I hold a private operating list at the Portland Hospital on Tuesday mornings. My secretary, Jo, would be pleased to advise on the costs involved for surgery, including the fees for both the Portland Hospital and the anaesthetist.
Once you have decided on a date for surgery to take place, Jo will provide you with all the information you need to liaise with your insurer.
The admission time to the Portland Hospital is 7.15 am.
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 provided to you by Jo.
My anaesthetist will meet you before the operation to discuss the way in which your child will go to sleep.
Once the operation has finished, your child will go to the recovery area and you will be called to accompany them back to the ward with one of the nurses. The most important thing at this stage is to encourage your child to have a sleep for as long as possible. Once they have woken up, they can have some sips of water and, provided all is well, something to eat. It is a good idea not to overdo things at this stage as some children do feel a little nauseous.
My operating list starts at 8 am and your child should be able to go home by early afternoon.
Your child will be discharged with pain control and/or antibiotics.
ADENOIDECTOMY
Adenoidectomy is a day case procedure taking around 15 minutes. It does require a short general anaesthetic. The surgery is done through the mouth so there are no cuts or scars on the outside. I use a technique which is called ‘suction diathermy’ which allows accurate removal of the adenoid with minimal blood loss.
What to expect afterwards
The procedure is not very painful but I do recommend regular paracetamol (Calpol) for 24-48 hours afterwards. Children may seem a bit more blocked up initially because of some swelling and may also say that their throat is sore. This will settle in a few days.
I ask you to keep your child away from other children (except for brothers and sisters) for the rest of the week. This is to prevent infection at the site where the adenoids have been removed.
Some parents report that their child’s voice sounds a little different after the operation. This is because there is more space at the back of the nose and air can now pass more easily down it.
One rare problem can be bleeding from the mouth or nose. If this occurs, please contact my secretary or, out of hours, the nurse in charge of The Portland Hospital immediately.
I would like to see your child 14 days after surgery to ensure all has healed well.
You should not plan to fly until your child has had their post-operative appointment.
GROMMET INSERTION
This is a day case procedure taking around 20 minutes. A grommet is a tiny (1.5 mm) plastic tube shaped like a cotton reel which is inserted into a small slit in the ear drum (called a myringotomy) in order to allow air into the middle ear. Such an operation is usually performed if a child has glue ear or repeated middle ear infections. Any fluid present in the middle ear is removed at the time of the surgery.
What happens after the grommet procedure?
Grommet insertion is not particularly painful but taking paracetamol (Calpol) for a day or so should settle any discomfort. Children can eat and drink whatever they like and can go back to school or nursery the next day. However, if your child has had another procedure too (such as adenoidectomy or tonsillectomy), please look at the post-operative instructions for those as they are different.
You will be given some antibiotic ear drops to use after the operation. These may say ‘eye drops’ on the bottle. This is because they are a safe type of medication to use with grommets. There may be small amounts of fluid coming from the ear for several days after the surgery. This may be slightly blood stained which is normal. If it persists, please contact my office. I would like you to keep all water out of the ears until you come to see me 2 weeks after the operation. I would suggest a piece of cotton wool coated in Vaseline in each ear for bath time. After that, it is only soapy water that needs to be kept out of the ears and so more cotton wool and Vaseline or commercially bought earplugs should be used for hair washing.
Can my child swim with grommets in the ears?
Yes. Swimming, even without ear plugs, has not been shown to cause ear infections in children with grommets. Diving and swimming deep underwater without earplugs should be avoided if possible, as these activities can cause some irritation.
What happens if the ear gets infected?
An infection in the ear can sometimes develop with grommets. This either spreads from the nose via the Eustachian tube or directly down the ear canal. It normally causes a mild earache and discharge. The discharge can be thick, sticky and smelly. If this happens, treatment with antibiotic ear drops may be required. Please call the office for advice or, if more convenient, your GP.
Can my child fly with grommets?
Flying with grommets is perfectly safe and the ears should be pain free as they are being ventilated properly.
What happens to the grommets?
Grommets stay in for a varying length of time but most fall out between 6 to 12 months after being placed. They usually become attached to wax and fall out of their own accord. It is important to check that the eardrum has healed properly behind the grommet and that the glue or infections have not recurred. For this reason, I like to see patients, with a new hearing test, every six months after surgery. The majority of children grow out of their ear problems but there are a small number who may need a second set of grommets placed.
TONSILLECTOMY
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. This is the intracapsular technique.
Pain medication
Having the tonsils removed can be painful, so it is very important for your child to take regular painkillers to keep everything under control.
For 10 days after surgery, I recommend that all children are given regular painkillers. 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 reduce the pain.
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 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 the rest of the week 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 tonsils removed. Bleeding at the time of surgery is dealt with (your child may be kept for one night afterwards to ensure that there are no problems). 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) and ask to speak to the Paediatric Site Practitioner (PSP). 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 they may have to have another operation to control this bleeding. This happens in around 1 of every 100 surgeries.
Post-operation Follow-up
There is a nurse available for advice at the Portland Hospital 24 hours a day and my secretary is available by phone or email during normal working hours.
I need to see your child 2 weeks after the operation to check that all has healed properly.
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