All of these conditions can be caused by the tonsils – swellings of glandular tissue at the back of the throat.
Tonsillitis in adults can also be linked to other diseases such as psoriasis, bowel problems, mouth ulcers, joint aches, lethargy, Myalgic Encepahilits (ME) and chronic fatigue syndrome.
Mr. Mike Dilkes provides the most current, optimal testing and treatments for tonsil and tonsil stones removal, based on medical research and consultations with leading experts in the USA and Germany.
Laser vapourisation micro-tonsillectomy usually involves minimal blood loss, and can be relatively safely performed inpatients who are completely against possible blood transfusion (e.g. Jehovah’s Witness patients). It is done under magnification using the operating microscope and micromanipulator.
The intracapsular removal of approximately 95% of the tonsil tissue means that this procedure is effective. Also, since the tonsil capsule is intact, it is safer than dissection (bipolar, etc.) tonsillectomy, where the capsule is completely removed, as the major vessels to the side of the tonsils (paratonsillar vein, superior and inferior tonsillar arteries, ascending pharyngeal artery) are not exposed.
Micro-laser tonsillectomy for adults – an intracapsular technique
In adults, we recommend the intra-capsular flash scanned or computerised pattern generator (CPG) Carbon Dioxide laser procedure, either under local anaesthetic (tonsillotomy) or general anaesthetic (tonsillectomy).
Tonsillotomy is a partial removal of the tonsils under local anaesthetic (spray – no injections). This is a lunchtime treatment – go to work in the morning, have it performed at lunchtime and go back to work in the afternoon. There is usually little post-operative pain and often no time off work is required at all.
However, only 40-80% of the tonsils can be removed at any one time (depends on their size at the start – big tonsils need more treatment), so more than one procedure can be required.
Micro-laser tonsillectomy under general anaesthetic is a same-day procedure where patients are kept in hospital under observation for 4 hours post-op. This technique removes around 95% of the tonsils in one attempt, so the need for a second procedure is much lower (2%). Time off work is kept to a minimum, generally it is 48 hours after surgery. There is some pain, which lasts around 7 days post-op, but as soon as the patient is over the anaesthetic, and if tolerating the prescribed painkillers well (Diclofenac and Co-Dydramol), then return to normal life is usually possible.
Ideally, surgery is performed on a Friday, so the weekend is spent recovering, and Monday back to work.
Our studies ( in particular, a single blind, matched, controlled study) and patient feedback have confirmed to us that the intracapsular Carbon Dioxide laser tonsillectomy using a flash scanner or Computerised Pattern Generator (CPG) – in conjunction with an operating microscope and micromanipulator – is much less painful during the entire postoperative course compared to traditional tonsillectomy.
Post-operative pain lasts for 5-7 days, and patients usually eat normally (79% said their diet did not change in a review of cases), returning to work around 2 days after the operation. Furthermore, the post-operative bleeding risk is dramatically reduced.
Only two patients have needed to return to surgery for bleeding out of our series of over 1,000 people treated. Both of these patients bled despite having been well and at home for 5 days – they developed an infection, antibiotics don’t seem to help this (Cochrane review). They were both fine
This dramatic pain reduction is due to the tonsil capsule being kept intact – meaning that the throat muscle and blood vessels around the tonsil are not exposed. The flash scanned Carbon Dioxide laser is the best instrument we know to do this, as it is quick and bloodless.
Very large tonsils may need a two-technique procedure, where the tonsils are debulked using monopolar diathermy, then lasered. This is more painful than a standard laser micro-tonsillectomy.
The only downside of this technique is that small remnants of tonsil tissue are left behind. These may need further surgery, although it is rarely that this is required (1:50 cases). All of our patients go home on the day of surgery, after 4 hours (DayCase surgery). Hospital-generated statistics show that our overnight stay is 0%, as is our readmission rate. Source: The Hospital of St John and St Elizabeth, Spire Roding Hospital.
Tonsillectomy for children under general anaesthetic
In children, a bipolar, non-laser dissection is used, since young children generally have little problem with dissection techniques. Children are also treated as day cases when this technique is used. Local anaesthetic injections around the tonsil bed are given at the end of the operation. This means that as they wake up they are not in any pain, and this helps them to settle quickly.
Children over age 8 can be treated with the laser technique, since the dissection technique becomes increasingly painful after age 6 or 7. In children, it appears that the revision rate (need for a redo) is higher than in adults, since they seem to have more active tonsil tissue, so the small remnants are more likely to cause problems.
Even more painful than tonsillitis, quinsy is an abscess on the outside of the tonsil, causing spasm of the jaw muscles, ear pain and an almost complete inability to swallow. It is usually on one side only, and is often triggered by tonsillitis. In acute cases, treatment is by draining pus and giving intravenous fluids and antibiotics. Hospital admission for a few days is required.
Surgical treatment of quinsy
We recommend a general anaesthetic and an intracapsular laser vapourisation tonsillectomy, in which the tonsil is vapourised using the flash scanned Carbon Dioxide laser. Vapourisation is extended into the abscess cavity to exteriorise it so that repeated infections cannot occur.
A tonsil which is enlarged on one side, persistantly painful, sometimes with ear pain, bleeding and swallowing problems, might be cancerous and needs to be looked at urgently.
Initially an ENT consultation and an MRI scan are the minimum requirement. If these suggest cancer, a microscope controlled wide excision of the tonsil with the Holmium-YAG laser can be an effective way to completely remove the cancer in a rapid and bloodless manner. On many occasions, patients can avoid further treatment with more radical surgery, chemotherapy or radiotherapy.