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Tonsillectomy

THE DAY OF THE OPERATION:

Preparation:

The reasons for your child’s operation will be clearly explained to you at your pre-operative appointment with the doctor.  You will be given the opportunity, if you wish, to see the ward where your child will be and meet one of the nurses to discuss details of the admission.   Your child will not be able to eat or drink anything for a few hours before the operation, and clear instructions regarding this will be given to you by my secretary. My anaesthetist will meet you before the operation to discuss the way in which your child will go to sleep.

Day of the Surgery:

You will be asked to come to the hospital first thing in the morning and will be shown to your room to settle in.  Both the anaesthetist and myself will come round to see you and you will have the chance to discuss the anaesthetic in more detail, and also ask me any final questions that you may have.

The Tonsillectomy Surgery itself:

You and your child will be brought down to the area where the Operating Theatres are.   You will be shown into the room where the anaesthetic is given and be allowed to stay with your child until they are asleep.   The operation itself takes approximately 20 minutes and the tonsils are removed through the mouth, so there are no cuts or scars on the outside.   Your child will move to the Recovery area when the surgery is complete, and will be looked after there until they have started to wake up.  The nurses will then call you to be with your child and take them back to the ward.  

The recovery period:

Once back on the ward, your child will be encouraged to sleep for as long as possible.   This is usually for around an hour or two.   They will then be allowed to have some sips of water and, providing that they do not feel sick, they will allowed to drink a little more and possibly to have something to eat later on.   The afternoon will be spent quietly on the ward and it will give you an opportunity to talk to the nursing staff about the after care that will be necessary.   They will explain to you about the painkillers that are very important to allow your child to get better as quickly as possible.  

I will come and see you and your child the next morning, and provided all is well, they will be allowed to go home.   You will be given all the painkillers that you need and also some antibiotics to help the healing process.

Pain medication:

Having the tonsils removed can be painful, so it is very important to take regular painkillers to keep everything under control.  

For the 10 days after surgery, I recommend that all children are given regular painkillers.  

I would like them to take paracetamol (Calpol) four times a day and an anti-inflammatory painkiller three times a day.   I usually recommend that diclofenac (Voltarol) is given for the first five days of the recovery, as it is quite a strong medication and, for the next five days, ibuprofen (Nurofen) is usually adequate.   These two types of medicine can be given at the same time as they do not interact with each other.  You will also be given codeine phosphate medication if your child is still uncomfortable and it is not time for the regular medication to be given.   There will also be a course of antibiotics to take for 10 days, to prevent any infection developing while things heal.

Eating and drinking:

It is important that your child eats and drinks as normally as possible after the operation.   This will encourage healing and actually makes the pain less.

Brushing Teeth:

There is no reason why you cannot gently brush your child’s teeth after the operation.

Other things to look out for:

It is common for children to complain of pain in their ears after they have had their tonsils out.   This is because the nerves that supply the tonsils also supply the ears.   It is very unlikely that there is actually a problem in the ears themselves.  

If you do look in the back of the mouth, you may see that things look white.   This represents the healing process and will gradually clear as time progresses.   At two weeks after operation, things should look back to their normal pink colour.  

Going back to school:

Children should be kept away from school or nursery for two weeks after the operation.   This is to try and reduce the chance of them catching an infection from another child, which may slow their recovery.   There is no problem with them mixing with their family, or going outside for short periods of time, provided they do not overdo it.

Bleeding:

There can be bleeding associated with having your child’s tonsils removed.  Bleeding at the time of surgery is dealt with and your child is kept for one night afterwards to ensure that there are no problems initially.   However, bleeding can occur as part of the healing process, any time from a few days after the operation until 10 days after the surgery.   If bleeding occurs, it usually comes from the child’s mouth and, if you notice this, you should contact the hospital for advice (020 7580 4400).   Out of every 100 children who have this operation, five will get some sort of bleeding at home afterwards.

Very rarely there can be significant bleeding after the surgery. If this occurs you will need to take your child to the local accident and emergency department, calling an ambulance if necessary. Sometimes there may have to have another operation to control this bleeding.   This happens in around 1 of every 100 surgeries. 

Follow Up:

There is a nurse available at the Portland 24 hours a day for advice and my secretary is in her office during normal working hours. I need to see your child 2 weeks after the operation to check that all has healed properly.

For further information relating to Tonsils please click here