Tonsil Stones: Surgery Risks and Insurance Coverage in Taiwan

Tonsil stones

After the consultation, due to the stones being more deeply embedded, outpatient treatment to remove the stones is not possible.
Hospitalization for a tonsillectomy is required.
The physician mentioned that there is no immediate necessity for surgery but advised monitoring for any enlargement, swelling, or coughing up blood, which would necessitate surgery.
I would like to ask the physician if there are any potential complications from the surgery.
Is the surgical procedure covered by health insurance or is it considered an out-of-pocket expense? Thank you, doctor.

Ms. Chen, 20~29 year old female. Ask Date: 2016/06/30

Dr. Ji Zhaoyun reply Otolaryngology

Hello Ms.
Chen, regarding the criteria for tonsillectomy that you inquired about, they are generally as follows: 1) Enlarged tonsils causing respiratory issues or conditions such as obstructive sleep apnea; 2) Presence of malignant tumors; 3) Recurrent tonsillitis, which is internationally recognized as: a) More than 7 episodes of tonsillitis in one year; b) More than 5 episodes of tonsillitis per year for two consecutive years; c) More than 3 episodes of tonsillitis per year for three consecutive years.
These conditions indicate recurrent tonsillitis, for which removal is recommended.
After tonsillectomy, you will no longer experience tonsillitis with future colds.
As for the immune function of the tonsils, it primarily exists during childhood; therefore, if an adult has medical necessity (as mentioned above), the tonsils can be removed.
Tonsillectomy is covered by health insurance, and the potential complications mainly include: 1) Postoperative bleeding; 2) Wound infection, although the likelihood is low.
Pain may occur for three days post-surgery, and a light, cool diet is recommended, avoiding hard and irritating foods.
Wishing you safety and health.
Sincerely, Dr.
Chi Chao-Yun, Director of the ENT Department, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/06/30

More Info

Tonsil stones, also known as tonsilloliths, are calcified deposits that form in the crevices of the tonsils. They can cause discomfort, bad breath, and sometimes pain, leading to the consideration of surgical intervention. In your case, it seems that the tonsil stones are located deep within the tonsils, making outpatient treatment ineffective, and your physician has recommended surgery as a potential solution.

Understanding the Need for Surgery
The decision to undergo surgery for tonsil stones is often based on the severity of symptoms and the frequency of occurrences. If the stones are causing significant discomfort, recurrent infections, or other complications, surgical removal of the tonsils (tonsillectomy) may be warranted. However, as your doctor mentioned, if the stones are not causing immediate issues, monitoring the situation is a reasonable approach.

Risks of Surgery
Like any surgical procedure, tonsillectomy carries certain risks. Common complications include:
1. Bleeding: This can occur during or after the surgery. While most bleeding is manageable, in rare cases, it can be severe and require additional medical intervention.

2. Infection: Post-operative infections can occur, although they are relatively uncommon. Proper post-operative care can help mitigate this risk.

3. Pain: Pain is expected after the surgery, and it can last for several days to weeks. Pain management strategies will be necessary.

4. Swelling: Swelling of the throat can occur, which may temporarily affect breathing and swallowing.

5. Changes in Voice: Some patients report changes in their voice after surgery, although this is usually temporary.

6. Anesthesia Risks: As with any surgery requiring anesthesia, there are inherent risks, particularly for individuals with underlying health conditions.

Insurance Coverage in Taiwan
In Taiwan, the National Health Insurance (NHI) system generally covers medically necessary procedures, including tonsillectomy, when performed for valid medical reasons. However, coverage can vary based on specific circumstances, such as whether the surgery is deemed urgent or elective.
If the surgery is performed due to recurrent infections or significant discomfort caused by tonsil stones, it is likely to be covered by NHI. However, if the procedure is considered elective or if there are additional factors that complicate the case, there may be out-of-pocket expenses involved. It is essential to discuss this with your healthcare provider and the hospital's billing department to understand what costs may be incurred.

Conclusion
In summary, while surgery for tonsil stones can be effective in alleviating symptoms, it is not without risks. The decision to proceed with surgery should be made collaboratively with your healthcare provider, taking into account the severity of your symptoms, the potential benefits of surgery, and the associated risks. Additionally, clarifying the insurance coverage details with your healthcare provider will help you prepare for any financial implications. If you notice any worsening symptoms, such as increased swelling or bleeding, it is crucial to seek medical attention promptly.

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