Tonsillectomy & Adenoidectomy

Tonsillectomy & Adenoidectomy

STRUCTURE AND FUNCTION

The back of the throat and nose contains an abundance of lymphatic tissue that fight infections by producing antibodies. Of these the 2 main collections are the palatine tonsils and the adenoids. The palatine tonsils are small, round pieces of tissue that are located in the back of the mouth on the side of the throat. The palatine tonsils can usually be seen in the throat by using a light. The adenoids are located in the space at the back of the nose (nasopharynx) and cannot be seen by looking in the throat or the front of the nose.

TONSILLITIS

Tonsillitis occurs when the tonsils become inflamed from infection. Tonsils and adenoids may cause problems if they become enlarged or infected. Tonsillitis is most commonly seen in children between the ages of 6 and 8. There are many causes of tonsillitis (viruses, bacteria, fungal infections). Cigarette smoke may increase incidence of tonsillitis. Symptoms of tonsillitis may include: sore throat, fever, headache, decrease in appetite, not feeling well, nausea, vomiting, stomach aches and painful swallowing. If tonsils are very large  periods of apnoea (stopping breathing) may occur at night.

 ADENOIDITIS

Adenoiditis is an inflammation of the adenoids due inflammation or infection. Symptoms of adenoiditis or enlarged adenoids may include: mouth breathing, noisy breathing or snoring, nasal speech, or if very large  periods of apnoea may occur at night.

TREATMENT

Specific treatment for tonsillitis and adenoiditis will be determined based on: age, general health and medical history; severity and frequency of infections; the occurrence of any airway problems; and your opinion or preference.

  

TONSILLECTOMY AND ADENOIDECTOMY (T&A)

In children the tonsils and adenoids are frequently removed at the same time, but sometimes, only one is removed. Tonsillectomy and adenoidectomy (T&A) surgery is one of the most common major operations performed on children.

 The most common reasons for performing tonsillectomy and adenoidectomy are recurrent tonsillitis (not just a sore throat) and/or  airway obstruction causing problems with breathing. A sleep study may be ordered in some children.

Pre-operative instructions

·        DO NOT TAKE ASPIRIN OR ASPIRIN RELATED MEDICATION FOR 14 DAYS PRIOR TO SURGERY     (NB:  PANADOL, PANADEINE and PANADEINE FORTE can be taken)

        see Last Page– Medications to Avoid

·        If an attack of tonsillitis occurs within 2 weeks of the surgery, you need to contact my rooms as it may be wise to postpone the surgery.

·        Prior to surgery, you will meet with the anaesthetist, a doctor with specialised training in anaesthesia. He/she will take a medical history, perform a physical examination and formulate a plan of anaesthesia. This will be discussed with you and your questions will be answered.

 The  Procedure

·        The surgery is performed in an operating room under general anaesthesia with the patient in the BECKENBURG position (ie head-up or reversre Trendelenburg). A drip into the vein is inserted at this time. This will help with fluid input during and after the surgery.

·        The tonsils and/or adenoids will be removed using cautery and dissection through the mouth. Following surgery the patient will be taken to the recovery ward and monitored closely. After the patient is fully awake, the patient will be taken back to the ward.

·        If there is any significant bleeding this will be reviewed by the surgeon, and if severe, the patient may return to the operating theatre.

Post operative Care

While in hospital

Tonsillectomy requires an overnight stay in hospital.

After discharge

bullet The patient needs to be at home and rest for 10-14 days postoperatively. The pain following tonsillectomy is considerable and can worsen after the first few days. It can be quite severe for up to 10 days. There may be referred pain to the ears and chewing gum can help.

·         DO NOT TAKE ASPIRIN OR ASPIRIN RELATED MEDICATION FOR 3 WEEKS FOLLOWING SURGERY(Panadol, Panadeine or Liquigesic should be taken as needed)see  Back Page– Medications to Avoid

bullet No school or work for two weeks.
bullet It is essential to drink a lot of fluid.
bullet Food may be taken as tolerated. Sucking ice cubes, ice blocks can help.
bullet Patients should not venture far from home during this post operative period.
bullet White slough in the throat and bad breath is normal after tonsillectomy, however, if extreme redness and any fever is present the patient needs to be reviewed.
bullet POST OPERATIVE BLEEDING

There is a risk of bleeding although rare, up to 14 days post operatively. If bleeding is only a few drops, sucking ice cubes and rest may be all that is necessary. If bleeding is severe and has persisted for 10 minutes or more, the patient should be taken immediately to your nearest Hospital Emergency Department and your Surgeon will be contacted.

Adenoid Note: If the adenoids alone are removed there is usually a lot less pain but there is still a risk of bleeding. Schooling may be resumed after one week. The rest of the postoperative instructions above, apply to adenoidectomy also.

A postoperative visit to my rooms should be arranged 14-16 days after surgery

  

RISKS OF TONSILLECTOMY AND ADENOIDECTOMY

  • General anaesthesia: there the usual risks with any general anaesthesia.
  • Bleeding, may be serious (possibly 1:200 operations or less);
    • occasionally the patient needs return to operating room, and rarely a blood transfusion may be needed.
  • Infection.
  • Minor facial burns from the electrical device used to control bleeding.
  •  Dental injury.
  • Post-operative breathing problems may develop (usually in children with preoperative breathing problems).
  • Minor changes in the voice - usually only relevant to singers.
  • Swallowing difficulty, leakage of drinks through the nose, and unclear speech (rare).
  • Other complications are possible.

 

MEDICATIONS TO AVOID BEFORE AND AFTER SURGERY

All medications that you are currently taking should be discussed with your surgeon prior to your operation.

There are two groups of drugs which are very important to avoid prior to your operation. These are Aspirin containing medications, and a family of drugs called 'Non Steroidal Anti Inflammatory Drugs' (NSAID’s). Both of these drugs affect the ability of your blood to clot, and so may predispose to post operative bleeding and complications.

 Please make sure to check this list carefully and avoid ALL these medications for two weeks prior to surgery, and for three weeks after surgery. If you have any questions regarding this or are taking any of these medications for specific conditions, please contact your general practitioner and notify this office.

Some herbal supplements (such as Garlic) may increase the risk of bleeding. Thus ALL herbal supplements should also be avoided for the above time periods specified.

Notes: BECKENBERG position (ie head-up or reverse Trendelenburg). BECKENBERG position (ie head-up or reverse Trendelenburg).BECKENBERG position (ie head-up or reverse Trendelenburg).BECKENBURG position (ie head-up or reversre Trendelenburg).BECKENBERG position (ie head-up or reverse Trendelenburg).

 

ASPIRIN & ALOXIPRIN                                                                                                    NSAID's

 

ASA ARTHRITIS STRENGTH ASPIRIN                                                                        ARLEF

ASPRO & ASPRO CLEAR                                                                                            ARTHREXIN

ALKA-SELTZER                                                                                                          BRUFEN

ASPALGIN                                                                                                                 BUTAZOLIDIN

ASPRODEINE & ASPRODEINE SOLUBLE                                                                   BUTAZONE

BAYER ASPIRIN                                                                                                        CLINORIL

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CARDIPRIN                                                                                                                INFLAM

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ENSALATE                                                                                                                    PONSTAN

MORPHALGIN                                                                                                                RHEUMACIN

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PERPAIN                                                                                                                           OTHERS

RHUSAL                                                                                                                             CELEBREX

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