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Q: Tonsil removal effects on voice - pros and cons - tonsilectomy ( Answered,   0 Comments )
Question  
Subject: Tonsil removal effects on voice - pros and cons - tonsilectomy
Category: Health > Conditions and Diseases
Asked by: leftright-ga
List Price: $10.00
Posted: 02 Dec 2003 23:09 PST
Expires: 01 Jan 2004 23:09 PST
Question ID: 282940
I'm a 27 year old male vocalist considering having my tonsils removed
next month after a recent severe bout with tonsilitis. I'd like
pointers to any data that speaks to potential effects of tonsilectomy
on my voice and other potentially harmful side effects, risks or
downside such as weakened immune system, etc...

Thanks!
Answer  
Subject: Re: Tonsil removal effects on voice - pros and cons - tonsilectomy
Answered By: pinkfreud-ga on 03 Dec 2003 13:50 PST
 
Here's an excellent discussion of factors involved in adult
tonsillectomy. This is part of a surgical consent form that is used by
a firm of head and neck surgeons:

"RISKS 

1. Bleeding is usually minor but can be severe enough that another
trip to the operating room and/or a transfusion would be required.

2. Infections are very unusual after surgery but when they occur can
usually be controlled with antibiotics.

3. Throat pain after this surgery can be expected, can be severe, and
may last at least two to three weeks.

4. You may notice changes in your voice or you may have problems with
fluids coming up into the back of the nose when swallowing. This
usually goes away with time but can be permanent.

5. This surgery will be done under general anesthesia. Complications
of anesthesia can be severe but are rare. If you have any questions
regarding anesthesia, you may discuss them with the anesthesiologist
before surgery.

6. Death from this surgery or anesthesia is very rare but has been reported. 

BENEFITS This surgery has a high degree of success in the treatment of
recurrent throat infections. It will not prevent all infections, but
should significantly decrease the number and severity of episodes. If
the reason for doing this procedure is to rule out a malignancy, it
will allow your doctor to have the tonsils examined by a pathologist.

ALTERNATIVES In the case of recurrent infections, the alternative is
to do nothing and continue to take antibiotics when needed. In the
case of possible tumor, the area in question can be observed over
time, but this may delay the diagnosis and jeopardize the chances for
successful treatment."
 
Head & Neck Surgery Associates: Adult Tonsillectomy
http://www.hnsaonline.com/Adult%20tonsillectomy%20consent%2008-18-02%20JB.pdf

Note that the surgical consent form above mentions "changes in your
voice" as a possible aftereffect. Interestingly, if there is a vocal
change, it may be a positive one, as found in this medical study:

"OBJECTIVE: Our goal was to assess patient perception and acoustic
characteristics of voice before and after upper airway surgery.

STUDY DESIGN AND SETTING: We conducted a prospective assessment of 44
surgical patients preoperatively and postoperatively at a tertiary
care, academic hospital. Operations included septoplasty and
turbinectomy (n = 28) and septoplasty, turbinectomy,
uvulopalatopharyngoplasty, and tonsillectomy (n = 16). Patient opinion
measures included Voice Handicap Index score, perception of vocal
resonance, and change in voice. Acoustic measures included assessment
of the relative amplitude of selected formants (resonances) of the
vocal tract.

RESULTS: Mean Voice Handicap Index scores were unchanged after
surgery. Nine patients (20%) perceived their voice to be improved
after surgery. None perceived the voice to be worse. Postoperative
changes in relative formant amplitudes were statistically significant.
These changes caused the acoustic features to become more
representative of normative data than the preoperative values.

CONCLUSION: Upper airway operations can affect acoustics and perception of voice. 

SIGNIFICANCE: Patients are unlikely to perceive a change in voice as a
result of upper airway surgeries, but in those cases where a
difference is perceived, it is likely to be a positive change."

PubMed: The effect of upper airway surgery on voice
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12161728&dopt=Abstract

Another study determined that adult tonsillectomy can result in an
improved quality of life, fewer missed workdays, and fewer physician
visits. Note that the average age of these patients was 27.3 years,
which makes these findings quite appropriate to your case:

"To determine the economic impact of adult chronic tonsillitis and the
economic improvement from adult tonsillectomy, we studied patients who
underwent adult tonsillectomy for chronic tonsillitis with the Glasgow
Benefit Inventory and a questionnaire for disease severity parameters
before and after tonsillectomy. The economic impact of chronic
tonsillitis and adult tonsillectomy were computed with a break-even
time analysis model. Eighty-three adult patients (average age, 27.3
years) completed the study with an average duration of follow-up of
37.7 months. The patients exhibited a mean improvement in quality of
life of +27.54 4.63 after tonsillectomy according to the Glasgow
Benefit Inventory. In the 12 months following the procedure,
tonsillectomy resulted in yearly mean decreases in number of weeks on
antibiotics by 5.9 weeks, number of workdays missed because of
tonsillitis by 8.7 days, and physician visits for tonsillitis by 5.3
visits."

Annals of Otology, Rhinology & Laryngology: Abstracts
http://www.annals.com/2002/Nov2002_abstracts.htm

Here you'll find more on the study referenced above:

Brigham and Women's Hospital: Research finds benefits for adults who
have tonsils removed
http://www.bwh.partners.org/publicaffairs/News/chronictonsilitis.asp

The Cleveland Clinic has published a useful page of info about the
pros and cons of tonsillectomy in adults:

Cleveland Clinic: When does an adult need a tonsillectomy?
http://www.clevelandclinicmeded.com/ccjm/aug2003/tonsill.htm

Another good article from the Cleveland Clinic:

Cleveland Clinic Journal of Medicine: Tonsillectomy in adults: A paucity of data
http://www.ccjm.org/pdffiles/Mossad803.pdf

Google search strategy:

Google Web Search: "tonsillectomy" + "adults"
://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=tonsillectomy+adults

Google Web Search: "adult tonsillectomy" 
://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=%22adult+tonsillectomy

I hope this is helpful. Please keep in mind that Google Answers is not
a source of authoritative medical advice; the material I've posted
above is for informational purposes, and should not be considered as a
diagnosis, nor as a substitute for the services of a qualified medical
professional.

If anything is unclear, or if a link does not function, please request
clarification; I'll be glad to offer further assistance before you
rate my answer.

Best wishes,
pinkfreud
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