Adenotonsillectomy

Adenotonsillectomy is usually performed in children who have problems associated with sleeping. Children who have problems associated with snoring or obstructive sleep apnoea should be assessed as to whether they need to have their tonsils and adenoids removed. This assessment includes determining whether your child seems to stop breathing throughout the night as well as whether they snore every night.

Snoring in children every night is abnormal. We now know that children who snore every night are not getting appropriate quality sleep and the recommendation is that they have an adenotonsillectomy. Signs or symptoms of obstructive sleep apnoea are more concerning and it is strongly recommended that children who have sleep apnoea have an adenotonsillectomy. To determine the quality of your childs sleep it may be helpful if you bring a video of them sleeping to your appointment.

In many cases adenotonsillectomy can be done as a day stay procedure. After the operation it is very important that your child drinks enough fluid as they can easily become dehydrated. The main risk associated with this procedure is a risk of bleeding. For this reason it is important that you stay around the Gold Coast within one hour of the Gold Coast University Hospital. If your child does have bleeding which continues for more than a few minutes then make your way to the Gold Coast Hospital regardless of the time of day or night. It is rare for patients to have to return to theatre for their bleeding.

For further information on adenotonsillectomy post operative information refer to our post operative handouts. For more technical information on this topic refer to the Expert Opinion in ENT podcast series in which Dr Robinson has interviewed Dr Shyan Vijayasekaran on Adenotonsillectomy.

To further discuss having an adenotonsillectomy make an appointment with one of our surgeons.

Adenotonsillectomy post operative instructions

What to expect

Immediately post op – The pain is usually not too bad. The area where the operation was performed has local anaesthetic in. This is the time to ensure that your child starts eating and drinking. Give them regular panadol and nurofen.  The local anaesthetic will wear off in approximately 10 hours.

Day 1 – This is usually the worst day of pain. Give your child regular pain relief. Give them as much fluids as they will drink as well as giving them regular icy poles. The throat will look white, this is normal. Your child may complain of sore ears, this is also normal.

Day 2 – 3 – Give them regular pain medication regardless of whether they are in pain or not. The pain is usually better that day one. Keep their fluids up. If your child doesn’t feel like eating then they don’t have to but drinking is essential. Also ensure they have regular icy poles. They may complain of feeling like they have tonsillitis, this is also normal.

Day 4 - 7– Give your child pain relief only as required.

Day 8 – 10 – It is not unusual for the pain to increase for 24 hours. This is normal. Give regular pain relief for this 24 hour period. After this period the pain usually subsides.

Pain relief?

Panadol – Take this regularly for the first 3 days regardless of whether you are in pain or not

Ibuprofen [Nurofen] – You can take nurofen if the panadol is not effective pain relief for you and provided you are not allergic to it or have asthma. A large study has demonstrated that the use of nurofen post tonsillectomy does not increase the risk of bleeding after this surgery. We recommend you take the nurofen no more than 3 times a day and to take it during a meal as it can cause significant stomach upset.(Cardwell, Siviter et al. 2005)

Oxynorm – Oxynorm is a safe drug in paediatrics provided it is given in the correct dose. The first time you give your child oxynorm give them the dose no later than 3pm in the afternoon. This will allow you to assess their response to the medication. Give oxynorm if your child is complaining of pain which is not settling with nurofen and panadol. You do not need to give this medication regularly.

Painstop – Painstop has an unpredictable response in some patients. There have been some adverse outcomes with painstop post adenotonsillectomy due to some patients metabolizing this medication at a faster rate than other patients. We do not recommend painstop for this reason.(Ciszkowski, Madadi et al. 2009, Kelly, Rieder et al. 2012)

Does my child need antibiotics?

A white coating over the back of your child’s throat and bad breath is normal. This is not an infection. Several large studies have demonstrated that there is no benefit from taking antibiotics after having a tonsillectomy. For this reason we do not routinely prescribe antibiotics post tonsillectomy

How much water should my child drink?

You need to ensure that your child does not become dehydrated and one of the best measures of this is your child going to the toilet regularly. Ensure that your child drinks enough water to be going to the toilet or having a wet nappy 3 times per day at least.

What should I give my child to eat?

Your child can eat and drink anything they like. There are no absolute rules for what you must do after having your tonsils out. In general, most people prefer to eat soft food. Some food groups will hurt to eat and drink, including citrus, toast and spicy food. You do not do any damage by having these however your child may find them painful to eat.

How many icy poles should I give my child?

Aim to give them at least 5 icy poles per day. You can substitute ice cream for icy poles.

How much time do they need off school / kindy?

As a general rule most children have one week off. They can go to daycare or school in the second week if they feel up to it.

What to do if my child gets bleeding?

A very small amount of bleeding post operatively is very common. On approximately day 7 many people notice that they spit up a very small amount of blood, approx. 1ml. If this does happen give them a cool drink of water and an icy pole. If this continues then proceed to the emergency department at the Gold Coast Public hospital where there is an ENT surgeon on call 24 hours per day.



 

Cardwell, M., et al. (2005). “Non-steroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy.” Cochrane Database Syst Rev(2): CD003591.

Ciszkowski, C., et al. (2009). “Codeine, ultrarapid-metabolism genotype, and postoperative death.” N Engl J Med361(8): 827-828.

Kelly, L. E., et al. (2012). “More codeine fatalities after tonsillectomy in North

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