Tonsillectomy in KPHB, Hyderabad

The operation is done while you are fully asleep (general anaesthetic). It is done through the mouth and takes thirty to forty-five minutes. Most patients stay one night to be watched, above all young children and adults. The stay is at Sinocare ENT Hospital, or at an associated hospital where an overnight bed is needed. You are told which at the first visit. You go home the next morning with painkillers on a timetable and a written sheet of what to expect. Children are back at school in about a week. Adults should plan two weeks away from work. There is a check-up in the second week.

Tonsils are graded one to four by size. The grade sits alongside the history when the decision is made. Small tonsils that keep getting infected are treated with medicine first. That means the right antibiotic course for each bout, with gargles for the pain, such as benzydamine. Surgery comes into the talk when the infections keep coming despite that, or when the tonsils are large enough to block the airway.

For infections that keep coming back, the usual limit is around seven bouts in one year. Over two years it is five a year, and over three years, three a year. Each bout has fever, pus on the tonsils and swollen neck glands, and a doctor’s record of it. A history of “frequent sore throats” without that pattern is usually not a reason for surgery, and you are told so.

For blocked breathing, which is the most common reason in children:

• Loud snoring every night, with pauses in breathing
• Sleeping with the neck stretched back, restless, sweating
• Breathing through the mouth, tiredness in the day, irritability, poor focus at school
• Trouble eating, or a child who is small for their age because eating is hard work

Other reasons: a pocket of pus around the tonsil (quinsy), above all if it keeps coming back. Tonsil stones that keep coming back with bad breath that will not settle are another. So is one tonsil larger than the other, which is checked, not assumed.

You are fully asleep, and it is done through the mouth. There are no cuts on the outside. The tonsil is removed from its bed, and bleeding is controlled before you wake.

Coblation tonsillectomy. The older way was a wire loop (snare) and cutting with steel. Coblation uses a wand that dissolves the tissue at a fairly low heat, rather than cutting and burning through it. That means less bleeding during the operation, and less pain in the days after. It does not take away the bleeding risk described below. It does not shorten the two weeks of care that follow either. It makes those two weeks easier than they used to be.

The gland behind the nose (the adenoids) is removed in the same sitting where both block the airway. This is common in children.

Thirty to forty-five minutes. Staying one night to be watched is usual, above all in young children and in adults.

• A record of each bout, if infection is the reason. Bring prescriptions and records. The history is the reason.
• A sleep study where blocked breathing is the reason and the picture is unclear, above all in adults. See sleep apnoea surgery.
• A look at the nose and adenoids in children, since both usually play a part.
• A check that you are fit to be put to sleep. Tell us of any family history of bleeding problems.
• Fasting exactly as the anaesthetist, the doctor who puts you to sleep, tells you.

Recovery from tonsillectomy is sore, it lasts about two weeks, and it follows a pattern. Knowing the pattern in advance is most of what makes it manageable.

Days 1 to 3. A sore throat, pain felt in both ears, and bad breath. A white-grey coating covers the places where the tonsils were. It looks alarming, but it is normal healing. Take painkillers by the clock, not only when it hurts.

Days 4 to 8. Usually the most uncomfortable stretch. It catches people out, because they expected steady progress. Pain often peaks now. Swallowing is the work of the week, and eating and drinking are the job.

Days 8 to 14. The coating comes away, and the pain settles over a few days. Children usually recover faster than adults. An adult should plan on two weeks away from work, not two days.

Throughout. Drink all the time. Eat normal food where you can. Chewing and swallowing keep the area clean and speed healing, more than a diet of ice cream does. Avoid crowds and infections for two weeks. Stay near home for the full two weeks, because of the bleeding warning below.

The risks are explained before you agree to the operation, and each one comes with a plan.

• Bleeding, which is the one that matters. A small number of patients bleed. It happens most often between day 5 and day 10, when the healing layer comes away. It can be minor. It can also be sudden and heavy. Coblation reduces bleeding during the operation. The risk in the second week belongs to the healing area, and it is managed by being prepared. Any bleeding from the mouth after tonsillectomy means going to a hospital emergency department at once. Do not wait to see if it stops, and do not phone first. Now and then, a return to the operating room is needed to stop it. This is why you stay within reach of a hospital for two weeks. It is also why you go home with that instruction in writing.
• Not drinking enough (dehydration), above all in children who refuse to drink because it hurts. It is the most common reason for coming back into hospital. It is prevented by painkillers on a timetable and drinks by the clock.
• Pain worse than expected, and pain felt in the ears. Both are normal, and both are explained in advance. The pain plan is written for you before you go home.
• Infection of the healing area, treated with antibiotics.
• Voice change, uncommon and usually temporary.
• Damage to teeth or lips from the tool that holds the mouth open. This is uncommon. Mention a loose or capped tooth beforehand.
• The anaesthetic, talked through with the anaesthetist.