Tonsillectomy

Initial consultation

The initial consultation is a critical step before deciding to perform a tonsillectomy. During this appointment, your ENT consultant will review your child’s medical history, including the frequency and severity of throat infections or breathing problems related to enlarged tonsils. The doctor will also conduct a thorough physical examination of the throat and may evaluate for signs of tonsillar hypertrophy or sleep-disordered breathing.

In cases where sleep-disordered breathing or obstructive sleep apnoea is suspected, additional assessments, such as sleep studies, may be recommended in select cases, particularly if the diagnosis is uncertain or the child has other medical conditions. The consultation also includes discussing the potential benefits and risks of the surgery, such as reduced postoperative pain with specific techniques, like partial or intracapsular tonsillectomy, compared to the standard method.

Parents or patients will have the opportunity to ask questions about the procedure, recovery time, and postoperative care. Your consultant will explain what to expect during the recovery period following your tonsillectomy, including typical timelines of up to two weeks for complete healing.

This appointment is also when the consent form is reviewed and signed, ensuring that the patient or guardian is fully informed about the surgery, including possible postoperative complications such as postoperative haemorrhage or secondary bleeding. Understanding these factors helps patients and families prepare mentally and practically for the surgery and recovery process.

In some cases, the consultant may discuss non-surgical treatment alternatives or the option of partial tonsillectomy, which is more commonly considered in children with obstructive sleep apnoea rather than for recurrent infections, as some tonsil tissue remains and may still become infected. The goal is always to tailor the treatment to the patient’s specific tonsil problems and overall health status.

Preparing for surgery

Before your child undergoes a tonsillectomy, there are several essential steps to take to ensure a smooth procedure and recovery. First, it is crucial to follow all pre-operative instructions provided by your healthcare provider. These may include fasting guidelines, medication adjustments, and other specific preparations.

Additionally, ensure that you arrange for post-operative care and support. Your child will need plenty of rest and a comfortable environment to recover in. Stock up on soft foods and liquids, as these will be easier for your child to consume after the surgery.

The tonsillectomy procedure is performed under general anaesthesia, ensuring that the patient is deeply asleep and does not feel pain during the operation. This is crucial for patient comfort and safety. The anaesthetist will monitor the patient throughout the surgery to ensure a smooth procedure.

The surgeon will then carefully remove the tonsils, taking care to minimise any bleeding. The entire procedure typically takes about 30 to 45 minutes.

During the surgery, the surgeon works within the tonsil bed, the area where the tonsils are attached to the throat. Various surgical techniques can be employed to perform a tonsillectomy, including cold knife dissection or coblation (a form of low-heat radiofrequency energy). Each method aims to remove the tonsils completely or partially, depending on the indication and surgical plan. Partial or intracapsular tonsillectomy may be chosen to reduce postoperative pain and bleeding.

The surgical team takes great care to control blood pressure and minimise bleeding during the procedure, as the tonsil area is highly vascular. Effective pain management protocols are also planned to address post-operative pain once the patient is awake.

In some cases, tonsillectomy is combined with other procedures, such as adenoidectomy, especially in children with sleep disordered breathing or obstructive sleep apnoea. The goal is to improve airway patency and alleviate symptoms associated with enlarged lymphoid tissue.

Immediate post-surgery care

After the surgery, your child will be taken to a recovery room where they will be monitored until they are fully awake. This is a standard procedure to ensure that they regain consciousness safely and are stable before being moved to a regular room or discharged.

It is crucial to administer regular painkillers to manage pain effectively. Pain relief should be given consistently, every four to six hours, during the initial days following the surgery to ensure your child’s comfort and aid in the healing process. Ensure that you only administer medications as advised or prescribed by your consultant.

Additionally, monitor for signs of fresh bleeding, which requires urgent medical attention. While some old blood being coughed up is normal, fresh red blood is a sign that needs immediate medical intervention.

Long-term recovery

The long-term recovery process after a tonsillectomy is crucial for ensuring a full and healthy recovery. It is important to note that the recovery period typically lasts one to two weeks, during which the child should refrain from school and other activities. This timeframe helps manage pain levels, avoid infections, and allow the throat to heal correctly.

Resuming a regular diet promptly after surgery is essential. Consuming solid foods helps clear the tonsil area of debris, reducing the risk of infection. Additionally, maintaining adequate hydration is crucial throughout the healing process. Proper nutrition plays a vital role in recovery, enabling the child to regain strength in the days following surgery.

Complications and risks

While tonsillectomy is a standard and generally safe surgical procedure, it does carry potential complications and risks that should be considered before undergoing the procedure. One of the most common risks is bleeding, which may occur during or after surgery and, in rare cases, may require a second procedure to control. Infection is a rare complication and may include fever, pus formation or wound inflammation. These are typically manageable with supportive care or antibiotics if needed.

Some patients may experience difficulty swallowing following the surgery, which is typically temporary but can persist in rare instances. Pain is an expected part of recovery, particularly throat pain, and effective pain management is essential to ensure comfort and facilitate healing. Pain relief is usually achieved with regular or prescribed medication. It is necessary to discuss these potential risks and complications with your consultant before surgery. They can provide advice tailored to your child’s individual health needs and help you make an informed decision about whether tonsillectomy is the right choice for your child.