Tonsillectomy

This is another very common procedure and the usual indications are recurrent and acute tonsillitis but also children with obstructive sleep apnoea who because the tonsils tissue is so large that they cannot breath properly at night. There are many surgical techniques for removing the tonsil and at present there is no clear advantage of one over the other, although this is at present a subject of a Royal College of Surgeons of England Audit and so it may be possible in the near future to make more specific recommendations. The major complications of tonsillectomy are 1) pain, this is inevitable to some degree and some patients experience minimal pain, others particularly adults may suffer badly. Interestingly children may well complain of earache more than a sore throat, we call this referred pain and is due to the unusual nerve supply of the ear. If this should occur it does not mean that anything has gone wrong with the operation at all. Pain is often worse between the 5th and 10th day after the operation and may require quite strong painkillers. 2) Haemorrhage, this is the most serious and dreaded complication. Haemorrhage may occur within 24 hours of the operation, which we call reactionary haemorrhage. If this does happen then of these cases approximately 80% occur within the first six hours of the operation and the person is usually taken straight back to the operating room to have the bleeding point stopped. After 6-8 hours the chances of bleeding over the next day or two are extremely small, although spitting the odd bit of blood is not unusual. For this reason surgery as a day case is becoming increasingly popular. The second period, during which haemorrhage can occur is between day 5 and day 10 after the operation, this is called secondary haemorrhage. It may or may not be associated with an infection of the area. It is usually treated by admission to hospital with bed rest and antibiotics. The approximate incidence of these complications are that secondary or reactionary haemorrhage occurs in about 3% of cases, approximately half of those patients admitted with secondary haemorrhage can be treated by bed rest and antibiotics alone and approximately half will require a second operation to stop the bleeding.

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