Tonsillitis

What types of tonsillitis are there?

Tonsillitis is most commonly a viral infection, but sometimes this infection can progress to a bacterial infection, which needs antibiotics to settle the infection. Most viral infections only need supportive care, but some can be more serious, such as glandular fever. An uncommon type of tonsil infection is a Quinsy, which is an infection around the tonsil that needs to be drained by an ENT surgeon.

Why do we do a tonsillectomy?

Tonsillectomy surgery is done for various reasons. In children, the main indications are sleep apnoea and recurrent tonsillitis. In adults, the tonsils can be removed for sleep apnoea and recurrent tonsillitis, as well as part of treatment for Head and Neck Cancer.

How is a tonsillectomy done?

The tonsils are removed via the mouth using a variety of techniques, such as cold dissection with surgical instruments, diathermy or other techniques such as co-blation, all of which are effective.

What should I expect after the tonsillectomyoperation?

On the day of the surgery you will feel some discomfort, and usually only a small to moderate amount of pain. You will likely still be able to eat a reasonably normal diet. In the next few days, the pain will tend to increase in most patients, with a bit more difficulty eating and drinking. In these days, it will be very important to take the pain relief medication as prescribed by Dr Sommerville or Dr Slaughter (see separate section). After about 7 days the pain and eating problems will start to decrease and you will feel more comfortable as the days approach the end of the 2-week recovery period.

If you do look in the mouth, the uvula (the thing that hangs down in the middle) will often be swollen, and the tonsils will usually have a white slough on them. This is normal and not a sign of infection. If you have fevers or new ear pain then this may be an infection and either Dr Sommerville, Dr Slaughter or your GP should be consulted.

How long is the recovery after a tonsillectomy?

We ask that patients allow a full 2 weeks for recovery, which includes allowing for non-attendance at school or work during this period. Some patients will not require this full amount of time to feel normal, but restriction of activity during this period is advised in order to minimize the post-operative bleeding risk.

What should I avoid in the recovery period?

Vigorous exercise, distant travel, alcohol, smoking are all discouraged.

When will I see Dr Sommerville or Dr Slaughter for a post-operative review?

Dr Sommerville and Dr Slaughter like to see his patients at 2 weeks unless there is another reason to see them earlier (which will be organised specifically with you).

Pain relief after the operation

There are a number of options that can help with the pain. The mainstay is to keep eating, drinking and talking. This will move the muscles at the back of the throat and help to reduce the swelling around the tonsils.

Panadol/Panadeine/Panadeine Forte – all these medications can be useful but only one of them should be taken at a time. Standard panadol can be taken regularly in combination with the other prescription only medications. If panadol is not enough, then panadeine can be bought from the chemist without a script, but panadeine forte is a lot stronger and will require a script.

Painstop for children – this often is enough for kids, but will need to be taken regularly. If pain levels are not too bad, parents can just give normal panadol instead, but some form of regular analgesia is recommended at least in the first week.

Endone – this is available for both adults and kids and is often prescribed by Dr Sommerville or Dr Slaughter. It is useful to combine this with paracetamol in both kids and adults, or possibly even panadeine in adults if required. This medication is quite strong and may produce drowsiness or constipation.

Important notes:

  1. Take the medications only in the dosage prescribed by Dr Sommerville or Dr Slaughter - as described on the packaging.
  2. Non-steroidal anti-inflammatory medications such as Nurofen, Ibuprofen, Naproxen, aspirin are not recommended unless as a last resort as they increase the risk of bleeding.

What should I eat?

You can eat anything you want, as long as you keep eating and drinking! We are told that some things can sting a bit (such as tomatoes or orange juice) but otherwise there is no restriction and the patients can have whatever they like in the two-week recovery period to keep themselves hydrated and nourished.

What if I have bleeding post-operatively?

If there is only a spot or two of blood then that is usually fine, but if there is continuing bleeding, or bleeding in large amounts that then stops, then the patient should attend an emergency department. If there is significant bleeding that is ongoing, then an ambulance should be called and the patient taken to the closest emergency department. It doesn’t matter if this is a public or private hospital as Dr Sommerville and Dr Slaughter are accredited at almost all hospitals in Brisbane, as long as the patient is safe. If during office hours, please call Dr Sommervilles and Dr Slaughter's rooms to let him know of the problem, but if after hours please call the after hours number and either Dr Sommerville or Dr Slaughter or whoever is covering from his on-call group will take care of the patient.

Please discuss any further issues you have with Dr Sommerville, Dr Slaughter or the anaesthetist.