Tonsillectomy

What are the tonsils?

The tonsils are part of a group of lymphoid tissues (like the glands in your neck) that help to fight off infection from germs that are breathed in or swallowed. As you get older. your tonsils become less important to tight infection. Your surgeon has recommended a tonsillectomy. However, it is your decision to go ahead with the operation or not. This document will give you information about the benefits and risks to help you make an informed decision.

If you have any questions that this document does not answer, you should ask your surgeon or any member of the healthcare team.

How does tonsillitis happen?

Tonsillitis happens if the tonsils become infected. This causes pain, fever and difficulty swallowing and can make you feel unwell. Tonsillitis usually gets better within seven to ten days. Antibiotics may help if the tonsillitis is due to a bacterial infection. However, tonsillitis is often due to a virus and antibiotics do not help. A tonsillectomy is recommended if tonsillitis is frequent. For children, a tonsillectomy is recommended when the child has had at least four attacks each year for two years in a row. For adults, fewer attacks are needed before a tonsillectomy is recommended, as attacks tend to be more severe (sometimes needing treatment in hospital) and there is less likelihood of the attacks stopping on their own. it is important to realize that sore throats. such as those that happen with a common cold, will still happen after a tonsillectomy. The operation prevents tonsillitis, but will not prevent all sore throats.

What are the benefits of surgery?

A tonsillectomy will prevent you from getting tonsillitis and the resulting pain, fever and difficulty swallowing.

Are there any alternatives to surgery?

Surgery is recommended, as it is the m dependable way to stop tonsillitis hat keeps on coming back. In adults medical treatment is less likely to be effective. especially following glandular fever.

What will happen if I decide not to have the operation?

You will keep on getting tonsillitis. Occasionally, an abscess may form behind the tonsil. This is known as a ‘quinsy’ and needs the pus to be removed through a needle and treatment with antibiotics. Very rarely. the infection may spread further into the tissues of the neck causing a ‘parapharyngeal’ or ‘retropharyngeal’ abscess. This is a serious complication and needs an operation to drain away the pus.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes about half an hour.

Your surgeon will perform the tonsillectomy through your mouth.

• Cold dissection technique Your surgeon will use a steel instrument to peel or cut the tonsil away from the layer of muscle underneath it.

• Diathermy technique Your surgeon will use a diathermy instrument that uses heat to remove the tonsil and cauterize the area.

Your surgeon will then stop any extra bleeding.

What should I do about my medication?

You should continue your normal medication unless you are told otherwise. Let your surgeon know if you are on warfarin or clopidogrel. Follow your surgeon’s advice about stopping this medication before the operation.

What can I do to help make the operation a success?

Lifestyle changes

If you smoke, try to stop smoking now. Stopping smoking several weeks or more before an operation may reduce your chances of getting complications and will improve your long-term health.

For help and advice on stopping smoking, go to www.gosmokefree.co.uk.

You have a higher chance of developing complications if you are overweight.

For advice on maintaining a healthy weight, go to www.eatwell.gov.uk.

Exercise

Regular exercise can reduce the risk of heart disease and other medical conditions. improve how your lungs work, boost your immune system. help you to control your weight and Improve your mood. Exercise should help to prepare you for the operation. help with your recovery and improve your long-term health.For information on how exercise can help you. go to www.eidoactive.co.uk. Before you start exercising, you should ask a member of the healthcare team or your GP for advice.

What complications can happen?

The healthcare team will try to make your operation as safe as possible. However, complications can happen. Some of these can be serious and can even cause death. You should ask your doctor if there is anything you do not understand. Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you.

The complications fall into three categories.

  1.  Complications of anaesthesia
  2.  General complications of any operation
  3.  Specific complications of this operation

• Complications of anaesthesia

Your anaesthetist will be able to discuss with you the possible complications of having an anaesthetic.

• General complications of any operation

Pain, which happens with every operation. This ‘s the most common problem following a tonsillectomy, particularly for adults and older teenagers. The healthcare team will try to reduce your pain. They will give you medication to control the pain and it is important that you take it as you are told. Bleeding on the day of surgery (risk: less than 1 in 100) or in the following two weeks (risk: 6 in 100 if your surgeon uses the diathermy technique, 3 in 100 if they use cold dissection). Occasionally another operation is needed to stop the bleeding (risk: less than 2 in 100). If the bleeding ‘s heavy, you may need a blood transfusion . Infection in the surgical wound. If you experience bleeding that starts after you have gone home from hospital. it is probably as a result of an infection. Treatment includes antibiotics or further surgery if the bleeding does not stop quickly.

• Specific complications of this operation

Small pieces of the tonsil may be left behind (tonsil remnants). These remnants can continue to become infected and cause tonsillitis.

Lingual tonsillitis. There is some tonsil tissue in the back of the tongue. Sometimes this tissue will develop tonsillitis alter the real tonsils have been removed.

How soon will I recover?

In hospital

After the Operation you will be transferred to the recovery area. You should be able to go home on the same day. However. your doctor may recommend that you stay a little longer.

If you are worried about anything, in hospital or at home. ask a member of the healthcare team. They should be able to reassure you or identify and treat any complications.

Returning to normal activities

Your surgeon will tell you When you can return to normal activities.

You should not b ow your nose for at least a week after the operation. After this time you will blow out thick bloody mucus. Your nose will continue to feel blocked for quite a few weeks after the Operation.

Your surgeon will prescribe a nasal spray or drops for you to use, You may also need to use a nasal cleansing kit (nasal douche) to keep your nose clean. You may also be given a course of antibiotics to reduce the risk of infection.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask a member of the healthcare team or your GP for advice.

Do not drive until you are confident about controlling your vehicle and always check.

with your doctor and insurance company first.

The future

Most people make a good recovery. if your sinusitis is caused by an allergic reaction or polyps, you may need to continue with a nasal spray.

if you had polyps, they may come back again even if you use a nasal spray (risk: 4 in 10).

Summary

ln hospital

After the operation you will be transferred to the recovery area and then to the ward. You may be able to go home the same day. if you do go home the same day, a responsible adult should take you home in a car or taxi, and stay with you for at least 24 hours.

if a head bandage has been used, it will be removed the morning after surgery and you should be able to go home that day. However, your doctor may recommend that you stay a little longer. ‘ If you are worried about anything, in hospital or at home, ask a member of the healthcare team. They should be able to reassure you or identify and treat any complications.

Returning to normal activities

Your surgeon will tell you when you can return to normal activities. You should stay off work for two weeks. You will be able to fly without having a y problems with your ear.

Regular exercise should help you to return to normal activities as soon as possible Before you start exercising, you should ask a member of the healthcare team or your GP for advice.

Do not drive for at least 24 hours after the operation and not until you are confident about controlling your vehicle. Always check with your doctor and insurance company first.

The future

Most people make a good recovery. You will be seen in the outpatient clinic two to three weeks after the operation to remove the pack (if one has been inserted) and to check the graft. Sometimes ear drops are prescribed at this visit.

You should protect your ear from water, using cotton wool and Vaseline, until your surgeon is satisfied that the graft has worked. If the graft Is successful, you should not get ear infections and you will be able to swim and bathe as normal

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