Indications
Obstructive tonsils: associated with sleep apnea, dysphagia, speech defects and failure to thrive.

Recurrent sore throats
Otolaryngology guidelines

• 7 sore throats in 1 year.
• 5 in each of 2 years.
• 3 in each of 3 years.

Associated with

• Fever > 38°.
• Swollen anterior cervical nodes.
• Tonsillar exudate.
• Or positive strep culture.

Key feature: Recurrent sore throats which have significant impact on patient’s life: lots of missed time from work or school, association with febrile seizures, development of multiple antibiotic allergies and development of Strep complications.

Suspicion of tonsillar cancer
There are lots of other indications that are popular in specific regions or with specific surgeons.

Otitis Media is not an indication for Tonsillectomy!!
How they do a Tonsillectomy

• Patient is laid supine and operator sits at head of bed.
• Inserts mouth prop.
• Grasps tonsil with a tenaculum, retracts it medially, and dissects it from tonsil bed (constrictor muscles).
• Hemostasis in tonsil bed (various methods: cautery, pressure, ligatures and bismuth subgallate).
• Suctions clear oropharynx.

Complications with Tonsillectomy
Hemorrhage (most common complication, estimated at 2–3%)

• Intra–op.
• Primary (within first 24 hrs).
• Secondary (between 24 hrs and usually at most 10 days).
• Treatment of bleeds
• Local pressure with towel holder and gauze (can use epinephrine on gauze) – Hold for 10–20 minutes.
1. Silver nitrate cautery.
2. Cold water rinses.
3. Start IV and call the surgeon.
• Dehydration (common in kids who won’t eat due to pain).
• Weight loss (also common in kids who won’t eat due to pain).
• Fever (not common: usually related to local infection).
• Post–op airway obstruction (due to edema, hematoma, aspirated material).
• Local trauma to oral tissues.
• Tonsillar remnants.
• Death (uncommon, usually related to bleeding or anesthetic complications).

Post–op care

• Pain control.
1. Use liquid tylenol +/- codeine.
2. Parents’ unwillingness to give analgesics is associated with children’s refusal to eat which results in dehydration, weight loss and local infection
• Hydration (push fluids).
• Adequate diet: There’s no evidence that a special diet is required, obviously soft foods will go down easier.
• No smoking (delays healing).
• No heavy lifting/ exertion for 10 days (think it’s associated with late hemorrhage).
• Warn patients that pain will first abate over five days or so, then will increase for a day or two before completely disappearing (think this is related to eschar separation).

Normal post–op appearance Tonsillectomy
A gray and white eschar which lasts 7–10 days, analogous to the scab on a skinned knee after a bath.

See a clinical picture