What are Tonsils and Adenoids?
Tonsils and adenoids are collections of lymphoid tissue found in the back of the throat. The tonsils are often visible at the back of the mouth, while the adenoid lies at the back of the nose out of view. Lymphoid tissue is involved in defence against infection. In some people this tissue can become repeatedly infected causing significant episodes of throat pain and time off school or work. Occasionally more serious complications can occur with extension of infection out of the tonsils and into adjacent structures. In other patients, symptoms arise because of the excessive size of the tonsils and/or adenoid with nasal obstruction, snoring and obstructive sleep apnoea. Most commonly, these symptoms occur in children. If symptoms related to the tonsils and/or adenoid become severe and frequent then surgery to remove either or both the tonsils and adenoid may be advised.
What does surgery involve?
Tonsillectomy with or without adenoidectomy requires a general anaesthetic and usually an overnight stay in hospital. In selected children, surgery may be performed as a daycase. Although the procedure itself is usually relatively quick, recovery is often prolonged with significant throat pain for 7-10 days being the norm in adults. Children are usually pain free within a week (generally children have less severe postoperative pain than adults). I recommend 7-10 days off school for children and 10-14 days off work for adults.
Patients are encouraged to resume oral intake of fluids and food as soon as possible after surgery as this helps reduce postoperative discomfort and speeds recovery from surgery. Ear pain is a common side effect and is usually due to pain referred from the throat rather than a local ear problem. This will improve as the throat pain settles.
Bleeding may occur after this operation in about 0.5% of children and 1.0% of adults. Almost always this is within a few hours of surgery and, although bleeding usually is not heavy or persistent, there are occasions when patients have to be returned to theatre to control the bleeding. This type of bleeding is called primary haemorrhage. Secondary haemorrhage is haemorrhage that can occur some days after the surgery and arises from the healing tissue in the tonsillectomy wound. Usually secondary haemorrhage is light but may be heavy enough to necessitate admission to hospital for observation and on rare occasions, return to theatre. About 5% of patients will experience some light secondary bleeding. They should suck ice (spit out any blood) and contact me if they have persistent bleeding after 10-15 minutes.
Patients are best advised not to swim for a fortnight after surgery and should not resume strenuous exercise for 10-14 days. Examination of the throat after surgery, in all cases, will reveal a white/yellow slough covering the area where the tonsils were removed from. This is quite normal, represents healing tissue rather than infection and does not require antibiotic treatment. Aspirin should be avoided in all patients within two weeks of surgery as this greatly increases the risk of bleeding.
Following discharge patients should contact my rooms to book a followup visit approximately one month after surgery.
If there are any postoperative problems patients should
contact me.