Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon
Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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Tonsillectomy and or Adenoidectomy

Tonsils and adenoids are areas of lymphoid tissue at the back of the throat.  The tonsils are on either side and the adenoidal tissue sits at the very back of the nose, up behind the soft palate and the uvula, which hangs down at the back of the throat.  This tissue is part of the body’s immune system but is not the only lymphoid tissue in this area, the adenoidal tissue generally shrinks of its own accord from the age of 5 – 7 onwards.

In the case of troublesome recurrent acute tonsillitis it may be necessary to see an ENT Specialist for an opinion about necessity or not for tonsillectomy; adenoidectomy on its own is not common but more often associated with ventilation procedure involving grommet insertion for the middle ear.  This can be the case when there is glue ear and also large adenoids and removing these can reduce the risk for reaccumulation of the fluid.  If tonsils are being removed and adenoids are also enlarged then generally these would be removed at the same time.

Tonsils are generally removed for recurrent tonsillitis but occasionally removal, along with adenoidectomy, can be necessary when the airway is being obstructed and producing sleep apnoea.  Tonsils may be removed for histological assessment, especially in the presence of another neck swelling.

Risks

With these procedures there are small risks relating to primary bleeding, bleeding within the first 24 – 48   hours after surgery or secondary bleeding at 7 – 10 days.  The risk of a primary bleed is in the region of 1% and may require a trip back to theatres or a further general anaesthetic to seal a bleeding vessel.  Secondary bleeding may require reattendance or even readmission at the hospital and can also require return to theatre if a vessel needs to be sealed.  The incidence of secondary bleeding is probably in the region of 3 – 6%.

It is advisable to inform the surgeon and anaesthetist if there are any loose teeth or crowns as these can rarely be dislodged in the procedure or anaesthetic.

Having the tonsils removed is a painful procedure and this discomfort can be variable and occur through the 7 – 10 days following the procedure.

Recurrence or regrowth of tonsil tissue is unlikely but occasionally can occur.

In the event of a recent cough, cold or throat infection it may be advisable to defer surgery to reduce risk of complications.

The discomfort may be felt particularly in the ears, often in the case of children.  This is what is called referred otalgia or referred ear pain and still comes from the tonsil beds. The same nerve supplies the tonsils as part of the ear and this is the reason why this occurs.

The operation itself takes in the region of 30 – 60 minutes.  After the operation the throat is generally sore and Paracetamol or Ibuprofen, often alternating the two, would generally be advised half an hour before meals.  For the first 24 hours it is advisable to give pain relief even if the pain does not seem to be troublesome to ensure satisfactory eating and drinking.  After 1 – 2 days then this pain relief can be given more as required.

It is most important to eat and drink throughout the period of recovery.  Not only is this important for nutrition but the actual act of chewing and swallowing itself does exercise the throat muscles and also clears the back of the throat.  This encourages healing and reduces the risk of secondary infection.  It does not matter if full meals cannot be managed but better for regular eating and drinking, even if small amounts.  There are no specific dietary restrictions but it is often better for a child to have food or drink which he or she is happy with to promote their eating.  Fruit juices can be particularly irritating and are probably better avoided and chewing gum may have a beneficial effect by stimulating the use of mouth and throat muscles.

It is usual to see areas of white or sloughy debris at the back of the throat and this does not indicate an infection.  If there is any cracking or dryness at the corners of the mouth then a lip salve or Vaseline may be beneficial.

In the event of soreness which becomes so troublesome that swallowing itself is painful, then occasionally a small suppository can be used to administer a painkiller without the need for this to be (swallowed past a sore throat).

It is also important to keep the teeth clean to reduce risk of infection and promote healing and mouth gargles may be advised.

Generally two weeks would be recommended off school afterwards with very limited contact remaining at home in the first week and possibly a degree of contact in the second week.  It is better to avoid people with colds and illness if possible and also to avoid cigarette smoke.

Bleeding may occur after tonsillectomy but, if there is to be a primary bleed, this would generally occur within the first 4 hours during the period of close observation in the hospital environment.  A small amount of fresh blood may occur in the mouth or saliva in the first 10 to 12 days but if there is a troublesome or worrying bleed after discharge then it may be necessary to attend the local hospital or Accident & Emergency Department.  Readmission for observation, gargles and antibiotics may be required and occasionally a return to theatre to seal or tie a persistent vessel.

In the event of not being able to eat or drink at all because of discomfort coming on after the procedure occasionally readmission can be required for stronger analgesia and, in the event of a temperature, antibiotics may be required.

If adenoids are removed then often this also is a day case procedure but occasionally overnight stay will be suggested.  There is a small risk of primary bleeding, bleeding can occur in the first 24 – 48 hours after surgery or secondary bleeding at around 7 – 10 days after adenoidectomy which may require re-attendance to a hospital although such bleeding is unusual and not occur in more than 1% of cases.

It is possible that black or brown “swallow” of blood may be brought up in the period after recovery as sometimes a little of this can track down to the stomach during and immediately after the operation but, although appearance can be troubling, this is not a problem and they may actually feel better after bringing this up!