Tonsillectomy or sinus surgery or both?

May 29, 2008 1:05 PM

I am a classic example of poorly-designed nose and throat, and I want to fix it. But my ENT doesn't have any advice and I don't know what's going to do the trick.

Post-nasal drip, rampant sinus infections, tonsillar crypts (and accompanying gross white debris), snoring, permanent stuffy nose, coughing up phlegm. It's a hoot. I've tried allergy medicine and neti pots, and while both help a little, I'm never in the clear. I was at the ENT today and he said that despite all of my symptoms none are so bad that it's clear what needs to be done. It's been a dream of mine to get my tonsils taken out, and they're what I've blamed, but now I'm nervous that it might be some crabby sinuses causing the ruckus and the tonsillectomy will result in bupkis. I can get a CT scan that might provide answers, but I'm on a cafeteria insurance plan and am reluctant to spend $400 unnecessarily. I know I don't have any polyps. So any IANAD-advice from people who have been there? What worked, what didn't?

posted by ictow to health & fitness (10 comments total)

I had exactly the same symptoms as you a few years ago, except for the stuffy nose. I had my tonsils taken out and didn't do anything about my sinuses. Two awful weeks of recovery from the tonsillectomy, then years and years of bliss. It made a huge difference.

(The gross white things are called tonsiliths, by the way.)
posted by The corpse in the library at 1:53 PM on May 29, 2008

I found out the tonsillectomy is around $750, while sinus surgery would be at least $2000. Given that and the corpse in the library's helpful response, I'm gonna go the tonsillectomy route and cross my fingers.
posted by ictow at 2:06 PM on May 29, 2008

I have similar problems, including the nasty tonsiliths (they're actually pretty common).

Can you get a second opinion?

I would go for the CAT scan first, because wouldn't it suck to have surgery on the wrong part of your body? One person's anecdote is not really a great reason to schedule major surgery.

I would also suggest taking measures against acid reflux. Some chronic ear nose throat problems are caused by "silent reflux", which doesn't hurt like heartburn but does irritate and damage the delicate tissues in your throat and in your sinuses, leading to chronic problems (including sinus infections). If you wake up hoarse or have heartburn symptoms, this is definitely what I would suggest. I have been cutting out acidic foods and taking generic zantac 75, and it's been helping a lot. No surgery at all. Woo!
posted by sondrialiac at 3:01 PM on May 29, 2008

I've never really had any problems with heartburn or the symptoms you listed, so I'm doubting that's the issue. I do have very hole-y, very large tonsils that seem to contribute to a lot of my problems. The ENT believed taking them out would probably be good for me; he just wanted to know if I wanted to fix around with the sinuses while he was in there. I think for now I'll stick with the tonsillectomy and see where I stand in a year.
posted by ictow at 3:12 PM on May 29, 2008

Ugh, don't let him just poke at your sinuses if there's nothing obviously wrong with them. I, too, have dreamed of getting my tonsils removed because of their nasty hole-yness.

Good luck with the surgery!
posted by sondrialiac at 3:47 PM on May 29, 2008

I'm not sure what kind of sinus surgery you'd be having, but I do know that a family member of mine had some form of sinus surgery and it has somewhat helped him. But not entirely.

I had a tonsillectomy a few years ago after having MANY, MANY strep throat infections. I've never had one since.
posted by majikstreet at 4:08 PM on May 29, 2008

I'm in Canada and things may be done differently here, but it seems very odd to me that your surgeon would be willing to operate on your sinuses without a CT. I've been to many doctors for my sinus problems and they all insisted on a CT (the current one wants two). While my ENT can see inside some of my sinus cavities with his scope, he tells me that he can't see all of them and that the CT scan is the only way to see inside those.
posted by ssg at 4:15 PM on May 29, 2008

I had my tonsils removed when I was 18. They were always infected, I always had a strep infection or one brewing... etc., so on, so forth. Well, I never get throat infections anymore, but my allergies went HAYWIRE after my tonsils weren't there anymore. They were pretty bad to begin with, but I had a hard time wanting to even live for several years thereafter.
posted by houseofdanie at 4:55 PM on May 29, 2008

My little sister snored and always had some kind of cold, and finally went to an ENT (we were Kaiser Permanente kids back in the Old Days when you used to have to really bully your pediatrician before you could get referred to a specialist). The ENT said "Oh, my god! This child can't breathe!" and out came the tonsils and adenoids. I've never heard my sister snore since.

Get a second opinion, I'd say.
posted by crinklebat at 6:19 PM on May 29, 2008

Nthing the cat scan. CAT scans are used both diagnostically and preparatively for surgery. Don't let anyone cut into your head without one. Your doctor should have it in advance of surgery just to see the "lay of the land."
posted by answergrape at 10:17 AM on May 30, 2008