Obstructive tonsils: associated with sleep apnea, dysphagia, speech defects and failure to thrive.
Recurrent sore throats
- 7 sore throats in 1 year.
- 5 in each of 2 years.
- 3 in each of 3 years.
- Fever > 38°.
- Swollen anterior cervical nodes.
- Tonsillar exudate.
- Or positive strep culture.
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.
Hemorrhage (most common complication, estimated at 2–3%)
- 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.
- Silver nitrate cautery.
- Cold water rinses.
- Start IV and call the surgeon.
- Pain control.
- Use liquid tylenol +/- codeine.
- Parents’ unwillingness to give analgesics is associated with children’s refusal to eat which results in dehydration, weight loss and local infection
TonsillectomyNormal 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