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Surgery

ADENOIDECTOMY

This information has been written to help answer some of your questions about the operation of adenoidectomy. If you are still in doubt as to what is intended after reading it, please do not hesitate to ask.

The Operation

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.

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.

What to expect afterwards

The procedure is not very painful but I do recommend regular paracetamol (Calpol) for 24-48 hours afterwards. If you think your child is still unsettled, I am happy for you to give some junior ibuprofen (Nurofen). 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 10 – 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

What is a grommet?

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.

Recurrent Ear Infections

Ear infections are common and are usually not serious. However, if they are recurrent, grommets may be recommended as they can help reduce the frequency of infection or make the symptoms less problematic by allowing the ear to drain.

The Operation

Your child will have to stop eating and drinking for a few hours before the operation. My secretary will go over the exact details and you will also be given a letter confirming all arrangements. My anaesthetist will see you on the day of the surgery and explain the process of getting your child to sleep. He has a website which you may find helpful. The procedure itself will take about 10 to 15 minutes.

What happens after the grommet procedure?

After the operation, your child will go to the recovery area for a short time and then you will be called to come and take them back to the ward with one of the nurses. They may feel a bit tired or nauseous but after a few hours they should be able to go home. 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. 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 eardrops 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.

Is it all right to 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 put in. They usually become attached to wax and fall out of their own accord. It is important to check that the eardrum has healed up 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

Preparation

The reasons for your child’s operation will be clearly explained to you at your pre-operative appointment. If you wish, you will be given the opportunity 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 for 7.00 am and will be shown to your room to settle in. Both the anaesthetist and I will come to see you and your child and you will have the chance to discuss the anaesthetic in more detail, and also ask me any final questions you may have.

The tonsillectomy surgery

You and your child will be brought down to the area where the theatres are. You will be shown into the room where the anaesthetic is given and will 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 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 be allowed to drink a little more and possibly 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. Provided all is well, they will be allowed to go home. You will be given all the painkillers your child needs and also some antibiotics to help the healing process.

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 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 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 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 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 they 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 for advice at the Portland Hospital 24 hours a day 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.