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Tonsillectomy

Adenotonsillectomy

Function:         Tonsils consist of lymphoid tissue where immune reactions take place, especially in children. The adenoid pad also consists of lymphoid tissue which is situated at the back of the nose. Excessive immune reaction of this lymphoid tissue presents as tonsillitis or adenoid inflammation.  Although this is a normal reaction, it can become very severe or recurrent in nature in some people.  This may also lead to enlargement of tonsils and adenoids, which can lead to snoring and mouth-breathing.  All these conditions are then deleterious to one’s health and removal of the tonsils and/or adenoids are indicated.

After this there is still sufficient lymphoid tissue left over in the mouth, nose and throat to facilitate normal immune function.

Procedure:     Various methods are used to remove tonsils.  This can include cold steel (traditional method), coablation surgery, laser or forms of electro-cautery.  The surgery is done under general anesthesia in all cases.

Complications:

  • Pain – A tonsillectomy is painful irrespective of the method applied for removing the tonsil. Pain usually lessens dramatically after 1-2 days, but may worsen again. In most cases patients are pain free after 7 days, although this may take longer, especially in adults.
  •  Bleeding – The tonsil bed is dry when the patient leaves the theatre. Re-bleeding occurs in 1% of cases and mostly within 7 days after surgery. Please note: this refers to blood that is being swallowed, or flowing from the mouth and not bloodstained mucus seen immediately after surgery.
  •  Eating – The patient should return to his/her normal diet as soon as possible post-operatively. Initially, it might be easier to swallow a soft diet. Eating early will decrease the pain en reduce the chances of re-bleeding and infection.

Should any complications (especially bleeding) occur, please contact your doctor or go to the emergency room.

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Surgery Of The Ear

General indications for ear surgery:

  • Outer ear
    • Bony or cartilage overgrowth in the ear canal eg. Swimmer’s or surfer’s ear.
    • Repair of bat ears and other cosmetic ear surgery.
  • Middle ear
    • Grommets – discussed elsewhere
    • Ear drum repair
    • Hearing repair in certain types of deafness
    • Treatment of chronic running ear (pus)
    • Removal of certain tumors
    • Combinations of the above
  • Inner ear
    •  Removal of tumours
    • Implantation of certain hearing devices and prostheses such as cochlear implants, Bone-anchored hearing aids (BAHA) etc.

How is the operation performed?

Due to the small size of the ear microscopes and endoscopes are used. Equipment is specifically engineered to suit the work in such a confined space.

What to expect:  (not applicable to grommets)

During the operation, you will be under anaesthesia and unaware of anything.  After the procedure, you will experience moderate pain.  The ear will also be covered with a bandage and a soluble plug left in the ear canal which renders you very deaf in the ear.  The bandage is generally removed after a few days and the plug left to dissolve or removed.

Water must be kept out of the ear until your doctor tells you otherwise.

You will see the doctor again for follow-up visits.

More information about specific operations can be given by your doctor.

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Surgery Of The Nose

Common operations of the nose

  • Septoplasty – correction of a deviated septum (central part of nose).  These patients have a chronically blocked nose due to obstruction by bone or cartilage.
  • Rhinoplasty – Correction of a deviated nasal bridge, humps, saddle noses or other deformities of the bridge.
  • Septorhinoplasty – combination of the above.
  • Turbinectomy – reducing the size of the turbinates in the sides of the nose.  These patients also present with a chronically blocked nose.
  • Fess – Functional endoscopic sinus surgery.  Removal of diseased mucosa and polyps, clearing of obstructed sinus openings etc.  There is a wide variety of procedures that resort under this heading.
  • Nose operations are mostly done under general anesthesia – the patient will thus not be aware of any pain during the procedure.

Potential Complications

Structures such as they eyes, tear ducts, nerves, blood vessels and meninges (sheaths covering the brain and containing brain fluid) are all in the vicinity when working in a nose.  Any of these might be injured, depending on the type of operation being done.  Your doctor will be able to give you a good idea of whether these risks are pertinent in your procedure.

After the surgery

After any nasal surgery the nose might feel blocked for a few days to a week due to swelling in the area.

Nasal plugs may be placed in the nose after surgery to control severe bleeding.  In most cases however, we try to not use this.

There may be a watery or bloodstained discharge from the nose which can be controlled by using cotton wool or gauze.

Do not rub or scratch the nose as this may cause damage.

Use only the rinse and sprays that has been prescribed by your doctor to clear the nose. Under no circumstances should you blow your nose.

Severe bleeding can be controlled by local pressure to the nose. You should contact your doctor as soon as possible or go to casualties for help.

Follow-up visits will be scheduled after surgery.

More detail about procedures can be discussed with your doctor.

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Grommets / Ventilation Tubes

Purpose:          The purpose of the grommet is to ensure ventilation of the middle ear, i.e. to let air flow from outside into the middle ear. Normally this ventilation would be performed via the Eustachian tube that runs from the middle ear to the back of the nose.  However, in a diseased ear the function of this tube can become poor. If this situation does not resolve spontaneously or on medication a grommet may be indicated.

In a sick ear pus can also flow out through the grommet although this is not its primary function.  Pus is an indicator of infection and should be treated. If this is the case, please contact your doctor immediately.

Operation:       For children the procedure is performed under general anesthesia. In adults it can be performed under local anesthesia in the rooms. Usually there is immediate relief post-operatively after insertion of the grommet(s). Slight pain or discomfort may occur and can be treated with painkillers. Your doctor may prescribe ear drops which can flow through the grommet into the middle ear. During the first few days after the operation bloodstained pus might flow from the ear – if this persists and your doctor did not prescribe ear drops, please inform him of this discharge.

Follow-up:       Please visit your doctor 10-14 days after the procedure to confirm that everything is in order. Should there be any problems before that time, e.g. a discharge that persists in spite of treatment, you should contact your doctor earlier.

Important: The ear should be dry and without pus if the grommet is functioning and the ear healthy.

Long Term:     A grommet will stay in the ear for anything from 3 months up to five years, depending on the type of grommet and the individual response of the patient. The normal period is about 10-12 months.

It will fall out spontaneously after this time.  If a grommet does not fall out of the ear the patient is followed up for some time before the surgeon might consider removing the grommet.

Should ear symptoms (deafness, blocked feeling, earache, pulling of the ears, or a discharge) occur, please consult your Doctor.  Showering, bathing, washing of hair and swimming normally do not cause any problems as very little water reaches the eardrum and if so is not under pressure.  Diving or swimming deep under the water should be discouraged as this might force water through the grommet into the middle ear. These patients should wear earplugs when swimming.