Tonsillectomy and adenotonsillectomy | Tapahinga repe korokoro

Tonsils and adenoids are lumps of tissue (similar to the glands in your neck).

The tonsils sit on either side of the back of your throat (pharynx). Adenoids sit where the back of your nose meets your throat. You should be able to see your tonsils but only your doctor can see  your adenoids as they're more difficult to see.

Tonsils and adenoids are part of your body’s system that fights infection (immune system) and are only important during the first few years of life. 

A tonsillectomy (tapahinga repe korokoro) is an operation to remove your tonsils. About 4 in 1000 children have a tonsillectomy every year. An adenotonsillectomy is an operation to remove both your adenoids and your tonsils. Tonsils and adenoids are not essential and removing them won't harm your immune system.

Once your adenoids are removed, they very rarely grow again. After your tonsils are removed, you shouldn't get tonsillitis again but you can still get throat infections due to colds and the flu.

Tonsils and adenoids are only removed if they are doing more harm then good.

Obstructed breathing

Your doctor may recommend an operation if you or your child have swollen or enlarged tonsils that block your airways and cause snoring, difficulty breathing or short pauses in breathing (sleep apnoea). The operation is more successful if no other conditions are contributing to sleep-disordered breathing, eg, obesity. One third of operations are performed because of sleep apnoea. 

Frequent and severe bouts of tonsillitis

Your doctor may recommend an operation if you or your child have ongoing or repeated infections of the tonsils (tonsillitis) that are affecting your daily life.

Your doctor may recommend an operation when there is so much damage to your tonsils that they remain infected and do not respond well to antibiotic treatment. This may cause a sore throat much of the time, often with bad breath and sometimes yellow, cheesy, bad-smelling and bad-tasting material in the small cracks of your tonsils.

Other reasons

• If you have an abscess behind your tonsils (quinsy) that does not respond to drainage.
• If you have diabetes, heart valve problems or immunodeficiency, tonsillectomy may be considered because of concerns that the tonsil infection may spread to other parts of your body.
• If a biopsy is needed to evaluate a suspected tumour of the tonsil. 

During the operation

• A tonsillectomy or adenotonsillectomy usually takes less than an hour.
• It is performed under a general anaesthetic so you won't feel anything.
• The parts that need to be removed are taken out through your mouth. Usually, there are no cuts on your neck or stitches in your throat.

How long do you need to be in hospital after the operation?

• After the operation, your doctor will check to see how well you are recovering. Their checks will include how well you are able to eat and drink.
• You should be able to go home on the same day, but you may need to stay the night.

While healing takes place, your throat will be very sore for 10–14 days. Your throat will look white in colour and may develop scabs while it heals. This is normal. Any stitches at the back of your throat could take up to two months to disappear.

Below are some ways to help the healing process.

Medication

Regular pain relief (such as paracetamol) can help with the pain after the operation. Not all pain relief is suitable for pain after tonsillectomy. Your doctor or nurse can advise you about what pain relief is best to use. 

Don't give children any aspirin or aspirin-containing medicines (such as Aspro, AsproClear or Codis). Aspirin can increase the risk of bleeding during or after the operation and may increase the risk of a serious and rare disease named Reye syndrome. If you are unsure, check the medicine label and see if it mentions the words aspirin or salicylic acid.

Talk to your doctor or pharmacist if you are taking any other medicines,  rongoā Māori or herbal remedies. They may interact with the medicines you are taking.

Eating and drinking

• Try eating and drinking normally as soon as you can. It may feel more comfortable having softer foods at first.
• Avoid hot liquids, acidic or highly spiced foods for several days.
• Frozen yoghurt, cool fluids and ice blocks are a good option. Fluids are especially important to help recovery, to prevent dehydration and to prevent the build-up of debris and blood clots at the operation site.
• Taking pain relief 30 minutes before eating can help. However, follow your doctor's advice about pain relief.

Rest

After having your tonsils out you may need up to two weeks off school or work while your throat gets better. Get plenty of rest and try to avoid any heavy exercise.

There are risks associated with any surgery. Your doctor will discuss the risks of having a tonsillectomy with you. 

Other problems you may have include:

Bleeding

Bleeding from the area where the tonsils have been removed is the most frequent complication – it happens for about 2 in 100 people.

• If there is a large amount of blood (more than 1–2 teaspoonfuls), or if the bleeding continues for more than 10 minutes, seek urgent help
• If you do bleed, suck on some ice, have cold water to drink and rest your head on a high pillow.
• Bleeding is more common 7–14 days after the operation, but it can happen up to 21 days afterwards.
• Dehydration and too much activity after the operation can increase the chances of bleeding.
• It is best to avoid going away in the 3 weeks following the operation in case of bleeding. You should not travel overseas or to a remote area during this time.

Vomiting (feeling sick)

You might also vomit red, brown or black blood once or twice in the first day. You don't need to worry about this. But if it happens more often or if you are not able to keep down fluids, make sure you see a doctor.

Infection

Infection following the operation happens for about 5 in 100 people. Contact your doctor if you have a temperature higher than 38.5°C for longer than 4 hours. 
Earache

Some patients have an earache after the operation. This is because the tonsils share some of the same nerves. This is normal and should go away in about 2–3 days. 

Ongoing pain

Contact your doctor if you have ongoing pain that is not being controlled by the pain relief that was prescribed.