I am an adult considering having my tonsils removed because I'm tired of the constant infections in my tonsils. What are the risks of the procedure?

S.T.

First, surgical removal of the tonsils (tonsillectomy) may not be your only option.

The main risks of tonsillectomy are pain, dehydration and bleeding. The pain tends to be worse in adults than in children. The pain causes patients to avoid eating and drinking, and that leads to dehydration. In fact, dehydration INCREASES pain, and so it is possible to fall into a vicious circle of pain, poor oral intake, dehydration, MORE pain, LESS oral intake, MORE dehydration and so forth. Bleeding also seems to be more common in dehydrated patients, in my experience.

Bleeding deserves special mention. Bleeding can certainly occur during the operation, but this is usually not too worrisome. The surgeon takes care of it immediately. Bleeding can also occur as you are waking up from the anesthetic. This is unfortunate when it occurs, but it is usually only an inconvenience. You will be placed under a second general anesthetic, and your surgeon will promptly control the bleeding.

No, the really nasty bleeding is that which most commonly occurs seven to 11 days AFTER surgery. We think this is the time when the "scab" first begins sloughing off. Approximately one in 20 patients will experience a significant degree of bleeding at this time. What is "a significant degree of bleeding"? Enough that you will feel compelled to call your doctor, or go to the emergency room. (By the way, "seven to 11 days" is only the most common interval. I have heard of folks who bled 20-30 days after surgery! This, fortunately, is very rare.)

Late bleeding is more common among patients over age 11 and those with a history of chronic tonsillitis. It is a worrisome problem. If the bleeding does not stop on its own, or if it is not easily treated in the emergency room, you will have to undergo another general anesthetic so that your surgeon may stop the bleeding. In contrast to the tonsillectomy, this time you will probably NOT have an empty stomach. At the very least, you will probably have swallowed some blood. This is hazardous, since you could vomit and aspirate (choke on) this blood while you are being placed under anesthesia. Anesthesiologists have ways of coping with this situation, but I have never met one who did not dread these cases to some degree.

This is just a brief discussion of the surgical risks. I recommend that you discuss them thoroughly with your surgeon.