Tonsils

Information for Parents

What are the tonsils ?
At the side of the throat are swellings called tonsils.

What do they tonsils do?
Tonsils are made of lymphoid tissue, just like the adenoids and appendix. There is lymphoid
tissue in many parts of the body. Lymphoid tissue contains cells from the immune system.
Removing a small amount of lymphoid tissue however does not prevent your body from
fighting germs.

Doesn’t my child need his tonsils?
Although tonsils are part of the immune system sometimes they can cause more harm than
good. Children generally have fewer infections following tonsillectomy not more as the tonsils
have become a site of recurrent infection.

Why do we remove tonsils?

Tonsils can cause a number of different problems. In the past tonsils have been commonly
removed. Nowadays we only recommend removal if the tonsils are causing a lot of trouble.
1. Recurrent infections
Some people are prone to recurrent infections in their tonsils (‘tonsillitis’ ). If this is
impacting significantly on their lives then it may be better to have the tonsils removed
(‘tonsillectomy’). In children, this may be recommended if they are missing a lot of school.
2. Breathing difficulties
Large tonsils can cause obstruction to the breathing, especially at night. Children may
have pauses in their breathing. Recurrent pauses are known as obstructive sleep
apnoea. If a child has sleep apnoea they may have secondary effects during the day. It
may cause them to fall asleep during the day and impair their concentration and school
performance. These problems have been shown to be much improved by removal of the
tonsils and adenoids. In very severe cases obstructive sleep apnoea causes heart
problems.
3. Other problems

Rarely tonsils can get diseased. Abscesses and occasionally tumours can form in the
tonsils. Sometimes abnormal looking tonsils need to be removed to exclude these
problems.
What happens on the day of the Operation ?
Eating and drinking

Your child will have to have nothing to eat and drink for a few hours before the operation. You
will be given instructions with regard to this.

Before the Operation

You and your child will see the anaesthetist and the surgeon. The surgeon will explain the
procedure once again and ask you to sign a consent form.
What happens during the Operation?
The operation involves a general anaesthetic. While your child is asleep the tonsils are
removed through the mouth. There is usually only a little bleeding and this is controlled before
the child is allowed to wake up.
What happens after the operation?

Recovery

Immediately after the operation your child is taken to the recovery room while still asleep and
observed carefully as they start to wake up. When they are sufficiently awake the nurses will
call you.
Going Home

Children having their tonsils removed will generally stay overnight. They will be seen by the
doctor the following morning and if they are eating and drinking sufficiently well and do not
have a high temperature then they will go home that morning.

Looking in the throat
After having your tonsils removed the throat appears white. The new lining of the throat is
forming under the white coating. As the throat heals the white coating gradually disappears.
This takes about two weeks.

Sore Ears

The pain following tonsillectomy is commonly referred to the ears. It is usual for children to
complain of earache. Parents often worry there may be an ear infection however the ears are
quite healthy.

Pain Medication

Having your tonsils removed is painful. This can be controlled by pain medication, which is
given regularly while in hospital. Often the child seems quite well in the early stages due to
the medication. It is important to continue with regular pain medication while your child is at
home.
It is not uncommon for the pain to get worse during the first week after the operation and then
gradually improve during the second week. Eating and drinking will help and should be
encouraged.
The main painkillers used are paracetamol (calpol) and diclofenac (voltarol). Codeine
phosphate is available for additional pain relief if required. These three types of medication
work independently hence they can be given together (as directed by your doctor). Antibiotics
are often given to prevent infection.
When can my child go back to school or nursery ?
After removal of the tonsils children should keep away from school for two weeks. This is
simply to try and reduce the chance of them picking up an infection from another child which
will make them feel more uncomfortable. They can mix with family and close friends.
Follow up appointments

Your child will be seen about two weeks after the operation.

What are the risks of tonsillectomy?
Tonsillectomy is one of the commonest operations performed in the United Kingdom and
problems are uncommon. No operation is however without any risk.
A general anaesthetic is required. Your child will be fully assessed by a paediatric
anaesthetist before the operation who will answer your questions with regard to this. Parents
often worry about anaesthesia but the risks in a healthy child are extremely small indeed.
Occasionally children experience some bleeding at home after tonsillectomy. This is usually
minor, however in the event of bleeding your child should see a doctor.
Much less commonly a child has serious bleeding after tonsillectomy. If your child has
persistent bleeding you should take them directly to the nearest accident and emergency
department by ambulance if necessary. If you are unsure what to do the nurses on the ward
where your child was admitted for surgery can give you advice by telephone.

Source: http://www.benhartley.org/Tonsils.pdf