Tonsillectomy

Tonsillectomy is the name for the surgical removal of the tonsils. Removing the tonsils prevents further episodes of tonsillitis, although patients can still get a sore throat from other causes (e.g., pharyngitis). The procedure is performed under a general anaesthetic as a day case. Patients can usually go home the same day after a period of observation.

 

Indications

The SIGN guidelines (2010) give the indications for tonsillectomy. The number of episodes of acute sore throat they specify for a tonsillectomy are:

  • 7 or more in 1 year
  • 5 per year for 2 years
  • 3 per year for 3 years

 

Other indications are:

  • Recurrent tonsillar abscesses (2 episodes)
  • Enlarged tonsils causing difficulty breathing, swallowing or snoring

 

Complications

  • Sore throat where the tonsillar tissue has been removed (this can last 2 weeks)
  • Damage to teeth
  • Infection
  • Post-tonsillectomy bleeding
  • Risks associated with a general anaesthetic

 

Post Tonsillectomy Bleeding

Post tonsillectomy bleeding is the main significant complication after a tonsillectomy. Significant bleeding can occur in up to 5% of patients who have had a tonsillectomy requiring urgent management. This can happen up to 2 weeks after the operation. Bleeding can be severe and, in rare cases, life-threatening due to aspiration of blood.

 

Management:

  • Call the ENT registrar and get them involved early
  • Get IV access and send bloods including an FBC, clotting screen, group and save and crossmatch
  • Keep the patient calm and give adequate analgesia
  • Sit them up and encourage them to spit out the blood rather than swallowing
  • Make the patient nil by mouth in case an anaesthetic and operation is required
  • IV fluids for maintenance and resuscitation, if required

 

If there is severe bleeding or airway compromise, call an anaesthetist. Intubation may be required.

Before going back to theatre there are two options for stopping less severe bleeds:

  • Hydrogen peroxide gargle
  • Adrenalin soaked swab applied topically

 

Last updated July 2021
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