TONSILLECTOMY
What are tonsils?
The tonsils serve as filters to produce antibodies directed at specific germs. Like all filters, once they clog up they spill into the system. This is what happens to chronic tonsillitis. This manifests as a recurrent sore throat, poor appetite and recurrent pain. Another feature could be that of bad breath.
The indications for tonsillectomy are:
Recurrent attacks of tonsillitis - i.e. more than 4 attacks in the preceding year, when antibiotics are prescribed almost every three months for the condition. What this means is that every 3 months antibiotics are prescribed for the condition. Most people fit into this category.
If the tonsils are so large that they obstruct breathing and eating. Here the child will have symptoms of breathing difficulties at night, usually snoring, and it is usually accompanied by an enlargement of the adenoids. The latter are tonsils at the back of the nose and enlarge in response to chronic infection. This causes snoring and can also be responsible for recurrent middle ear infections.
If one tonsil is larger than the other. Removal here is for the purpose of examination under the microscope to exclude certain illness, such as maglignacy.
A tonsil abscess - Quinsy. This condition is not seen often today since the use of antibiotics. These constitute the major indications for tonsillectomy.
You or your child will fit into one of the above categories.
Admission to hospital
As anesthesia has become safer over the years, these operations are now being done on children worldwide as a day clinic cases. Your child will be admitted in the early morning, usually before 06h30 having nothing to eat for at least 6 hours prior to surgery. This is absolutely vital for and if not adhered to, the surgery cannot be performed. If a child awakes during the night it is advisable to give him water to drink until approximately 04h00.
The operation is done first thing in the morning and usually takes about 20 to 30 minutes. The child remains in the clinic for most of the morning. If all has gone well during the day you may take your child home. If there is any concern then an overnight stay will be arranged. While in the clinic the child's condition will be monitored by the nursing staff and should any problem arise they will inform me.
On the day of the operation I encourage a normal diet. The child will be given pain killers which you must use liberally as prescribed. It is best given half an hour before meals. Encourage your child to chew. Most of the pain is due to muscle spasm and chewing a chip or chewing gum and biltong will help break the muscle spasm and relieve pain.
What problems can you expect?
Usually none, but one of the greatest concerns is bleeding. Heavy bleeding requires you to return to the hospital casualty department. The staff will be able to contact me.
Ear ache is a common complaint and is usually due to referred pain from the tonsil bed. Speech can be affected for a few days due to pain and swelling, and settles after about a week.
What about adults?
This is more difficult and complicated procedure. Admission to the hospital at least overnight is needed. It is more painful and require greater attention with the need to chew more vigorously post operatively.
LAST NOTE
A great deal of trepidation can be experienced by children going to hospital and especially the thought of going to theatre. I would suggest that you spend time with him or her explaining to them what he/she can expect. Please emphasize that at no time will any injection be given or anything done to hurt them. An informed child is a co-operative child, making the experience far less frightening for him/her. Should there be any other queries or questions that you have please feel free to contact me.
