Please note that the following is a general guideline/ discussion only.
WHY IS TONSIL SURGERY SO PAINFUL?
The reasons for the severity of pain is due to the large ulcers left behind after tonsil surgery and the extensive nerve innervation. These ulcers tend to slough and get infected due to a large number of bacteria in the oral cavity. Because the most amount of swelling appears between day four and day seven, this is the time that most patients suffer worst pain and potential bleeding.
(please refer to tonsillectomy operative instructions and talk with your doctor/ specialist for further advice)
POSTOPERATIVE METHODS TO CONTROL PAIN
There are several postoperative steps most surgeons take to help their patients through this period.
1) Instruct the patients to eat rough foods rather than soft foods and allow the tonsil beds to be de-sloughed naturally. This, in turn, will reduce infection thereby pain as well as the likelihood of bleeding
2) Stress the importance of keeping themselves well hydrated. Dehydration can compound matters and increase pain.
3) Give regular analgesia and stronger opiates such as Endone for breakthrough pain (usually after being tested during hospital stay). Some centres advocate Brufen, others are against this due to a possibility of increase bleeding, though unproven. Codeine (pain Stop) is generally avoided in children, due to some being poor metabolisers of this drug causing potential drowsiness.
4) Give antibiotics to reduce the bacterial load.
5) Give steroids to reduce swelling-usually intraoperatively
OPERATIVE METHODS
There are some surgical techniques, which can also help postoperative pain control.
In recent years new techniques of surgery have emerged. One is coblation assisted tonsillectomy. Coblation uses a much lower heat (around 40-70 Celsius) and a channel for cold water irrigation. The diathermy used more regularly in Australia produces much more heat (400 celsius) and as a result, more burn.
With Coblation Tonsillectomy, children in clinical studies have been shown to experience less pain and recover more quickly than those who received traditional tonsillectomies. This applies to the adult group as well, who tends to suffer more with diathermy surgery generally. It is however impossible to have no pain after tonsil surgery. Recent studies have shown partial tonsillectomy, otherwise known as "tonsillotomy" can further reduce pain. However, there is a risk of regrowth of tonsils.
OUR PRACTICE
Our practice uses coblation for tonsil surgery at the Peninsula Private and Bays Hospitals. We avoid diathermy. We find that most of our patients manage pain very well. We are also in the process of conducting a randomised controlled trial to see adding a probiotic gargle could further reduce pain in adults.