Children suffering from sleep apnoea “see our blog on this topic” whereby they snore loudly and cease breathing for brief periods along with choking noises. In this circumstance the tonsils (and adenoids) have grown faster than the child. This causes a relative disproportion in the size of the airway as the tonsils literally choke the child.
Children suffering from recurrent tonsillitis occurring at least six times in 2 years or adolescents missing significant amounts of schooling due to tonsillitis.
Adults suffering from tonsillitis. This tends to be more of a grumbling chronic infection rather than the florid and toxic illness seen in children with tonsillitis. Adults complain of a sore throat and fatigue. Their tonsils should be removed, particularly if they are missing time at work.
Adults with snoring or sleep apnoea.
Adults with tonsillar cancer.
Adults with bad breath resistant to mouth wash and not due to other causes e.g. reflux or dental carrier.
The function of the tonsil:
Tonsils are lymph nodes or filters of infection. However, being located directly inside the mouth, they can become infected themselves. Antibiotics may reduce the numbers of bacteria in the tonsils on a temporary basis but sometimes the tonsils carry a constant colony of infective bacteria. In this case they are no longer filtering infection and are no longer useful. There are 120 lymph nodes or filters for infection in the head and neck so without the tonsils there are 118 left to do the work of filtering infection, i.e.you can live without your tonsils.
The third tonsil is located at the back of the nose, level with the ears and up behind the uvula (or little dangling extension of your palate) in your throat. The adenoids usually shrink away after the age of 10. If not as they become infected or block breathing via the nose they are often removed at the time of tonsillectomy. There are very few pain fibres in this region. Therefore, this procedure does not add to the pain of surgery. The risk of bleeding from adenoids is less than that of tonsils. Very rarely surgery in this region can lead to reflux of food or speech via the nose.
Method of Surgery:
The tonsils are peeled out of the walls of the throat. The adenoids are scooped out of the back of the nose. Both these procedures are done under a full general anaesthetic. Electro cautery is used to seal the blood vessels. The procedure takes approximately twenty-five minutes. You will be with your child in the operating room as they go off to sleep and again in the recovery room as they awake. Expect disorientation. If you are calm this will soothe and settle your child more quickly. Please wait in the allocated waiting room so that you can be called into the recovery room at the appropriate time. Please do not duck outside for a cigarette or down to the cafeteria for a coffee, as it is distressing for your child and the nursing staff when they cannot find you.
Recovery in Hospital:
After the surgery the child or adult will have a drip in the back of the hand. This will help with hydration. Amazingly, children eat within hours after surgery. Adults do as well, though they are more aware of pain. The nursing staff provides regular pain relief. However, do not hesitate to ask if you require more pain relief. People stay overnight after tonsillectomy surgery though some patients may elect to go home the day of surgery. Almost all people are discharged home by 9am the day following surgery.
Recovery at home:
Expect to have good days and bad days during the two week recovery period following tonsillectomy.
It is important that pain relief is given regularly. If you wait too long you may not be able to use oral pain relief and be forced to use rectal suppositories. ABSOLUTELY NO NUROFEN is to be given two weeks before or after surgery for pain or fever. This medicine is dangerous in that it can cause profound bleeding by thinning the blood in a similar manner to Aspirin. YOUR PAIN WILL BE AT ITS WORST DAYS 5 THROUGH TO DAY 8 AS THIS IS WHEN SWELLING IS AT ITS MAXIMUM (adults and older children).
Use regular Panadol in the daytime and Oxynorm at night. Recovery usually takes 1 week though the younger the child, the faster the recovery. This may mean pain relief is only required for a few days.
For adults and older children/adolescents
Pain persists for approximately ten to twelve days. This means regular pain relief is required, however do sleep through the night if possible without waking specifically to take analgesia. Adult tonsillectomy is extermely painful, particularly days 5-8.
YOU MUST EAT TO AVOID POST OPERTIVE INFECTION AND BLEEDING.
The risk of bleeding is greatest days 5-12. Plan A – Moderately Severe Pain 2 Panadol 4th hourly daytime to max 8 per day
1 Targin (10/5) at bedtime OR Plan B – Very Severe Pain 1-2 Targin 12th hourly (10/5) i.e. two only in 24 hours) whilst taking 2 Panadols 4th hourly to max 8 per day.
Taking pain relief if you have not been eating wil make you dizzy and nauseated.
You must eat throughout the day
NO NUROFEN/ASPIRIN/DISPIRIN/IBUPROFEN/FISH OIL
Cepacol Forte lozenges can be taken anytime for breakthrough pain.
Avoid Aspirin, Disprin or Nurofen
(See general instructions Prior to Surgery Handout). These agents will cause bleeding. Use medicine given to you by the hospital. If you require more, contact our office and we will fax a script to your Chemist, or see your local doctor. Difflam lozenges contain local anaesthetic and are very soothing. They can be bought over the counter.
For adults and children
Expect ear pain, this is referred from the throat and does not mean your ears are infected. Temperatures on and off are normal and do not require extra antibiotics. Bad breath and a throaty voice are normal. Little boys’ voices often appear to be like Daffy Duck for several days. A green membrane on the back of the throat does not represent infection. This is the scab. Beneath it is red lumpy healing tissue. The tissue will take several weeks to flatten out. The raised areas do not represent re-growth of the tonsils.
A soft diet is recommended e.g. ice cream, mashed potato, and mince. If you wish to eat toast or chips chew them well. Expect to lose weight, as you will not be eating a normal volume of food. Some days you may only be drinking soup.
With modern surgical techniques the equivalent of a dessert spoon of blood is lost at the time of surgery. This amount is much increased if you have had Aspirin or Nurofen products within two weeks of the surgery. For this reason surgery must be rescheduled for your safety. Similarly if you have had tonsillitis in the 2 weeks preceding surgery you must reschedule to avoid undue bleeding. Following surgery there may be some blood staining of the saliva and nasal secretions for 24 hours. If bleeding occurs when you are at home phone our office immediately to speak directly with Dr Dunlop or attend the Accident and Emergency Department of the closest major hospital. One in 20 people will bleed, especially in the 2nd week as the scabs come away. This is not related to surgical technique and cannot be predicted. However, small bleeds can herald a large bleed so please contact us directly. Usually, it involves the equivalent of 1 tablespoon of blood. It is extremely rare for bleeding to be of larger amounts. Do not gargle as this can promote bleeding.
Take two weeks off following surgery. The first week will be for pain relief. During the second week you must still rest. Undue activity e.g. running, jogging may promote bleeding. Rest. Adults must not attend work. Children must be supervised by parents.
It is extremely rare for tonsils to regrow. Likewise it is extremely rare to suffer from on-going tonsillitis of the tongue base following tonsillectomy. Make your POST OP appointment for 2 weeks following surgery. Certificates will be organised for sick leave on this day.