Tonsillectomy

Question 1

Tonsillectomy

Answer 1

Surgical removal of the tonsils

Question 2

Purpose of tonsillectomy

Answer 2

Prevents further episodes of tonsillitis

Patients can still get a sore throat from other causes (e.g. pharyngitis).

Question 3

How is a tonsillectomy performed

Answer 3

General anaesthetic as a day case

Question 4

When is tonsillectomy indicated

Answer 4

7 + episodes of acute sore throat 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

Question 5

Complications of tonsillectomy

Answer 5

• 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

Question 6

Post tonsillectomy bleeding

Answer 6

Significant bleeding can occur in up to 5% of patients requiring urgent management.

Can happen up to 2 weeks after the operation.

Bleeding can be severe and rarely life-threatening due to aspiration of blood

Question 7

Management of post tonsillectomy bleeding

Answer 7

1. Call the ENT registrar early
2. IV access and bloods including an FBC, clotting screen, group and save and crossmatch
3. Adequate analgesia
4. Sit them up and encourage them to spit out the blood rather than swallowing
5. Nil by mouth in case an anaesthetic and operation is required

Question 8

If there is severe bleeding or airway compromise

Answer 8

Call an anaesthetist

Intubation may be required

Question 9

How to stop less severe bleeds

Answer 9

Hydrogen peroxide gargle

Adrenalin soaked swab applied topically