ENT - Tonsillectomy

Question 1

How do patients stay in hospital post tonsillectomy?

Answer 1

Patients can go home after 6-8 hours after observation

Question 2

When is a tonsillectomy indicated?

Answer 2

Recurrent tonsillitis
- 7 or more in 1 year
- 5 per year for 2 years
- 3 per year for 3 years

• Recurrent tonsillar abscesses (2 episodes)
• Enlarged tonsils causing breathing difficulty, swallowing or snoring

Can still get a sore throat

Question 3

What are some possible complications of a tonsillectomy?

Answer 3

Pain, sore throat
Damage to teeth
Infection
Post-tonsillectomy bleeding
General anaesthetic risk

Question 4

How long does a sore throat last post surgery?

Answer 4

2 weeks

Question 5

What is the most significant complication of a tonsillectomy?

Answer 5

Post tonsillectomy bleeding
Life threatening

Can occur in 5% of patients

Question 6

After how long can post tonsillectomy bleeding occur?

Answer 6

Up to 2 weeks post operation

Question 7

Why is post tonsillectomy bleeding life threatening?

Answer 7

Aspiration of blood

Question 8

How is post tonsillectomy bleeding managed?

Answer 8

• Call ENT registrar
• IV access and send bloods
• Keep child calm and give adequate analgesia
• Sit child up and encourage to spit blood rather than swallow
• Make child nil by mouth
• IV fluids for maintenance and resus as required

Question 9

What bloods are done in post tonsillectomy management?

Answer 9

FBC
Clotting screen
Group and save
Crossmatch

Question 10

What must be done if there is severe airway compromise in post tonsillectomy bleeding?

Answer 10

Call anaesthetist as intubation may be needed

Question 11

How can less severe bleeds be stopped?

Answer 11

Hydrogen peroxide gargle
Adrenaline soaked swab