Consultant ENT, Head and Neck and Thyroid Surgeon

Tonsillectomy

What is a tonsillectomy?

An operation to remove the tonsils. This information tells you what to expect when your child has an operation to take out his or her tonsils. It explains how the operation is done, how it can help, what the risks are and what to expect afterwards. The benefits and risks described here are based on research studies and may be different in your hospital. You may want to talk about this with the doctors and nurses treating your child.

You can find out more about your condition and your treatment choices at NHS Direct Online (www.nhsdirect.nhs.uk).
A tonsillectomy is an operation to remove the tonsils. Your tonsils are two small almond-shaped mounds that sit on either side of the back of your throat.
They are part of your body’s system for fighting infections.
In a tonsillectomy, a surgeon cuts the tonsils from the throat with special scissors or a heated knife.

Why does my child need this operation?

To stop your child getting tonsillitis: Children have their tonsils out to stop them getting tonsillitis. Tonsillitis is when the tonsils get infected with bacteria or viruses (germs). If your child gets tonsillitis he or she may have a very sore throat, a high temperature and a headache. Their tonsils usually get red and swollen. Your child may miss more school than other children do. To stop your child getting hearing problems: Sometimes children have hearing problems because of fluid trapped inside their ears. This is called glue ear. Swollen tonsils can stop fluid from draining out of the ears, and this can mean the ears get blocked. Tonsillectomy is not done very often for glue ear because there’s no evidence it works. Children can also get glue ear because of problems with their adenoids. The adenoids are swellings at the back of the nose. They are very like tonsils. When they get big they can also block fluid from draining out of the ear. An operation to remove the adenoids is called an adenoidectomy.

A surgeon will usually only suggest children have their tonsils out if they have had:

• At least five bouts of tonsillitis (sore throat, high temperature and headache) in the past year
• Frequent ear infections because of swollen tonsils
• Swollen tonsils that make it harder to breathe, or hurt so much that it’s hard to swallow
• Sore throats that stop them enjoying life. Your child may often miss school or find it hard to sleep.

Doctors can check that the problem is tonsillitis by looking down your child’s throat when it is sore.
Each year, about 45,000 people have their tonsils out. The operation is mostly done in children under 15

What happens during the operation?

The operation takes about 45 minutes. This is to make sure he or she recovers properly and that the place where the tonsils were cut out doesn’t start bleeding. Your child will probably have a general anaesthetic so he or she will be asleep during the operation. During the operation your child lies on his or her back, with
a support under the shoulders, so the head is tipped back a little. A breathing tube is put into his or her mouth, along with an instrument to hold the mouth wide open. The doctor sits behind your child’s head to do the operation, looking into the mouth upside-down. There are different ways to take out the tonsils.

• Cutting the tonsils out: The surgeon gently cuts out the tonsils and uses a small scoop to lift them out.
This part of the operation takes only a few minutes.
Lasers, ultrasound and freezing can also be used to take out tonsils. They are newer methods and aren’t commonly used.
Guidelines for doctors say that heat should not be used to cut away tonsils or seal the area after the operation because the heat can use bleeding.

How can this operation help my child?

• Taking out tonsils may mean less tonsillitis in the short term. For example, one study has found that in the first two years after surgery, most children have fewer throat infections (an average of three less infections than children on antibiotics).
• All the methods of taking out tonsils seem to work as well
as each other.
The surgeon then needs to stop the throat bleeding from where the tonsils used to be.
It takes about 15 minutes to 20 minutes to do this. Your surgeon will stop the bleeding with stitches or heat (diathermy).
If your child needs stitches, these will dissolve away after
the operation. The diathermy stops bleeding by heating the blood vessels to seal them closed.

What are the risks?

All operations have risks, and your surgeon should talk to you about them before the operation. The problems that may happen are called complications.
Anaesthetics can have side effects. The most common one is that your child will feel sick when he or she wakes up. Serious problems are rare, but doctors will keep a close eye on your child’s breathing, heartbeat, temperature and blood pressure. Very rarely, children have an allergic reaction to one of the anaesthetic drugs. You should tell the doctors if your child has any allergies.

Having a cough or cold increases the chance of chest problems so tell your doctor if your child has a cough or cold in the week before surgery. If your child is overweight, he or she may need to lose some weight before surgery. Being overweight increases the risks of problems from the anaesthetic.
Between 2 in 100 and 14 in 100 children having a tonsillectomy have some kind of complication.
Problems that can happen straight away
Bleeding: The most common problem is bleeding from the place in the throat where the tonsils were. It may be difficult to stop the bleeding. You may be more likely to bleed if your surgeon uses heat to remove your tonsils or seal the area. Between 4 in 100 and 6 in 100 children who have an operation that uses heat bleed heavily afterwards. About 1 in 100 children who have their tonsils cut away and stitched have heavy bleeding.
Bleeding can be stopped by putting a pad of gauze over the wound. If this does not work, your child may need to go back to the operating theatre to have the bleeding stopped, and may need to be given blood (a blood transfusion).
Damaged teeth: Occasionally, loose teeth may come out during a tonsillectomy, or a tooth can be chipped because of the pressure put on the teeth by the instrument that holds the mouth open.
Chest infection: Bits of blood and tissue from the operation can sometimes get into your child’s throat and down into his or her lungs. This can cause a chest infection and breathing problems. If this happens your child will need oxygen and antibiotics.
Dying from surgery: There is an extremely small risk that your child may die from an operation to take out tonsils or adenoids. Between 1 in 15,000 and 1 in 25,000 children who have these operations will die from the operation.