Tonsillectomy

Tonsillectomy is the surgical removal of the tonsils.

The tonsils are two pads of glandular (lymphatic) tissue; one situated each side of the back of the throat.

The role of these pads is to help provide a defence against infection, which, in this case, enters through the nose or mouth.

The tonsils are relatively small in the first year of life and increase in size, as a child grows older. If the child or adult has frequent throat, sinus, or ear infections, snoring or breathing problems, the tonsils may need to be taken out.

This surgery is called a tonsillectomy. It may be done alone or with another operation, such as an adenoidectomy, ear tube insertion, or sinus surgery.

Problems Related To Tonsillitis

Tonsils are prone to swelling and enlargement. This can lead to a condition called tonsillitis. If these attacks become regular and severe, or cause complications, your doctor might suggest an operation.

Some reasons, which suggest that an operation should be carried out, include:

• Chronic tonsillitis that doesn't clear up with antibiotics.
• Frequent ear infections associated with tonsillitis.
• Breathing difficulties due to enlarged tonsils.
• Abscesses forming in the throat
• A child failing to thrive because of difficulty in swallowing due to frequent infection and enlargement of the tonsils.
• Recurrent bouts of tonsillitis followed by pain, discomfort and high temperature.

Tonsillectomy procedure:

A tonsillectomy is performed under general anesthesia. The surgery takes about one hour. The patient's mouth is propped open and the tonsils are clamped with particular instruments.

The glandular tissue is contained inside a 'skin lining' - this lining is cut using scalpel, scissors, laser or an electric current (electrocautery). The tonsils are then removed. Each tonsil pad has a substantial blood supply, so electrocautery is often used to fuse the blood vessels and reduce the risk of hemorrhage.

Immediately after the operation:

After the operation you can expect:

• When you wake up, you will be lying on your side - this is to prevent choking should any bleeding occur from the tonsil pad.
• Painkilling injections, if necessary.
• The nursing staff will observe you regularly to check your pulse, blood pressure, breathing rate, and check your throat for any signs of bleeding.
• For the first four hours after theatre, you will probably not be allowed to have any food or liquids.
• A sore throat.
• You may find it difficult to eat or drink but you will be encouraged to do so - the more often you use your throat, the better.
• You can expect a hospital stay of just one day or so.

Tonsillectomy Side Effects And Complications

Some of the possible side effects and complications of tonsillectomy include:

• Excessive bleeding from the tonsil pads. Most cases of hemorrhage happen within one week of surgery.
• The scabs that form on the wounds may give you a bad taste in your mouth.
• The pain may ease within two days or so then burn again up to six days after the operation. Ear pain may also be included.

Self care:

It is normal to see raw white areas where the tonsils were removed. These will go away in about two weeks. They may cause some bad breath, which also will go away.

A chewing motion may help decrease ear pain. An antibiotic may be prescribed to prevent a post-operative infection. Use a cool mist humidifier at home to help keep moisture in the air.

Your child should not blow his/her nose or clear the throat after surgery. There may be a nasal quality to your child's voice. This is normal and may last for several weeks. Your child can talk after surgery but it may hurt.

Be guided by your doctor but general suggestions include:

• Don't smoke.
• Avoid vigorous exercise immediately after the operation.
• Usually, you should have a week or so at home before returning to work or school.
• Avoid crowded, enclosed areas (such as cinemas) for at least one week, to reduce the risk of infection.
• Your sore throat may last for two to three weeks, but try to get back to your normal diet as soon as possible - avoid sticking to a jelly and ice cream diet.
• Some foods can cause irritation and pain - avoid sour drinks (such as citrus fruit juices), spicy foods and roughly textured foods for about 10 days or so.
• Avoid taking aspirin, since this painkilling drug can exacerbate bleeding. Only take those painkillers recommended by your doctor or surgeon

Diet:

The patient needs to drink a lot of liquids. Avoid citrus juices (orange or grapefruit) because they may burn the throat. Avoid spicy foods and foods which might rub the throat like Doritos or potato chips.

Soft foods such as cooked fruits, ice cream, soups, puddings, gelatin, scrambled eggs or mashed potatoes are easier to swallow. Limit activity to calm play for two days with plenty of rest time.