Choosing the best tonsillectomy technique: coblation versus traditional surgery
Tonsils can be removed with a variety of techniques when treating conditions such as obstructive sleep apnoea, sleep-disordered breathing, snoring or tonsillitis. The best approach for you or your child will depend on whether the underlying issue is frequent infection of the tonsils or blocked airways due to enlarged tonsils.
What are tonsils and why do they need to be removed?
Tonsils are clusters of lymph tissue that sit either side of your throat at the back of your mouth. They protect your body against infections that enter through the mouth and nose. But while tonsils are meant to protect our health, they can sometimes become a cause of health issues.
Tonsillitis occurs when the tonsils become infected, causing swelling, redness, pus, pain and fever. Tonsils can be enlarged due to infection, allergies, or irritants; and sometimes you can be born with large tonsils. Enlarged tonsils can block airways, leading to disrupted sleep, breathing issues, and poor concentration or hyperactivity during the day.
If you or your child have recurrent tonsillitis, where the tonsils become frequently infected, or tonsils that block your airways, then removing your tonsils in an operation called a tonsillectomy can significantly improve quality of life.
Complete tonsil removal for infections
When there is a high burden of tonsil infection, Dr McKenzie recommends complete removal of the tonsils, including their capsule (the covering of the tonsil). This technique, known as an extracapsular tonsillectomy, is most effective in stopping recurrent bouts of tonsillitis. Removing the entire tonsil reduces the chances of infection returning, as no tonsil tissue is left behind.
Recovery from a tonsillectomy takes 10-14 days, and it’s recommended to take two weeks off school or work to help with recovery. While it does involve discomfort and an interruption to normal activities, the long-term benefits usually outweigh the short-term challenges for patients who suffer from repeated infections.
A different technique for airway obstruction
In cases where the issue is airway obstruction due to enlarged tonsils, Dr McKenzie offers a surgical technique that results in less pain, less bleeding and a faster recovery. This procedure is known as coblation intracapsular tonsillectomy.
What is coblation?
Coblation stands for “controlled ablation”. Ablation is a medical term meaning to remove tissue, so coblation refers to the controlled removal of tissue. In the case of a tonsillectomy, coblation involves using a special instrument to precisely remove tonsil tissue at cooler temperatures (40-70°C) than other technologies like electrocautery (400-600°C). Because coblation works at cooler temperatures, it causes less damage to surrounding tissues, resulting in less pain and quicker healing.
How is coblation intracapsular tonsillectomy different?
Unlike traditional tonsillectomy techniques, which remove the entire tonsil and its capsule, coblation intracapsular tonsillectomy removes most of the tonsil tissue but leaves a small area near the tonsil capsule.
What are the advantages of coblation intracapsular tonsillectomy?
This technique is gaining popularity because of its numerous benefits, particularly for children:
Less post-operative pain compared to traditional techniques
Earlier return to a full normal diet, often within just a few days
Quicker return to normal activities, with most children back to school within a week, as opposed to needing two weeks off
Reduced need for returning to hospital for more strong pain relief or fluids
Are there any disadvantages of coblation intracapsular tonsillectomy?
Because a tiny bit of tonsil tissue is left behind in the tonsil capsule during a coblation intracapsular tonsillectomy, there is a small (up to 3 in 100) chance that the tonsils may grow back. If this happens and tonsil problems recur, you may need surgery again in the future.
Who is this technique not suitable for?
Coblation intracapsular tonsillectomy is not suitable for all people with tonsil problems. If the primary issue is recurrent tonsillitis, rather than airway obstruction, Dr McKenzie recommends full removal of the tonsils, including the tonsil capsule. This is usually the best choice to prevent infections from occurring again. Dr McKenzie assesses each patient as an individual and recommends a technique based on your needs.
Where does Dr McKenzie operate?
Dr McKenzie operates at Brisbane Private Hospital in Spring Hill, Mater Children's Private Hospital/Mater Private Hospital in South Brisbane, and Greenslopes Private Hospital in Greenslopes for both paediatric and adult patients.
These hospitals all offer excellent paediatric nursing care support, and Dr McKenzie only uses specialist paediatric anaesthetists for your child’s procedure. This means that you can be assured that your child is in the safest possible hands as it takes a dedicated and comprehensive team of specialist nurses and doctors to safely provide paediatric ear, nose and throat surgery. Dr McKenzie has chosen these hospitals based on their ability to provide the highest level of care to your child.
For adult patients, Dr McKenzie selected these hospitals due to their access to intensive care units and the most modern facilities and resources to ensure the best experience for your procedure.
Are there alternatives to surgery?
Fully or partially removing the tonsils is generally the best treatment for tonsil problems. Antibiotics are not particularly effective in treating tonsillitis, and if tonsillitis recurs, then the risk of frequent antibiotic use needs to be weighed up against the risk and potential benefits of a tonsillectomy. For enlarged tonsils, the only option to correct issues with airway obstruction is full or partial removal of the tonsils.
What are the risks of surgery versus the risk of not removing the tonsils?
While all surgeries carry some risks, these are well understood and carefully managed by specialist doctors and nurses. It’s important to remember that leaving a chronic condition untreated can lead to worsening health problems that may become more difficult to treat over time. Dr. McKenzie will only recommend surgery when the expected benefits clearly outweigh the potential risks.
