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Tonsil surgery

By Peter Robb, Epsom & St Helier University Hospitals  & Haytham Kubba, Royal Sick Children's Hospital Glasgow

Disclaimer

The details in this section are for general information only. Always check with your own doctor.

What are tonsils?

Tonsils are small glands in the throat, one on each side. They are there to fight germs when you are a young child. After the age of about three years, the tonsils become less important in fighting germs and usually shrink. Your body can still fight germs without them. We only take them out if they are doing more harm than good.

Why take them out?

We will only take tonsils out if they cause recurrent sore throats despite treatment with antibiotics. 
The other main reason for removing tonsils is if they are large and block the airway. Sometimes small children have tonsils so big that they block their breathing at night.
A quinsy is an abscess that develops alongside the tonsil, as a result of tonsil infection, and is most unpleasant. People who have had a quinsy therefore often choose to have a tonsillectomy to prevent having another. 
Tonsils are also removed if we suspect there is a tumour. A rapid increase in the size of a tonsil or ulceration or bleeding occurs if a tumour of the tonsil develops. Tumours of the tonsil are rare.

Do I have to have my tonsils out?

It is not always necessary to remove the tonsils. You may want to just wait and see if the tonsil problem gets better by itself. The doctor should explain to you why he or she feels that surgery is the best treatment.
You may change your mind about the operation at any time, and signing a consent form does not mean that you have to have the operation. If you would like to have a second opinion about the treatment, you can ask your specialist. He or she will not mind arranging this for you. You may wish to ask your own GP to arrange a second opinion with another specialist.

Before the operation

Arrange for two weeks off work or school. Let us know if you have a chest infection or tonsillitis before the admission date because it may be better to postpone the operation. It is very important to tell us if has you have any unusual bleeding or bruising problems, or if this type of problem might run in the family.

How is the operation done?

You will be asleep under general anaesthesia. We take the tonsils out through the mouth, and then stop the bleeding. This takes about 30 minutes. A child who has had a tonsillectomy will then be taken to a recovery area to be watched carefully as he or she wakes up from the anaesthetic.

How long will I be in hospital?

In most hospitals, surgeons prefer tonsillectomy patients to stay in hospital for one night. In some hospitals tonsil surgery is done as a day case, if your home is close to the hospital. Either way, we will only let you go home when you are eating and drinking and feel well enough.

Possible complications

Tonsil surgery is very safe, but every operation has a small risk. The most serious problem is bleeding. This may need a second operation to stop it. About two out of evert 100 children who have their tonsils out will need to be taken back into hospital because of bleeding, and one of these will need a second operation. As many as five adults out of every 100 who have their tonsils out will need to be taken back into hospital because of bleeding, but only one adult out of every 100 will need a second operation. 
During the operation, there is a very small chance that we may chip or knock out a tooth, especially if it is loose, capped or crowned. Please let us know if you have any teeth like this.

After the operation

Some children feel sick after the operation, and may need to be given medicine for this, but it usually settles quickly. 
Your throat will sore for approximately ten days. It is important to take painkillers regularly, half an hour before meals for at least the first week.

Do not take aspirin because it may make you bleed. If you are giving painkillers to your child following tonsillectomy do not give more than it says on the label. Aspirin is not safe for children and should never be given to children under 16, unless prescribed by a doctor.

Eat normal food - it will help your throat to heal. It will help the pain too. Drink plenty and stick to bland non spicy food. Chewing gum may also help the pain.

You may have sore ears. This is normal - it happens because your throat and ears have the same nerves. It does not mean that you have an ear infection.

Your throat will look white - this is normal while your throat heals. You may also see small threads in your throat - they are used to help stop the bleeding during the operation, and they will fall out by themselves. 
Some people get a throat infection after surgery, usually if they have not been eating properly. If this happens you may notice a fever and a bad smell from your throat. Call your GP or the hospital for advice if this happens.

Adults and children will need 10 to 14 days off work or school. Make sure you rest at home away from crowds and smoky places. Keep away from people with coughs and colds. You may feel tired for the first few days.

Bleeding can be serious

If you notice any bleeding from your throat, you must see a doctor. Call your GP, call the ward, or go to your nearest hospital casualty department.

tonsil_image

Large obstructive tonsils in a child. Tonsils like this can result in sleep apnoea, which is cured by the removal of the tonsils and the adenoids.





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