What Are Tonsils?

The tonsils form part of the body’s immune system and act as filters, helping to produce antibodies directed against specific germs. Like any filter, however, they can become overloaded. When this occurs, they may themselves become a source of infection.

In chronic tonsillitis, this results in recurrent sore throats, poor appetite, repeated episodes of pain, and sometimes bad breath.

 

Indications for Tonsillectomy

Tonsillectomy may be recommended in the following situations:

• Recurrent tonsillitis
  This is defined as more than four attacks in the preceding year, typically requiring antibiotic treatment approximately every three months. The majority of patients fall into this category.

• Enlarged tonsils causing obstruction
  Tonsils may become so large that they interfere with breathing and eating. Children often present with night-time breathing difficulties, most commonly snoring. This is frequently associated with enlargement of the adenoids (lymphoid tissue at the back of the nose), which can also contribute to snoring and recurrent middle ear infections.

• Asymmetry of the tonsils
  If one tonsil is significantly larger than the other, removal may be advised so that the tissue can be examined microscopically to exclude conditions such as malignancy.

• Tonsillar abscess (Quinsy)
  Although now uncommon due to the widespread use of antibiotics, this remains an important indication for tonsillectomy.

 You or your child will generally fall into one of the above categories.

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Admission to Hospital

With advances in anaesthesia and surgical care, tonsillectomy is now commonly performed as a day procedure in children.

Your child will be admitted early in the morning, usually before 06h30, and must have had nothing to eat for at least six hours prior to surgery. This is essential for safety, and failure to adhere to these instructions will result in the procedure being postponed. If a child wakes during the night, small sips of water may be given until approximately 04h00.

The operation is performed early in the morning and usually takes 20–30 minutes. Your child will remain in the clinic for observation for most of the morning. If recovery is uneventful, discharge home will be arranged later the same day. Should there be any concerns, an overnight stay will be organised.

Throughout the stay, your child will be closely monitored by the nursing staff, who will contact me should any problems arise.

 

Post-Operative Care

A normal diet is encouraged on the day of surgery. Pain medication will be prescribed and should be used regularly as directed. It is most effective when given approximately 30 minutes before meals.

Encourage your child to chew. Much of the discomfort after tonsillectomy is due to muscle spasm, and chewing foods such as chips, chewing gum, or biltong can help relieve this spasm and reduce pain.

 

What Problems Can You Expect?

Most children recover without difficulty. The main concern following tonsillectomy is bleeding. Any significant bleeding requires immediate attention, and you should return to the hospital’s casualty department, where staff will contact me.

Earache is a common complaint and is usually due to referred pain from the tonsil area. Temporary changes in speech may occur due to pain and swelling, but this typically settles within about a week.

 

What About Adults?

Tonsillectomy in adults is generally a more painful and demanding procedure. Hospital admission for at least one night is usually required. Pain control requires greater attention, and adults are encouraged to chew more vigorously post-operatively to reduce muscle spasm and aid recovery.

 

Final Note

It is common for children to feel anxious about going to hospital, particularly when surgery is involved. I recommend spending time explaining what they can expect in a calm and reassuring manner. Emphasise that no injections or painful procedures will be given while they are awake.

An informed child is a cooperative child, and this greatly reduces fear and anxiety. Should you have any further questions or concerns, please feel free to contact me.