Tonsillectomy - Adult

Introduction

A tonsillectomy is a procedure designed to remove all of the tonsillar tissue from the side walls of the oral cavity.

Indications

The main indications are;

  • Recurrent tonsillitis.
  • Sleep apnoea.
  • Suspicion of malignancy / Tonsil asymmetry.
  • Complications of tonsillitis like Quinsy or Neck Abscess.

Risks

Tonsillectomy carries the same general risks as all operations including:

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

The main significant risk of Tonsillectomy is delayed bleeding, which may occur up to 2 weeks after surgery.

Treatment Alternatives

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

Preoperative Instructions

Tonsillectomy 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

The tonsils are removed using sharp instruments and any bleeding addressed using stitches and/or cautery. The procedure takes around 30 minutes.

Postoperative Instructions

Return to normal activities

It takes 10-14 days for most people to fully recover. You will need to stay home from work or school for at least 10 days following surgery.

General activities can be resumed when you feel up to it. Please avoid active sports, exercise and heavy lifting for 2 weeks.

Pain relief

You will experience some throat pain and discomfort for up to 2 weeks 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 that you 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.  Follow manufacturer’s instructions regarding dosage.

Dexamethasone: This is a steroid used to reduce pain, swelling and nausea. It is best taken early in the day as it can lead to insomnia. Please take as directed if prescribed.

Oxycodone (as required): This may 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. While taking Oxycodone it is important to realise that you should not drive or operate heavy machinery.

Please avoid (or minimise) 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.

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;
  • 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.

Please seek advice if pain relief measures are inadequate.

Antibiotics

In certain circumstances you may be prescribed antibiotics following surgery. Please take as instructed if advised. For most people following tonsil surgery they are unnecessary.

Diet

There are no restrictions on diet. You should drink as much as needed to avoid dehydration. Aim to maintain at least a 1.5 litre water intake daily while recovering.

Please contact Dr Morrissey if you are worried you are not drinking or eating enough. You may need to be re-admitted to hospital for intravenous fluids in some instances.

Fever

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

Bad Breath

Bad breath is expected following removal of tonsils and even more so if the adenoids are removed. It is part of the normal healing process. This usually settles after 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 (spitting or coughing up fresh blood), 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 surgery due to the risk of bleeding.  While extremely rare, a severe post-tonsillectomy bleed can be a life-threatening event and it will require an adequately staffed hospital to address this type of 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 the Toowoomba Base 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