Thursday, 2 January 2014

[www.keralites.net] Health: Information about Tonsils Removal

 

http://www.entnet.org/HealthInformation/tonsilsAdenoidsPostop.cfm

 

  • A tonsillectomy, commonly referred to as "getting your tonsils out," is a surgery to remove the tonsils when a child has tonsillitis or frequent infections that won't go away in spite of using antibiotics. 
  • An adenoidectomy is a surgery to remove the adenoids when a child has had breathing problems or ear and sinus problems that won't go away with antibiotics.
  • A tonsillectomy and adenoidectomy (T&A) is done to remove both the tonsils and the adenoids when a child has both breathing and swallowing problems.
  • Because the surgeon can reach the tonsils and adenoids simply by opening the child's mouth, there are no incisions (cuts) needed on the outside of the skin. 


 

This factsheet is for people who are having their adenoids and/or tonsils removed, or who would like information about it. It's relevant for both adults and parents of children who are having the operation. However, for simplicity, we refer to 'you' throughout.

Adenoids and tonsils are small lumps of tissue at the back of your nose and throat. An operation to remove your tonsils is called a tonsillectomy and an operation to remove your adenoids is called an adenoidectomy. An operation to remove both is called an adenotonsillectomy.

You will meet the surgeon carrying out your operation to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About adenoid and tonsil removal

Adenoids and tonsils help fight ear, nose and throat infections in young children. Your adenoids lie where your throat meets the back of your nose. Your tonsils lie at the back of your throat, one on each side.

Illustration showing the location of the adenoids and tonsils

Tonsil removal

Most operations to remove tonsils are done in children, but adults can have them removed too. Inflammation of your tonsils is known as tonsillitis. Your GP may refer you to an ENT surgeon (a doctor who specialises in identifying and the surgical treatment of conditions of the ear, nose and throat) to remove your tonsils if you have had tonsillitis:

  • more than seven times in the last year
  • five times or more in each of the last two years
  • three or more times in each of the last three years
  • and then developed a quinsy (a collection of pus between a tonsil and the wall of your throat)

Having your tonsils removed can be an effective treatment for reoccurring and persistent tonsillitis.

Adenoid removal

Most operations to remove adenoids are done in children. The most common reason for removing adenoids is glue ear. If your child is under three and is having grommets inserted for glue ear, his or her adenoids will probably be removed at the same time. Having your adenoids removed is an effective treatment for reoccurring ear infections and nasal blockage caused by enlarged adenoids. However, surgery isn't always needed for children as they often grow out of these problems.

If your child has enlarged adenoids and tonsils, he or she may develop a condition called obstructive sleep apnoea – this causes breathing problems at night. If this happens, your surgeon may recommend an adenotonsillectomy.

What are the alternatives to having your adenoids and tonsils removed?

You may be prescribed antibiotics but, generally, they don't help and aren't used for long-term treatment.

Children's adenoids and tonsils shrink as they get older, so an operation isn't always necessary. Ask your GP for more advice.

Preparing for adenoid and tonsil removal

Your surgeon will explain how to prepare for your procedure. If you have a cold or infection in the week before your operation, it's important to let the hospital know. The operation may need to be postponed until you have fully recovered.

You will have the operation under general anaesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.

Your surgeon will discuss with you what will happen before, during and after your operation, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during adenoid and tonsil removal?

The operation usually takes around 30 minutes but this will depend on whether you're having your tonsils or adenoids removed, or both.

There are several different methods to remove tonsils and adenoids, which include the following.

  • Traditional method – your surgeon will carefully cut your tonsils and/or adenoids out using specialised instruments. He or she will apply pressure to stop the bleeding, and use dissolvable stitches or heat to seal the wound.
     
  • Lasers or ultrasound waves – your surgeon will use high-energy waves to cut out your adenoids and/or tonsils and will seal the blood vessels to stop any bleeding.
     
  • Diathermy – your surgeon will use heat from an electric current to cut out your adenoids and/or tonsils. He or she may gently suck the tissue out with a special instrument and will seal the blood vessels.
     
  • Power-assisted adenoidectomy – your surgeon will use a microdebrider (a powered instrument with a very small rotating tip) to remove your adenoids.

Video: how an adenotonsillectomy is carried out

What to expect afterwards

You may need to rest until the effects of the anaesthetic have passed. Try to drink and eat as soon as you feel ready.

You may need pain relief to help with any discomfort as the anaesthetic wears off. You will usually be able to go home when you feel ready, unless your surgeon recommends that you stay overnight. Before you go home, a nurse will give you a date for a follow-up appointment.

You will need to arrange for someone to drive you home. You should have a friend or relative stay with you for the first 24 hours after your operation.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

If your surgeon used dissolvable stitches, the amount of time they will take to disappear depends on the type of stitches you have. Ask your surgeon for more information about when you can expect them to disappear.

Recovering from adenoid and tonsil removal

It usually takes about a week or two to make a full recovery from adenoid or tonsil removal, but this varies between individuals, so it's important to follow your surgeon's advice. Rest for this time and stay at home. Keep away from crowded and smoky places, and from people with coughs and colds.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Your surgeon may prescribe you stronger painkillers as well as antibiotics. Always ask your doctor or pharmacist for advice and read the patient information leaflet that comes with your medicine.

Try to drink enough fluids and eat normally. If it's uncomfortable to eat, it may help to take a painkiller (such as paracetamol) half an hour before meals. Don't take aspirin as it may cause bleeding. See our frequently asked questions for more information.

Your throat may look white as your skin heals. If you notice any bleeding from your throat or nose, contact your GP or hospital immediately.

What are the risks?

As with every procedure, there are some risks associated with having your adenoids and tonsils removed. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Common side-effects include:

  • feeling sick
     
  • a sore throat, earache and stiff jaw or neck
     
  • a blocked nose – this usually clears within a week or so
  • a change in your voice – you may sound like you're talking through your nose; this can last for around two to four weeks

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic or an infection. Specific complications of operations to remove the adenoids and/or tonsils are uncommon, but include:

  • bleeding after the operation
     
  • damage to your teeth or jaw – this can be caused by the instruments that are used to keep your mouth open during surgery
     
  • infection and breathing problems – there is a risk that blood and tissue from the operation may get into your throat
     
  • injury to your Eustachian tube (the tube that connects your middle ear with your throat)

Children who have had their adenoids and tonsils removed may find that their voice sounds different after surgery. This is because, before the operation, the enlarged adenoids and tonsils may have prevented the child from hearing high-pitched sounds clearly. After the operation, these sounds are easier to hear and so it may seem to your child that his or her voice is higher than it used to be. 

 

Produced by Stephanie Hughes, Bupa Health Information Team, July 2012.

For answers to frequently asked questions on this topic, see FAQs.

http://www.bupa.co.uk/individuals/health-information/directory/a/adenoid-and-tonsil-removal

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