Tonsillectomy
Why do we take out Tonsils?
Although the tonsils are made of lymphoid tissue that is part of the body's defence system they can be a source of recurrent infections giving rise to sore throats with associated fever. If these are frequent and severe enough to affect a child or parent's quality of life, then removing them is a reasonable decision.
The tonsils may also enlarge and cause problems with breathing and swallowing. Children may have trouble with breathing at night and this may affect their quality of sleep - a condition called obstructive sleep apnoea. Some children with large tonsils have an increased sensitivity to swallowing harder textured food such as pieces of fruit and meat, which may cause them to gag or choke on such types of food.
How do you remove tonsils?
The procedure is carried out under general anaesthetic. A gag is inserted to open the mouth.
There are 2 methods in removing or reducing the size of the tonsils including bipolar dissection and the coblation technique and your surgeon will discuss the benefits and risks of each procedure.
Coblation technique
The coblation technique uses radio frequency energy to create a plasma field that ablates the tonsil tissue at lower temperatures. The recovery is less painful than the bipolar dissection technique. However there is a risk that any remaining tonsil tissue may grow and if there is a history of tonsillitis this may recur within the tonsil tissue left behind.
Bipolar disssection
The tissue overlying the tonsil is incised and the tonsil dissected away from its bed using fine forceps which cauterise the blood vessels to prevent bleeding. The actual procedure takes between 15 - 20 minutes, with the whole operation lasting about 30-40 minutes. In older children and adults with very scarred tonsils the surgery may take longer because of increased scarring. The surgery is often combined with an adenoidectomy if there are any nasal airway issues.
What to expect after the operation?
At the site where the tonsils were, this often looks white. This is the normal healing process and does not mean that there is an infection.
Pain
This is a painful operation. It is important to plan the surgery well as your child will need one-to-one care for 7 - 10 days post-op. Most mothers describe this period as like having a young baby again.
The first 3 - 4 days are not too bad but the pain becomes worse on days 5 - 7
It is essential to have a structured regime of pain relief. We suggest regular paracetamol, alternating with Nurofen, every 3 hours. For the first 7 days it is important to do this even during the night. Please use the same doses that were given in hospital - these are much higher than what is on the box.
It is a good idea to have something to eat about 20 minutes after giving the pain-relief
Ear ache
This is very common after surgery and happens because the same nerve connects the tonsil as well as the ear - a sensation known as referred pain.
Voice change
Parents often find that their child's voice becomes higher after surgery. This is simply a result of the muscles in the throat contracting to minimise pain. It is a temporary symptom, but may take a few weeks to fully recover.
What foods are best?
The best types of foods are soft textured foods. Bread, pasta and yoghurt are usually the preferred foods. Ice lollies and ice cream usually go down well. Citric type foods (fresh fruit and tomatoes) sting and are best avoided.
It is easy to become dehydrated, so it is important to have lots of fluids. The key to recovery is frequent swallowing which cleans the tonsil beds.
How long before my child can return to school or travel?
It is recommended that your child have at least 2 weeks off school to recover.
We strongly advise against any long distance travel by train or plane for 3 weeks after the surgery. This is in case there are any complications which may delay recovery and there remains a risk of bleeding until the tonsil bed has fully healed.
What can go wrong after tonsil surgery?
Unmanageable pain
Whilst most patients can manage with regular painkillers after surgery, some patients may have more difficulty and this then leads to a slow return to oral intake which in turn worsens the pain. In this situation it is sometime best to be readmitted to the hospital for rehydration with intravenous fluids for 24-48 hours.
Bleeding after surgery
The surgery itself is relatively bloodless. However, bleeding after surgery can occur in about 3- 5% of patients and usually happens around day 5 - 7.
We would recommend that you sleep in the same room as your child in case this happens during the night. Signs of bleeding are either obvious bleeding which is visible or you may hear a wet gurgling sound if your child is asleep. If this is the case have a look in their mouth to check if there is any bleeding.
Why does it happen?
It is believed that poor oral intake leading to dehydration is a factor. Sometimes as the tonsil bed heals it can form granulation tissue which can easily bleed. Should the bleeding be persistent then Immediate attendance to your nearest accident and emergency department is essential if this occurs or if there is a lot of bleeding call for an ambulance.
Occasionally there may be a need to return to the operating theatre to stop the bleeding. It is for this reason that there should be constant supervision and no travel on long journeys after surgery for at least 6 weeks.
