This leaflet provides information about having a tonsillectomy. We hope it answers some of the questions that you or those who care for you may have. This leaflet is not meant to replace the discussion between you and your medical team but to help you understand more about what is discussed. If you have any concerns about your illness or your treatment please contact your surgeon, head and neck clinical nurse specialist (CNS) or your key worker. Contact details for your CNS are listed on page 4. A tonsillectomy is a surgical procedure to remove the tonsils from the back of the mouth/throat. It is performed under general anaesthetic. Tonsils are small glands at the back of the mouth/throat located in an area known as the oropharynx. They are part of your body s immune system and act as protection from inhaled particles and germs. As you get older, tonsils become less important in this role. A tonsillectomy may be suggested if you have suffered multiple severe cases of tonsillitis or quinsy. Quinsy is an abscess (swelling) that develops between the tonsil and the wall of your throat. Removing your tonsils will prevent tonsillitis or quinsy from recurring in the future. A tonsillectomy is sometimes performed because there is a concern that there may be a tumour or something suspicious in the area of the tonsils. In this case a tonsillectomy may be performed as part of an investigative procedure called a panendoscopy. There is a separate information sheet entitled Having a panendoscopy about this procedure. Consent Before treatment begins you will be asked for your permission (consent) for the hospital staff to perform this procedure. Your doctor and/or clinical nurse specialist/key worker will carefully explain what is involved (details will vary according to each individual case). No medical treatment can be given without your consent. If you do not understand what you have been told let the staff know straight away so they can explain again. You may also find it useful to write a list of questions before your appointment and to have a relative or friend with you to help you remember the discussion when the treatment is explained. You will receive a copy of all communications sent to your GP. Please let us know if you would prefer not to receive this. p1
The procedure is performed under general anaesthetic. Once you are asleep, your tonsils will be removed through the mouth and any bleeding caused by their removal will be stopped. The procedure usually takes about 30 minutes. As with any operation there is small risk associated with having a general anaesthetic. However, a tonsillectomy is generally a safe and quick procedure. With this operation there is also a small risk you could also experience some of the following: Bleeding Tonsils have a rich blood supply and this can be a potentially serious complication. Bleeding can occur at the time of surgery and for up to two weeks afterwards. Bleeding occurs in approximately three to five per cent of patients following this procedure. The level of bleeding can range from a small spot of blood in the saliva to a severe bleed. A severe bleed or haemorrhage tends to occur as a result of infection, normally several days after the operation. To try to reduce the risk of infection it is important that you eat and drink normal food including, as much as possible, harder food (e.g. toast) as this helps to prevent a build-up of debris at the back of the throat where bacteria can grow. If you have a severe bleed you will need to attend your local A&E department for assessment. You may then need to be admitted to theatre to stop the bleeding. Infection As with any procedure that involves a cut being made, there is a risk that bugs can enter the treated area and cause infection. Infection can occur at any point up until you have healed, but it is most likely within the first two weeks. Infection is less likely to occur if you are eating and drinking normally. The following could be signs of an infection: feeling feverish or shaky increased pain a very bad smell coming from the back of your throat If you have an infection, you may require antibiotic therapy to clear it. If you think you might have an infection you should contact your GP, or call 111 if outside of normal working hours. p2
Lip and/or tooth damage As your mouth is kept open during the procedure and instruments are passed over your teeth, there is a small risk that some damage could be caused to your lips and teeth. A gum guard is used during the procedure to reduce this risk as far as possible. Pain In adults, post-operative tonsillectomy pain can be severe, especially when trying to eat, drink and swallow. This can last for two to three weeks after the procedure. You may also experience some ear pain as a result of the surgery. Painkillers will be provided while you are in hospital and also upon discharge. If you feel that the painkillers are not working please inform the nursing staff so that your pain relief can be reviewed. You will be asked to come in on the day of your surgery, having fasted at home beforehand. You may be asked to attend at 07.30, although your slot on the operating list might be later on in the day, perhaps not until the afternoon. It is not possible to arrange the order of the list in advance because there can be urgent admissions, and the length of time needed for each person s surgery also tends to vary. Unfortunately, this can mean an unavoidable wait until you are taken to theatre. If you are placed later on the list, the nursing and aneasthetic staff will let you know if you can have some water whilst you are waiting. You can bring a friend or relative along when you come in and they can wait with you. You will be seen by the operating team and aneasthetist before your surgery and the ward nurses will help you prepare for theatre. They will take you to theatre when it is your turn to go. You will then be taken to the anaesthetic room and placed under anaesthetic. Following the procedure you will be moved to the recovery area and later transferred to the day surgery unit or ward. As the procedure involves having a short anaesthetic, you may feel a little tired afterwards. You may also experience a sore throat from where your tonsils were removed. Please let nursing staff know if you are experiencing any pain or if you have any concerns. Patients are often required to stay in hospital overnight following the operation, so that any risk of bleeding can be monitored. You might, however, be able to go home on the same day, after a few hours of recovery, providing you are able to eat and drink and you feel well enough. If this is the case you will need a responsible adult to accompany you home and make appropriate travel arrangements. Someone will also need to be with you at home overnight. p3
When you leave hospital you will be given a discharge summary and any medications or painkillers you need. You should also be given information about any follow-up appointments. Sometimes an outpatient appointment following tonsillectomy is required, but not in all cases. Please check with your nurse before you are discharged. You should wait at least 24 hours after your operation before driving. Check with your insurance company for further guidance on this if you are unsure. It may take a few weeks before you feel back to normal. You will need to take your painkillers regularly to help reduce the pain and help you to try to eat normally. Take your painkillers 30-40 minutes before meals to help maximise their effect whilst eating. You should also drink plenty of fluids. You may find that cold drinks are easier to swallow than hot ones. Try to rest for the first week or two and avoid busy places if possible to help reduce the risk of infection and promote healing. If you normally smoke you should avoid this for at least two weeks. You should also avoid dry atmospheres (such as air conditioned rooms, or hot, centrally heated rooms without circulation), for at least two weeks. Try to avoid taking very hot baths or showers for a couple of weeks. A warm temperature is suitable but not very hot as this can sometimes increase the risk of bleeding because the heat will cause the diameter of your blood vessels to widen. If you are on blood thinning medications please ask the Ear Nose and Throat (ENT) team to let you know when it can be restarted following your surgery. It is normal to have bad breath following your tonsillectomy and for the back of your throat to appear white. If the smell gets worse, the colour at the back of your throat changes to yellow or green and you feel unwell, you should seek medical advice. If you notice some blood in your saliva, rinse you mouth with cold water or suck on an ice cube. A small amount of blood is not uncommon. However, if you are concerned or the bleeding is significant you should seek medical advice by either contacting the ENT department at the hospital, or by going to your local A&E department. If you have any concerns following your operation you can telephone the head and neck CNS on 020 3311 0115. Alternatively, you can telephone the ENT clinic on 020 3313 5584, or the head and neck ward (10 south) on 020 3313 1958 or 020 3313 1961. p4
We aim to provide the best possible service and staff will be happy to answer any of the questions you may have. If you have any suggestions or comments about your visit, please either speak to a member of staff or contact the patient advice and liaison service (PALS) on 020 3313 0088 (Charing Cross, Hammersmith and Queen Charlotte s & Chelsea hospitals), or 020 3312 7777 (St Mary s and Western Eye hospitals). The PALS team are able to listen to your concerns, suggestions or queries and are often able to help sort out problems on behalf of patients. Alternatively, you may wish to express your concerns in writing to: The chief executive s office Imperial College Healthcare NHS Trust Trust Headquarters The Bays, South Wharf Road London W2 1NY This leaflet can be provided on request in large print, as a sound recording, in Braille, or in alternative languages. Please contact the communications team on 020 3312 5592. p5 Head and neck Published: November 2014 Review date: November 2017 Reference no: 1049v2 Imperial College Healthcare NHS Trust