Leaflet Details
| Title | Paediatric Tonsillectomy and Adenotonsillectomy |
| Department | Ear, Nose and Throat |
| Author(s) | Miss Pandora Hadfield |
| Review Date | April 2022 |
| Next Review | April 2024 |
| Download | A5 Booklet PDF |
| Accessibility Options | Click on the Recite Me button to show our accessibility resources |
Patient Information
Why does my child need a tonsillectomy or adenotonsillectomy?
Children who suffer from frequent episodes of acute tonsillitis, sleep disordered breathing or sleep apnoea, benefit from having their tonsils, and possibly adenoids, removed.
Will losing their tonsils and adenoids adversely affect my child’s health?
The tonsils and adenoids form a very small part of the body’s entire immune system, and their loss will not be significant nor will your child be more prone to infections. In fact it is likely that they are no longer functioning well and the operation will improve your child’s health overall.
What will happen in the operation?
You can accompany your child to the operating theatre. During the procedure your child will be fully asleep under a general anaesthetic and the tonsils and (if necessary) adenoids will be removed via the mouth. The technique used will depend on your child’s symptoms and age, in general traditional instrumental dissection is used for recurrent tonsillitis as this removes the entire tonsil and its capsule; whereas Coblation, using a low temperature radiofrequency probe, is often preferable for younger children with sleep disorderded breathing, snoring and apneas as it is associated with less risk of bleeding and reduced postoperative pain. It aims to debulk the tonsils, improving the airway. Because it preserves the capsule and a small rim of tonsil tissue there is a small risk of future tonsillitis, which might need further surgery. We have specific information leaflets about Coblation and your child’s surgeon will discuss the most appropriate technique for you child with you. You will be able to return to your child as soon as they start waking up afterwards in the recovery area.
How will my child feel after the operation?
Your child will receive plenty of medicine to control discomfort during the operation, and afterwards in the ward. It is advisable to stock up on paracetamol (Calpol) and ibuprofen (Nurofen) syrup to use once you return home. It is important to drink and eat plenty (of all types of food) during the recovery phase as this helps the healing process. It is best to offer food at least half an hour after taking painkiller medicine, when it is fully effective. The pain will get better day by day over the next 2 weeks although at some point, often 3-4 days after the operation, it often gets a little worse. Just continue with the same routine of regular painkillers and encouraging your child to eat little and often. Chewing gum may help to keep the muscles active and painfree, which helps with eating.
Are there any risks?
Earache may occur due to referred pain from the throat, your child may have noticed this before with acute tonsillitis. Loose teeth may need to be removed during the anaesthetic for safety reasons. The voice may sound a little different for a short time as there will be slightly more space within the mouth after the procedure. If the adenoids are removed they may leave a small gap between the palate and the back of the throat, sometimes it take a few days for the muscles of the palate to adjust. It is possible that during this time fluids can be regurgitated back and out through the nose during swallowing, this is very rare and if it does occur is likely to settle down without further treatment.
Bleeding is very unlikely afterwards (less than 4% by traditional technique, even less by Coblation) but occasionally children need to return to hospital for observation while this settles down. It is normal to see some pinkish saliva (often on your child’s pillow) but if they spit out more than a spoonful of bright red blood or you are concerned please seek further advice from Oak ward where your child was admitted (between 07:30 - 20:00 Monday to Friday) or the A&E department at the Royal Surrey County Hospital, Guildford, where we have on call Ear, Nose and Throat (ENT) medical staff and emergency ENT beds. In case of emergency, such as continued fresh bleeding from the mouth, dial 999 for an ambulance to the Royal Surrey County Hospital. Any operation carries a small risk of unexpected death from the combined effects of the anaesthetic and surgery. Death from any cause after tonsillectomy is rare, between 1 in 10,000 and 1 in 40,000.
When can my child leave hospital?
Many children go home a few hours after the procedure but some are advised to stay for one night, particularly children under 3 years of age or those with symptoms of Obstructive Sleep Apnoea.
When can my child return to normal activities and school?
It is advisable to stay off school for 2 weeks after the procedure, both to avoid infections and because traditional tonsillectomy is painful for most of this time, needing regular painkillers throughout. Those children who have had Coblation tonsillectomy are usually able to stop taking painkillers after a few days.
Any further worries?
If you are concerned after the procedure, these please consult your GP, the ward at St. Peter’s Hospital or in an emergency the A&E department at the Royal Surrey County Hospital, Guildford.
- Oak Ward, St. Peter’s Hospital: 01932 722712
- Royal Surrey County Hospital: 01483 571122
Further information: https://www.entuk.org/patients/conditions
Consultants and Specialists
- Mr Sam Cartwright, Consultant ENT Surgeon
- Mr Andrew Cruise, Consultant ENT Surgeon
- Mr Stephen Derbyshire, Consultant ENT Surgeon
- Miss Pandora Hadfield, Consultant ENT Surgeon
- Mr John Hadley, Consultant ENT Surgeon
- Miss Marysia Kalinkiewicz, Associate Specialist ENT
- Dr Tatiana Gutierrez, Speciality Doctor ENT.
