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A Revolutionary Treatment For Tonsillitis
What are tonsils?
Tonsils are the two lumps of tissue, each about the size and shape of a large olive, in the back of your throat on either side of your tongue. The tonsils and adenoids form a ring of tissue in the back of the throat. If the tonsils and adenoids are large, they narrow the airway and reduce the flow of air into and out of the lungs. A swollen tonsil may cause snoring, breathing problems and even sleep apnea. Tonsils are lymphoid tissues - the type of tissue that the body uses as a defense mechanism to fight infections. Lymphoid tissues are present all along the lining of the nose, mouth and throat as well as in the neck, groin, and armpits. As you get older, the tonsils become less important in your body's defense system. They also become smaller. If the tonsils get infected often in your teenage years, then your tonsils may continue to be swollen even when you reach adulthood.
Do tonsils play in role in protecting us from infections?
Yes! But mostly when you were a baby. In the first two to three years of childhood, these tissues "catch" infections, sampling the individuals environment to help develop childhood immunities (antibodies). They make a small portion of the body's defense systems and almost vanish, as we get older. In some cases they can catch incoming germs, which cause infections. They can get infected often and swollen enough to touch each other in the back of the throat. They are sometimes so large that they touch each other from side to side, also known as "kissing" tonsils.
What would happen if I had my tonsils removed?
A medical study has shown that children who suffer from frequent episodes of tonsillitis (such as 3-4 times each year for several years) were healthier after their tonsils were surgically removed. It is important to know that children who must have their tonsils and adenoids removed suffer no loss in their body resistance to infections.
We will discus a new method of treating tonsils in detail later in this site. If you are a physician or surgeon and would like to see the detail please read the Tonsillar Radioablation.
Tonsillar Radioablation
What are the benefits of the new tonsillar ablation with radiofrequency (Coblation) procedures?
· It is easy
· Done in the office
· Generally there is minimal bleeding
· Minimal to moderate post operative pain
How is tonsillar ablation done?
The procedure is normally done in the office. Local anesthesia is used in all cases in combination with IV sedation. A radiofrequency probe is placed in 4-6 locations in the tonsils. The probe is kept in position for only 10-15 seconds. Patients are discharged with a prescription for antibiotics and a special mouthwash and a rinse. Patients can return to work immediately after the procedure. (If you would like the details of the procedure please see the tonsillar radioablation article)
Do I need to stay overnight in the hospital after a tonsillar ablation?
No! One of the greatest features of this new procedure is that you can go home immediately after the procedure. This procedure is currently being done exclusively at Dr. Madani's office.
What can I eat after tonsillar ablation?
Following tonsillar ablation, a soft food diet is recommended for few days after surgery then you can return to normal food.
What should I expect after tonsillar ablation?
You should expect a mild to moderate sore throat for a few days. Antibiotics will be given to you to prevent infection. Please make sure to use it! A special prescription mouthwash will be given to you to rinse out your mouth. Healing will be completed within 12 weeks. A second procedure may be needed depending to the size of your tonsils. Any questions or concerns you have should be discussed openly with us. We are here to assist you.
Is this procedure covered by my insurance?
No. This procedure, although helpful in the reduction of enlarged tonsils, is considered cosmetic.
Tonsillar RadioAblation Article
Scientific Paper- This an exert from published article: Modified for better understanding
Author: Dr. Mansoor Madani
Introduction:
Although there has been a significant drop in number of tonsillectomies performed annually in children, there are millions of adults that suffer from chronic irritation of the tonsils. Enlarged tonsils are one of the contributing factors in obstructive sleep apnea. Many complications have been reported with traditional tonsillectomies, including infection, bleeding, dehydration, angular cheilitis, Dysgeusia, pulmonary edema and loss of time from work or school.
Background of tonsillectomy:
There have been varieties of methods advocated to resect the tonsils including the use of guillotine, electrocautery, laser and bipolar
scissor. In early 1999, the author introduced tonsillar radio-ablation. Hundreds of patients were treated with a similar procedure for palatal radio-ablation. Patients were seen for the treatment of enlarged tonsils because of chronic inflammation, (multiple) tonsillitis, multiple Strep throat infections requiring frequent antibiotic treatment, obstruction of the airway, and snoring problems. Other considerations were chronic tonsillar hyperplasia, with tonsillar crypt causing further accumulation of food and bacteria leading to infection and halitosis. It must be emphasized to patients that RF procedures primarily reduce the tonsillar size and are not designed to remove the tonsils. The debulking process may require repeat sessions later for further reduction of the tonsils.
Tonsillar radioablation (Tonsillar channeling procedure)
There are certain precautions that are recommended with this procedure to avoid complications. Starting two days prior to the surgery, patients are placed on antibiotic prophylaxis, or IV administration of antibiotics one hour prior to surgery for a non-infected and non-inflamed tonsil. Chlorohexidine (Peridex®) mouth rinse is given several days prior to surgery and patients are asked to continue to use it twice daily for at least two months post-operatively. Assurance is made to identify and manage any pre-existing infection, fever and sore throat.
The patient is placed in the supine position. Chlorohexidine (Peridex®) mouth rinse is given to the patient to keep in the mouth, gargle and rinse for one minute. Two-3 ml of Marcaine 0.5% with 1:200,000 Epinephrine is injected into the base of the tonsil starting in the lateral part of the soft palate and extending to the area of the lateral wall of the pharynx (tonsillar bed). A plastic double-cheek retractor is placed on the inside of the cheek to give the best visualization and also to protect the patients lips.
The Coblation® unit is set to 6 and the Coblation® Reflex wand 55 is used to deliver the appropriate energy. A conductive saline gel is used and applied to the entire uninsulated portion of the probe and is placed on the most prominent surface of the tonsil (Figure 7). The foot pedal is used for a short period of time to activate the unit and to insert the probe into the tonsil. Superficial heating of the tonsillar mucosa must be avoided to prevent superficial erosion. This procedure is a submucosal procedure and does not include resection of the tonsils in most cases. Once the un-insulated probe is completely inserted in a horizontal direction, the energy is applied for approximately 10-15 seconds. The same procedure is repeated four to six additional times on that side. This step is repeated on the other side.
TONSILLAR RADIO-ABLATION POST-OP CARE
Patients are carefully monitored and evaluated for need of additional procedures. The patients are advised that the healing process takes up to three months following surgery and additional treatments may be necessary. These procedures do not remove the tonsils in their entirety nor do they cure sleep apnea. They will not necessarily prevent a common cold or future Strep infections. The patients are discharged after assurances are made that there is no bleeding and the detailed explanation of the postoperative instructions are given.
Generally, a prophylactic antibiotic, such as Cipro® (Ciprofloxacin hydrochloride, Bayer Corp, West Haven CT), Keflex® (Cephalexin, Dista Products, Co., Indianapolis, IN) or Cleocin® (clindamycin hydrochloride, Pharmacia & Upjohn, Peapack, NJ), is given to the patient prior to the surgery, and patients must continue to take it for a period of 10 days after the procedure. Additionally, they are asked to use a Chlorohexidine mouth rinse twice daily for a period of two months following surgery and a regular mouth wash as often as possible. Pain medication is generally limited to an over-the-counter pain reliever. A sensation of tightness in the back of the throat is normal for the first week after the procedure. Patients are advised to return in one week unless there was a need to return earlier and weekly then after.
TONSILLAR RADIO-ABLATION RESULTS
One hundred eighty-seven patients (please not these patients were amongst our earliest cases treated the total number of cases performed at present time are much higher) , with age range of 13-56 were treated in an office setting with the Coblation® channeling to reduce tonsillar bulk. The group was comprised of 124 (66%) male and 63 (34%) female patients. Thirty-nine percent of patients were treated because of frequent tonsillar infections and 61% were treated to alleviate the symptoms of obstructive sleep apnea. Patients were followed up from three months up to two years with an average of 15 months. There was no bleeding during or after the procedures. Two patients developed a recurrence of their tonsillar infection up to 6 months after surgery. The discomforts were minimal and, if needed, patients were advised to take over-the-counter pain relievers. All procedures were done in an office setting with average duration of procedures under 30 minutes. All patients treated reported no voice changes or fluid reflux. The day after the procedures, 100% of patients returned to work or school.
Why We Snore
We all snore occasionally, but in most cases it is a problem that self-corrects and does not bother anyone. In some, it is compounded by a deadly condition of impeded breathing. Basically, you stop breathinganywhere from a few seconds up to 20, 30, or even 100 times or more per minute This stoppage of breathing plus snoring along with a few other symptoms are known as obstructive sleep apnea.
I snore and stop breathing, could I die from it?
In fact, you can have very serious complications if you suffer from sleep apnea. With sleep apnea, you are more prone to have:
* Heart attack (myocardial infarction) or MI
* Stroke
* Hypertension
* Emotional issues & mood problems (getting agitated & upset easily, having shorter
attention span, depression, having anxiety)
* Sexual problems
* Car accidents
* Lose time from your work and unable to perform well at work
* Increased chance of stopped breathing altogether (higher morbidity & mortality), so a patient with sever obstructive sleep apnea and other risk factors such as obesity, high cholesterol level, hypertension, etc has much higher chance of dying young and/or while they sleep! It has been estimated that over 3800 people die every single year from complications of sleep apnea in the United States only.
How about my life, my job?
Quality of life issues range from sleeping in separate bedrooms, body fatigue, irritability, nervousness, arguments and even divorce has been brought up by many couples.
* Personal financial impacts range from an increased cost of medical care, prescription & over the counter drug expenses.
* Institutional impacts at work could range from:
* Job related Illness and injuries to self as well as coworkers
*Increased Healthcare expenses to self as well as employee
*Causing injuries to others (buss & truck drivers)
*Inability to focus & concentrate at work
*Inability to perform complex tasks
*Afternoon job performance issues
*Reduced problem solving ability
*Tired & sleepy at work
*Reduce productivity
Why is it that more men snore than women?
We have examined over 20,000 patients for snoring and sleep apnea and have operated on several thousand patients. We estimate that ration of Men versus women are 9:1. We believe that a major reason is the mens body size, and their anatomy. We cant disregard genetics, hormones and other factors either.
