Tonsillectomy

Question 1

What is tonsillectomy?

Answer 1

Tonsillectomy is the name for the surgical removal of the tonsils. Removing the tonsils prevents further episodes of tonsillitis, although patients can still get a sore throat. The procedure is usually performed as a day case, and patients go home 6 – 8 hours after the operation, after a period of observation.

Question 2

Indications for tonsillectomy?

Answer 2

A common question you will get from patients and parents is whether a child needs a tonsillectomy for recurrent tonsillitis. The NICE clinical knowledge summaries give the number of episodes required for a tonsillectomy:

7 or more in 1 year
5 per year for 2 years
3 per year for 3 years

Other indications are:

Recurrent tonsillar abscesses (2 episodes)
Enlarged tonsils causing difficulty breathing, swallowing or snoring

Question 3

Complications of tonsillectomy?

Answer 3

Pain, particularly a sore throat where the tonsillar tissue has been removed. This can last 2 weeks.
Damage to teeth
Infection
Post-tonsillectomy bleeding
Risks of a general anaesthetic

Question 4

Post tonsillectomy bleeding?
Management?

Answer 4

Post tonsillectomy bleeding is the main significant complication after a tonsillectomy. Significant bleeding can occur in up to 5% of patients who have had a tonsillectomy and it requires urgent management. This can happen up to 2 weeks after the operation. Bleeding can be severe and in rare cases life threatening, usually due to aspiration of blood.

Management:

Call the ENT registrar and get them involved early
Get IV access and send bloods including a FBC, clotting screen, group and save and crossmatch
Keep the child calm and give adequate analgesia
Sit them up and encourage them to spit the blood rather than swallowing
Make the child nil by mouth incase an anaesthetic and operation is required
IV fluids for maintenance and resuscitation as required
If there is severe bleeding or airway compromise, call an anaesthetist as intubation may be required.

Prior to going back to theatre there are two options for stopping less severe bleeds:

Hydrogen peroxide gargle
Adrenalin soaked swab applied topically