The study on 54,696 patients shows that tonsil surgery provides very effective symptom relief!

The newest study by members of the National Tonsil Surgery Register in Sweden analyzed data from 54,696 patients operated with tonsil surgery (tonsillectomy) between 1997-2008. The purpose of this study was to analyze symptom relief 6 months after tonsil surgery in relation to age, indication, surgical procedure, complications and unplanned postoperative visits.

Tonsillectomy is a procedure in which palatine tonsils (part of our immune system) are surgically removed from the throat. This procedure is performed in response to repeated episodes of acute throat infections, snoring, obstructive sleep apnea (interruptions of breathing during sleep caused by partial or total blockage of the airway), or peritonsillar abscess (a.k.a. quinsy - collection of pus beside the tonsil).

In described study by Swedish authors, the most common indications for surgery were obstruction (49.7%), followed by recurrent bouts of throat infections (35.2%). The main outcome measure was the patient (or parent) reported symptom relief 6 months postoperatively.

Results of the study were that - for all indications - the symptom improvement was very high (92%)! This was defined as the patient reporting ‘my symptoms are gone’ or ‘my symptoms are almost gone’. The symptom improvement was the highest for patients operated on the indication peritonsillitis (more than 98%). The indications of obstruction, recurrent tonsillitis or chronic tonsillitis also reported a high degree (more than 96%) of symptom relief.

Tonsillectomy is one of the top 3 most common surgical procedures performed in children, and one of the top 10 surgical procedures performed in total population, with estimated annual incidence of 650 per 100,000 people. With such a high numbers of children and adults undergoing tonsillectomy, this study is valuable support to this procedure showing that operated patients report a high degree of symptom relief 6 months after surgery!

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REFERENCE:

Stalfors J, Ericsson E, Hemlin C, Hultcrantz E, Månsson I, Roos K, Hessén Söderman AC. Tonsil surgery efficiently relieves symptoms: analysis of 54696 patients in the National Tonsil Surgery Register in Sweden. ACTA OTO-LARYNGOLOGICA 2012;132(5):533-9.

Thyroid Gland Surgery 2: What You Are Likely To Experience With Thyroid Surgery?

There are two main types of thyroid surgery. Total thyroidectomy includes complete removal of the thyroid gland. For thyroid cancer, this is the most common type of surgery. It can be also used for goiter and hyperthyroidism treatment. Thyroid lobectomy includes removal of half of the thyroid gland. For this procedure to be performed, cancer must be small, non-aggressive and contained to one side of the gland. It is also used for treatment of non-malignant changes of the thyroid (like cyst, adenoma, or one-lobe goiter).

In most cases, surgery of the thyroid is not very complicated, and patients recover fast. I prefer to perform thyroid surgery with the use of harmonic scalpel, a novel instrument that cuts tissue and stops bleeding at the same time, so there is almost no blood loss during the surgery. Additionally, by using harmonic scalpel I do not need ligatures to seal the blood vessels, so the introduction of foreign bodies in the operative field is obviated. Removal of half of the thyroid will take 30-45 minutes, so if the entire gland is being removed the surgery will last about an hour to hour and a half. In most of patients, neck scar is just 2-4 cm long, and almost invisible couple of months following thyroidectomy.

One-month postoperative appearance of scar after thyroidectomy 

Numerous studies have shown that complications are more likely with surgeons who have less experience performing thyroid surgery, so it is very important that your surgeon performs thyroid surgery on a constant basis (at least 30 procedures per year). Thyroid surgery is generally considered extremely safe, but depending on your condition, an overnight or two-night hospital stay may be planned. There are some common short-term side effects after thyroid surgery such as discomfort when swallowing, and neck stiffness. Most patients can slowly walk even couple of hours following the procedure. Potential complications of the surgery are postoperative dysfunction of parathyroid glands or hoarseness, but most of them are transient and resolve within a week or two. In cases when total thyroidectomy is performed, lifelong thyroid hormone replacement therapy is required.

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Thyroid Gland Surgery 1: Reasons for Thyroid Surgery

The thyroid gland is located in the middle of the neck (above the trachea) and is shaped like a butterfly. It is an endocrine gland – the part of the endocrine system - and produces and releases hormones into the bloodstream. The main hormones produced by thyroid gland are thyroxin and triiodothyronin (T4 and T3) and they play a major role in regulating the body's metabolism. If these hormones are not produced in sufficient amounts, the body’s metabolism can be lowered by 40%!

If you are experiencing problems that may be caused by thyroid dysfunction (like fatigue, sleepiness, constant feeling cold etc.) your physician may order the thyroid hormone analysis. A condition in which the thyroid gland does not make enough thyroid hormones is called hypothyroidism. On the other side, condition in which the thyroid gland produces too much of thyroid hormones is called hyperthyroidism, and is characterized by overactive metabolism (insomnia, nervousness, overactive sweating, handshake, problems with heart rhythm etc.). In cases in which hyperthyroidism cannot be treated with medications, surgical removal of the part of the thyroid gland is the option.

Goiter is a term that refers to any enlargement of the thyroid gland and can be associated with a gland that is functioning properly or not. Worldwide, over 90% cases of goiter are caused by iodine deficiency. For particularly large masses, compression of the local structures (larynx, trachea, esophagus) may result in difficulty in breathing or swallowing, and in these cases surgical removal of the mass will help.

Today, the most common reason for the thyroid gland surgery is the nodule in the thyroid – but not every nodule discovered in the thyroid should be the reason to perform a surgery! About 5 to 10 percent of adults may have lumps in their thyroid that can be palpated by fingers on a simple physical exam, but with the aid of high-resolution imaging techniques nodules can be discovered in 30-40 percent of adults!

Ultrasound image of thyroid nodule (arrow) 

Thyroid gland is best evaluated using high-resolution ultrasonography. If one or more nodules are detected within the thyroid gland, doctor who specialize in neck ultrasonography will recognize detailed features of these nodules, like shape, vascularity, calcifications, diameter, and density. Some features are strongly suggestive that a nodule is benign in nature, and some raise concern that the nodule may be a cancer. In some cases it is impossible to distinguish between benign and malignant nodules with complete certainty. In these cases fine needle aspiration biopsy and review of tissue under a microscope may be recommended for further evaluation.

If a fine needle aspiration biopsy proves the diagnosis of cancer or further raises suspicion that the nodule may be a cancer, it is necessary to surgically remove a thyroid. An operation that involves the surgical removal of all or part of the thyroid gland is called a thyroidectomy. If treated on time, majority of thyroid cancer patients have an excellent prognosis. With the aid of surgery, and postoperative iodine treatment, cured are more that 95% of patients!!

Dr. Sasa Janjanin is double European Board-certified in ENT and Facial Plastic Surgery. He extensively trained in complete surgical and medical treatment of patients with disorders and diseases of the head and neck. However, his major expertise is in facial plastic, aesthetic and reconstructive surgery; problems related to thyroid and parathyroid glands; skin cancer; kid’s ENT problems; nose, sinus and snoring complaints; and sport and diving-related ENT problems.

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