Tonsillectomy

This is a common childhood operation which when performed safely and for the right reason can drastically improve the quality of life for a child.

Tonsillectomy - decision on surgery

Tonsillectomy is usually recommended in children for recurrent infection or airway obstruction if and when:

• the symptoms are severe enough
• the child is not just about to "grow out of it"
• for infection, the alternative of long term medical treatment has been discussed
• there are no particular medical problems

Why remove the tonsils?

Tonsils are usually removed because of recurrent infections or because their size is making eating and breathing difficult. After tonsillectomy, parents report improved feeding and breathing as well as more general improvements in health and energy.

How do you decide which children need their tonsils removed?

When infections are the problem, the decision to remove the tonsils is made because the problems of continued infections (time off school, courses of antibiotics etc) are thought to be worse than the problems of tonsillectomy (admission to hospital, anaesthetic etc). When obstruction to breathing and eating is the problem, the decision is often made on how disturbed the sleep pattern is, and on how your child's weight is progressing.

Can my child manage without his tonsils?

The tonsil's importance in the immune system (i.e. in fighting infection) fades soon after birth. Tonsils that are constantly infected cause, rather than prevent infection.

What are the risks?

Bleeding This is very rare during and immediately after the surgery. At 10 days when the scab falls off the tonsil, minor blood staining can occur in perhaps 1:200 children. Very, very occasionally there can be significant bleeding requiring transfusion. It is for this reason that all ENT surgeons advise patients not to travel until 10 days after surgery. As a severe bleed can very rarely be heralded by a small bleed, any patient who has bleeding after tonsillectomy should contact the hospital for advice.

Extremely rare risks include breathing difficulties in children with severe apnoea such as pulmonary edema and narcosis.  I have seen 2 cases in 40+ years! This German paper covers all possible problems if you want a complete list!

Anesthesia Given a paediatric anesthetist, a paediatric surgeon and a hospital equipped and used to dealing with children, the anaesthetic risks of a fit child having an anaesthetic for routine ENT surgery are very small indeed.

Tonsillectomy - procedure

Preparing your child and explaining what to expect will go a long way to making the day smooth and enjoyable for everyone. Please feel free to call the play specialist on the 5th floor to discuss the books and games which are available to help prepare your child for surgery.

Tonsillectomy usually involves a one night stay in hospital. Most parents stay with their child overnight. Parents are made to feel welcome and as involved as they wish.

Your child is usually admitted late on the morning of the surgery to acclimatize to the environment. You will also be seen by the anaesthetist (Dr. Adrian Lloyd Thomas), the resident doctor (a paediatrician) and Mr Albert to confirm details of the surgery and for you to sign the consent form.

Breakfast at least 6 hours before surgery is a good idea as it reduces any hunger. Clear fluids can be given up to 2 hours before surgery. Topical anaesthetic cream (The Magic Cream) may be put on and covered with a clear plastic film. This numbs the skin so that the anaesthetist can give the drugs needed to start anaesthesia. See Dr Lloyd-Thomas's own page for details

The operation takes 20-40 minutes though your child may be away for as long as an hour. You will be called in good time to be with your child as he/she recovers.

What happens after the procedure? Most children are a little disorientated and thirsty after the procedure and may cry despite adequate analgesia. Once they are fully awake and have had a drink they quickly improve and most will typically tuck into a hearty supper. Your child will stay in hospital overnight and then will usually be fit to go home in the morning after breakfast and having been seen by Mr. Albert.

Once at home most children do well with some pain which is controlled. Often the 3rd and 4th days are worst than the first couple of days.

Pain Given good analgesia the pain for most children is well controlled and not a major problem.

It is sensible to keep them away from children with infections for about a week, though your child will be given antibiotics If your child becomes unwell and develops a high temperature or if there is any sign of bleeding, please contact me or the hospital immediately.

There are numerous techniques used (Paper in ENT Today) 

Intracapsular tonsillectomy