Adenotonsillectomy

Introduction

Adenotonsillectomy is a procedure that involves the complete removal of the tonsils and adenoids.

Indications

The primary indications for Adenotonsillectomy are;

  • Recurrent tonsillitis / sore throats.
  • Obstructive Sleep apnoea.
  • Tonsillar Abscess.

Risks

Adenotonsillectomy carries the same general risks as all operations including:

  • Pain.
  • Bleeding.
  • Infection.
  • Scarring.
  • Failure to resolve symptoms.

The main significant risk of Adenotonsillectomy is delayed bleeding, which may occur up to 2 weeks after surgery. This complication occurs in approximately 1-2 per 100 cases when surgery is performed by Dr Morrissey.

Treatment Alternatives

There may be treatment alternatives suitable to you or your child that you can discuss with Dr Morrissey. Recurrent infections may respond to antibiotics in some cases while nasal sprays may assist in obstructive sleep apnoea in limited cases.

Preoperative Instructions

Adenotonsillectomy is performed under a general anaesthetic. You will need to fast prior to surgery and should follow the provided instructions. If you have any queries or concerns please contact your Anaesthetist, admitting hospital or Dr Morrissey.

Procedure

Under a general anaesthetic the adenoids are removed from behind the nose with a special instrument. Pressure or cautery is applied to control bleeding.

The tonsils are removed using sharp instruments and any bleeding addressed using stitches and / or cautery.

Postoperative Instructions

Return to normal activities

It takes 7-10 days for most children to fully recover. You will need to keep your child away from day-care, kindergarten and school during this period.

General activities can be resumed when your child feels up to it. Please avoid active sports, rough play and heavy lifting for 2 weeks.

Pain Relief

Children will experience some throat pain and discomfort for up to 10 days following surgery.  Ear pain, jaw pain and neck pain may also occur. This can be improved with pain relief but may not entirely disappear. During this time, it is recommended your child take some regular pain relief.

Medications

  • Panadol: Please take every 4 to 6 hours (with a maximum of 4 doses in a 24hr period), continue this regularly for 7-10 days.  If your child refuses oral pain relief medication, Panadol can be given as a suppository. Take as directed by the manufacturer.
  • Oxycodone Syrup: This will be prescribed for when Panadol is not sufficient. This will be needed in the first few days following surgery, but its use should diminish over time. Please take the prescribed dose as directed. This medication can cause drowsiness and constipation.

Please avoid the use of Ibuprofen (Nurofen) following surgery unless other measures are insufficient. While it can aid pain relief, it is also associated with a slight increase in the bleeding risk and hence is best avoided if possible.

If pain relief requirements exceed this, please contact Dr Morrissey.

Non-Medication Pain Relief

There is some evidence that the following measures may aid in pain relief after tonsil surgery:

  • Maintain hydration to keep the mouth moist;
  • Use chewing gum and/or chewy lollies to exercise the jaw. It works like physio for your mouth;
  • Ice blocks, ice-cream and other cool items can alleviate pain in the first few days after surgery; and
  • A varied diet including some harder to swallow items (bread/meat/apples and whole fruit) speeds up the healing process by ‘cleaning’ the operation site.

Diet

There are no restrictions on diet. Children are encouraged to drink as much as required, to avoid dehydration. Ice blocks are a good option as they are cold, have good calories and contain fluid.

If your child refuses solids but is maintaining good fluid intake, then this is acceptable.  At least 80mls fluids per kilo body weight each day is recommended.

Please contact Dr Morrissey if your child is not drinking or eating enough. They may need to be re-admitted to hospital for intravenous fluids.

Antibiotics

In certain circumstances, children may be prescribed antibiotics following surgery. Please take as instructed if advised. For most children, antibiotics will not be necessary.

Fever

It is common to have a mild fever for the first 24-48hrs after the operation.  Please call Dr Morrissey’s rooms or see your GP if there is a persistent fever greater than 38.5°C.

Bad Breath

Bad breath is expected following removal or tonsils and even more so if the adenoids are removed.  It is part of the normal healing process. This usually settles after around 3 weeks, if not sooner.

Bleeding

If there is any sign of fresh bleeding from the nose or mouth greater than a teaspoon in volume, please present to the nearest Emergency Department for assessment.

It is important to stay within 1 hour of a health service with an ENT surgeon for 7 days after tonsillectomy due to the risk of bleeding. While extremely rare, a severe post-tonsillectomy bleed can be a life-threatening event and will require an adequately staffed hospital to address the bleeding.

Follow Up appointment

A follow-up phone call is usually made 4-6 weeks after surgery in most cases. Where an appointment is needed you will be advised by Dr Morrissey. If at any stage, you wish to see Dr Morrissey his staff will be happy to arrange an appointment.

How to contact Dr Morrissey

For non-emergency issues please call (07) 4646 4275 for further instructions.

Dr Morrissey shares ‘on-call’ arrangements with other ENT surgeons and one is usually available to answer questions. After hours the "on call" ENT surgeon can be contacted via Toowoomba Hospital on (07) 4616 6000.

Should your concerns not be addressed via a phone call please present to your nearest Emergency Department.

In the event of an Emergency call 000 or attend the nearest Emergency Department.

Related Information

Tonsillitis
Snoring and Sleep Apnoea