Shrinking Tonsils Versus Full Tonsillectomy

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A 10-year study between 2008 and 2018 from Flinders University revealed that "shrinking" tonsils are a better option than a full tonsillectomy due to less pain and bleeding.

The procedure, also known as "sub-total tonsil reduction" or "tonsillotomy," was pioneered in Scandinavia but has increasingly become popular in the USA and elsewhere in the world.

Although the procedure takes longer to perform than a full tonsillectomy, the benefits were greater which is why more people need to be aware of the availability of this option.

The study's findings show that children who did not undergo full tonsillectomy, but only had their tonsils reduced with a small portion left intact, were able to resume normal activities within an average of 4.6 days compared to 11.1 days with those children who underwent full tonsillectomy.

According to Professor Simon Carney, lead researcher of Flinders University, these children were also three times less likely to experience any form of bleeding and eight times less likely to require readmission to the hospital due to the incidence of serious bleeding. 

Performing tonsil surgery is usually due to obstruction problems, such as snoring and sleep issues, and speech and eating problems. It is less common nowadays to perform surgery due to recurrent tonsillitis, according to Professor Carney.

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Full Tonsillectomy Versus Tonsillotomy

Total tonsillectomy is one of the most common ear, nose and throat (ENT) procedures performed among children.

Sara Attard, co-lead researcher, said that with a full tonsillectomy, the throat muscles are exposed which can cause more pain and higher risks of bleeding. If only a portion of the tonsil was removed (90-95%), and a small crescent-moon of tissue remains intact, it can cause less pain and bleeding. Parents would be reassured that there is less risk for tonsil hemorrhage and kids can go back to school so much earlier. 

Some findings show that children reported less pain within 2 weeks after surgery, fewer swallowing and sleeping problems, compared to tonsillectomy. 

However, after tonsillotomy, the regrowth of tissue may cause further problems like a recurrence of inflammation after several years down the road may require renewed surgery.

Currently, there is still insufficient data on renewed tonsillar surgery, which is why the benefit or harm of tonsillotomy in comparison with tonsillectomy can not yet be determined.

Indication of Tonsil Surgery

The reasons why children and adolescents require tonsil surgery are usually due to recurrent acute tonsillitis and enlargement (hyperplasia) of the tonsils. When there is an inflammation of the tonsils (tonsillitis) caused by viruses or bacteria, it is usually accompanied by pain, swallowing problems and fever. With tonsillar hyperplasia, it can cause narrowing or obstruction of airways and lead to sleeping problems like sleep apnea or breathing problems while sleeping.

When you're looking at the short-term basis, tonsillotomy may be advantageous over tonsillectomy since it can also improve obstructive symptoms, quality of life and postoperative immune function. However, in the long run, due to the rate of sleep-disordered breathing recurrence, tonsillotomy's dominance may be less than tonsillectomy.

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