Tonsillectomy

A tonsillectomy is the surgical removal of the tonsils, which are two pads of glandular (lymphatic) tissue on each side of the back of the throat. Tonsils help defend the body against infection which may enter through the nose or mouth. They are prone to inflammation and enlargement, which can lead to a condition called tonsillitis. A doctor usually suggests a tonsillectomy when tonsillitis is frequent and severe, or causes complications.

The operation

A tonsillectomy is performed under general anaesthesia. The surgeon will use a special device to keep the mouth open so that they can see the tonsils during the surgery. The procedure takes approximately 45 to 60 minutes. This includes the anaesthetic, the operation and time spent in the recovery room.

Your child will stay in hospital overnight for observations but should be able to go home the next morning if he/ she can eat and drink, swallow medicine, does not have any severe pain and is not bleeding from the nose or mouth.

Note: There is a slight risk of bleeding within 14 days after discharge, so it is important to stay within 45 minutes of the Queensland Children’s Hospital during this time. Families from regional or remote areas should make suitable accommodation arrangements.

Preparation for surgery

Do not give your child Aspirin for one week before the operation or two weeks after. Do not give ibuprofen (Nurofen®) for 72 hours before the operation.

After the operation

All children react differently to surgery. They may cry, be distressed, be awake and alert, or very sleepy. Do not be alarmed as your child will settle after a short time.

Your child will have either Intravenous Therapy (IV drip) or an IV cannula overnight. This will be removed the following morning once your child is tolerating foods and fluid.

Pain relief

Pain relief will be prescribed by the doctor after your child’s operation. Paracetamol and Oxycodone (a stronger prescription-only medicine) are commonly used for pain relief after tonsillectomy.

Throat pain builds up for the first few days and is usually at its the worst around the fifth day after surgery. Pain and discomfort will usually then ease until the seventh or ninth day after surgery when some of the scab covering the tonsillectomy site falls off. After this there is a steady reduction in pain.

Some children will experience a mild earache after a tonsillectomy. This is because the ears and the tonsils share the same nerve.

It is important to provide your child with regular pain relief during their recovery. This includes waking them at night for one or two days after the surgery.

Do not wait for your child to say they have pain or they may not take their medication and may not eat or drink, putting them at risk of bleeding and dehydration.

Paracetamol can be given every four to six hours with a maximum of four doses per 24 hours or as directed. Paracetamol should be given regularly for the first 48 hours and then as required.

If pain is not relieved by Paracetamol alone, Oxycodone can also be used. Oxycodone can be given every four to six hours, with a maximum of four doses per 24 hours.

It is important for you and other carers to record the name of the medication, and the date and time you have given it to keep track of medication usage.

Do NOT give your child Aspirin for two weeks after the operation. Ibuprofen may be given after the operation if advised by your child’s doctor.

Do not give any other pain relief medicines without checking with your child’s doctor because some products may double-up with prescribed medication.

Local anaesthetic lozenges can also be used by older children to supplement pain relief.

Food and drink

For the first two hours after the operation, your child can have clear fluids (water, cordial, iceblock). When he/she is tolerating clear fluids your child may then have non- carbonated fluids (milk, ice-cream, custard).

Children may refuse to drink fluids after the surgery because of throat pain but they must be encouraged to drink regularly (half a cup every hour) to avoid dehydration. Dehydration can lead to increased pain and also increase the chance of bleeding.

Two hours after returning to the ward your child can eat regular meals. During the first eight hours after surgery your child may eat without too much discomfort due to the local anaesthetic used in the surgery.

It is important to maintain your child’s fluid intake at home to prevent dehydration. Your child should also resume their normal diet as soon possible, although he/ she will probably be fussy about food at first. Any food is better than none in the first few days. Some foods (hot and/or spicy, acidic) may cause discomfort when eating so should be avoided for a few weeks.

Chewing gum or chewy lollies will increase saliva production and help to reduce jaw stiffness.

Mouth care

Bad breath is a normal part of the healing process. Drinking plenty of water will help reduce the odour and teeth should be brushed as normal. The site where the tonsils have been removed will turn yellow/white – this is also normal.

Activity

Your child will need to stay home from school or childcare for two weeks and should avoid all sports and rough play. Encourage plenty of rest and quiet play or entertainment such as puzzles, reading and watching DVDs.

Post-operative review

A review of your child will be scheduled after the operation. This will be performed at an outpatient appointment or over the phone. If you have any concerns prior to the review, contact the hospital.

When to seek urgent medical attention

Contact your doctor or the hospital immediately if your child:

• has bright red blood in their nose or mouth
• has persistently high temperatures above 38°C
• has increased throat or ear pain not relieved by medication
• is not eating or drinking
• is nauseous or vomiting with no sign of relief
• is dehydrated. Look for signs such as dry mouth, dark or lack of urine, sunken eyes and looking increasingly unwell

If you cannot see your GP, go to your nearest emergency department.

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

In an emergency, call Triple Zero (000) and ask for an ambulance.

Developed by Ear, Nose and Throat. We acknowledge the input of consumers and carers.

Resource ID: FS005. Reviewed: February 2015.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.