of the tonsil tissue without a blade.

Other methods include heat-based tools such as electrocautery or diathermy, a powered shaver called a microdebrider, or traditional surgical scissors.

What happens before the operation?

Before your operation, you'll have a consultation to discuss your medical history, symptoms and any concerns, and you may need blood tests or other checks to confirm you're fit for surgery.

• Follow any instructions about stopping certain medicines several days beforehand
• Stop eating and drinking from the time you're told, usually from the night before, since you'll have a general anaesthetic
• Flag any loose, capped or crowned teeth to your surgical team beforehand
• Arrange for someone to take you home afterwards, since you won't be able to drive
• For children, try to keep them calm and explain simply what to expect before, during and after the operation.

What happens during the procedure?

The operation usually takes around 20 to 45 minutes, longer if it's combined with another procedure such as removing the adenoids. It's carried out under general anaesthetic, so you're asleep and won't feel pain, and follows these general steps:

1. Your mouth is held open so your surgeon can see your tonsils clearly – the operation is done through your mouth, so there are no external cuts or scars
2. Your surgeon removes the tonsil tissue – with Coblation, this is done using radiofrequency energy and a plasma field, which can remove some or all of the tonsil depending on the approach used
3. Bleeding is controlled as the tissue is removed, using techniques such as heat (diathermy) or the Coblation device itself
4. Any wound is closed, often with dissolvable stitches, or left to heal naturally, depending on the technique used.

What does recovery look like?

Tonsillectomy is usually done as day case surgery, so most people go home the same day, once they're eating and drinking again and have been watched for a few hours for any signs of bleeding.

An overnight stay is sometimes needed, particularly for younger children or if there's a higher risk of complications.

Recovery tends to take longer for adults than for children: children often feel back to normal within about a week, while adults usually need around 2 weeks. During the first few days, expect a sore throat, bad breath, tiredness, and sometimes earache, since the tonsils and ears share some of the same nerves.

Drinking plenty of fluids and eating soft, cool foods, such as ice cream, yoghurt or mashed potato, helps keep you comfortable and supports healing.

Pain relief, taken regularly and around half an hour before meals, makes eating and drinking easier, and any prescribed antibiotics should be taken as a full course.

Most people need around 7 to 14 days off work or school. During this time, try to avoid large crowds, people with coughs and colds, and smoky or dusty places, since your throat is more vulnerable to infection while it heals.

What are the risks and complications?

As with any operation, there are risks to be aware of. Your surgical team will talk you through these, but the ones reported most often include:

• Bleeding, either during the operation or in the two weeks afterwards. This is uncommon but needs urgent medical attention if it happens, especially if you notice yourself swallowing more than usual
• Infection in the wound, sometimes with a high temperature of 38.5°C or above
• Dehydration, if pain makes it difficult to drink enough fluid
• A reaction to the anaesthetic
• Changes to your sense of taste
• Damage to the lips, tongue or teeth, particularly if you have loose, capped or crowned teeth
• Needing a further procedure, for example if bleeding continues or tonsil tissue regrows after an intracapsular operation.