Tonsillectomy

Question 1

What is Tonsillectomy?

Answer 1

• This is the surgical removal of the tonsils
• By removing the tonsils it prevents further episodes of tonsillitis, although patients can get a sore throat from other causes such as a pharyngitis

Question 2

What are the indications for a tonsillectomy?

Answer 2

• Recurrent infections (7 or more in 1 year, 5 per year for 2 years, 3 per year for 3 years)
• Recurrent tonsillar abscesses (2 episodes)
• Enlarged tonsils causing sleep apnoea, difficulty breathing/ swallowing

Question 3

What are the complications of a Tonsillectomy ?

Answer 3

• Sore throat where the tonsillar tissue has been removed
• Damage to the teeth
• Infection
• Post-tonsillectomy bleeding
• General Anaesthetic risk

Question 4

What is Post Tonsillectomy Bleeding?

Answer 4

• Significant complication after a tonsillectomy
• Can happen up to 2 weeks after the operation
• Bleeding can be severe and in rare cases life-threatening due to the aspiration of blood

Question 5

What is the management of Post-Tonsillectomy Bleeding?

Answer 5

• Call the ENT registrar
• Get IV access and send bloods: FBC, clotting, Group and Save and Crossmatch
• Give the patient analgesia and keep them calm
• Sit them up and encourage them to spit out the blood rather than swallowing it
• Make the patient NBM
• IV fluids for resus
• IV tranexamic acid - strong evidence that it reduces the need for transfusions in surgical bleeding in general
• Go to theatre

Question 6

What are the red flags for Post-Tonsillectomy Bleed?

Answer 6

• Any patient who reports bleeding from the mouth/ nose following a recent tonsillectomy
• Young children who have recently undergone tonsillectomy who present with excessive swallowing or bloody sputum

Question 7

When do you admit patients for a post-tonsillectomy bleed?

Answer 7

• All patients who complain of fresh blood in their throat, whether or not this has stopped should be admitted for observation for approximately 12-24 hours
• A small, self-limiting bleed may prelude to a larger bleed

Question 8

What is the management for tonsillar pain?

Answer 8

• Paracetamol, NSAID, weak opioid
• Topical Difflam
• Antiemetics
• Plenty of fluids