Tonsillectomy - What It Is

Tonsillectomy is a surgical procedure done to remove the tonsils. The tonsils are located at the back of the throat and are part of the body's immune system to fight off infections. Done under general anesthesia, the surgeon cuts away the tonsils from the mouth using a cautery (burning) instrument. The tonsils are then removed, bleeding is controlled and the tonsils will be left to heal without stiches. The whole procedure takes under 60 minutes and is done as a day surgery elective.

When is a tonsillectomy recommended?

Specifically, the guidelines for surgery are:

  • 7 or more episodes of tonsillitis in one year
  • 5 or more episodes per year over a 2-year period
  • Severe tonsillitis
  • Tonsillitis that is not responding to antibiotics
  • An abscess in the tonsils
  • Grossly asymmetric tonsils

Tonsillectomy may be advised if the tonsils are enlarged and obstructing access to the adenoids during an adenoidectomy or if the physician suspects the presence of a tonsil.

Risks of a tonsillectomy

As with any other surgical procedure, risks include :

  • Bleeding

  • Reaction towars anestesia

  • Infection

  • Permanant change in voice (not a risk but possible outcome)

    Surgery Details

    I will not go much into the technicals of tonsillectomy since you can find out more online, about the tonsils and tonsillitis. I will however go in-depth with my experience with the surgery.

  • Patient : Me! arbeden?
  • Date Of Surgery : 28th Oct 2004 (2nd attempt. 1st attempt aborted due to fever)
  • Related Medical History : Chronic recurrent severe tonsillitis, enlarged tonsils
  • Medical facility : Tan Tock Seng Hospital
  • Dept : Otorhinolaryngology, Ear Nose Throat (ENT)
  • Surgeon/Physician I/C : Dr Nelson Chee
  • Nature of procedure : Tonsillectomy
  • Type : Day Surgery elective, Same Day Admission (SDA), OT 10
  • Scheduled length of stay : 2 days
  • Actual length of stay: 8 hours
  • Type of ward: B2
  • Total cost: $900 ++
  • Medical Leave granted: 15 days + 3 days (extention)

    Bill Breakdown

    Note : Price is before subsidy. Price in brackets reflects actual price paid, after subsidy.

    Room Charge: Class B2 for 1 day : $164 ($48)
    Daily Treatment Fee: $45 ($17)
    Consumables: $77.45 ($31.20)
    Investigations: (Lab + Specialised) $131.04 + $58.19 ($44.55 + $19.80)
    Medications : (Non standard + standard) $118.43 + $3 ($110.23 + $2.80)
    Surgical Procedure: $1422.09 ($500)
    Treatment Services: $13.52 ($7)
    Total: $2032.72
    Gov Subsidy: $1252.17
    Amount Payable: $780.58
    Medical Claims Proration System: $770.98
    Total Due: $9.60

    Surgery Diary

    Here's a day to day record of events from surgery day till the end of recovery phase. I do hope it will be informative to those who intend to do the procedure.

    Day 1:

  • 0735h Arrived at day surgery registration counter 1h before surgery time (0830h). Verified had nil by mouth (NBM) since 12md the night before.
  • 0745h Had weight checked. Emptied bladder.
  • 0750h Changed into surgical gown. Sealed belongings into bag provided. Messaged my dear that I'm going in and will see my wormie. SMS my mom on ward details.
  • 0803h Temperature, pulse, BP taken and recorded.
  • 0805h Looked around me and wondered why everyone had someone accompanying but I did not. *sigh* I miss my wormie..
  • 0810h OT staff came and said I was ready to be pushed in. Wah so fast..
  • 0811h Got wheeled out of the pre surgery holding area. First time being wheeled on a bed..
  • 0813h Turn left turn right, nearly got pushed into the wrong OT..
  • 0818h Finally got wheeled into the right one. Verified I had no drug allergies. Waited in the OT holding area.
  • 0820h People came in people went out. Quit stressful and distracting. Heard OT staff preparing in the OT, with class 95 playing softly in the background.
  • 0824h While waiting for surgeon, OT staff inserted IV plug into my left hand. Put on saline drip. Wasn't as painful as I thought. Phew..
  • 0831h Surgeon came in. Signed some documents. Appeared to be in a good mood. Said just as well I rushed this surgery cause the 8h surgery he was supposed to do was cancelled.
  • 0835h Wheeled into OT. Transfered myself onto the OT bed. Quite a small bed. With a headrest to prop up the head.
  • 0838h Removed upper part of my gown for monitoring sensors to be clipped on.
  • unknown anesthetist (she's quite pretty, mixed) inserted one syringe into IV plug. OT nurse provided O2 mask and asked me to breathe. Anesthetist injected first syringe. I waited and counted..nothing happened. Second syringe went in. Nothing happened. Third one went in, after she pulled the third one out, my head suddenly felt heavy. Very heavy. Wanted to say "oh its finally working" but before I could I guess I've ZZzzzzz...
  • 0950h I woke up in the recovery suite. One of the nurse was putting on my shirt and getting my IV plug left hand into the back-to-front pyjamas. I realised they already changed my pants..hah hah.
  • 0955h Staff gave me an electrolyte popsicle. And a survey form. Still felt drowsy. Did not feel much pain though. Didn't feel anything basically. Ticked all the survey boxes as "very satisfied" except for one box. I knew what I was doing, by the way.
  • 1005h Had the breathing tube removed from my nose. It was nothing, just to assist in breathing. They can't use an O2 mask for my surgery, can they?
  • 1010h Got wheeled out of recovery. Looked around and found the place unfamiliar. Looked like a back door. See nothing familiar to the OTs I saw earlier.
  • 1020h Finally got settled onto my bed. Ward 12c. Bed 94.
  • 1030h Nurse came to give me another electrolyte popsicle. Took temp, bp. Felt cold, feverish. But she didn't say anything so it must okay.
  • 1045h Ward doctor came. Surprise surprise, Dr Ivan Tan. We go to the same gym but I don't speak with him. This is the first time. Oh well. He looked into my throat, said it was a nice clean cut. And left.
  • 1330h My grandma came. What a surprise. Mom came later too. Told her I seemed okay. Want to be discharged. Ask for my doctor.
  • 1430h They left. MO came, and said my doctor recommended I stay till 8h after the surgery at least. By 6pm that day if I had no bleeding, can eat and drink, I can be discharged. Yay! So boring there. All old old people who seemed to do the same procedure, but all still KO. Perhaps I had a good surgeon. Yeh.
  • 1500h Tried to sleep. Slept a little here and there. Noticed the young guys seem to be in another ward behind me. Urgh!
  • 1530h BP and ECG taken at 30 min periods apparently. By trainees. One from NYP one from ITE, year 2.
  • 1700h Dr Ivan woke me, examined me. Said I could be released, if I could eat my dinner to ensure there is no bleeding. No kick man. I gobbled my dinner of porridge, mashed cauliflower and minced pork down.
  • 1755h Pharmacy staff came, and gave me my medicine. Augmentin, Paracetomol, Celebrex, Difflam gargle/lozenges for 2/52
  • 1815h Waiting for my mom to come so I can be taken off the drip!
  • 1820h She finally came. Trainee nurse took me off the drip. Luckily it didn't really hurt. Didn't feel much.
  • 1830h Went to pee (finally!), waved goodbye and left. Feeling pretty good.
  • 1930h Watched whatever's left of Xi3 Ling2 Men2.
  • 2000h Took my medicine, and watched SG Idol. No TV in hospital, that's why I wanted to go home heh heh..

    Day 2:

  • Felt the pain sink in. Felt weak, a little feverish (low grade 37.2).
  • Swallowing was tough. Had to do with very soft food. Didn't feel like eating much.
  • Felt miserable. Waited for my dear to come. Couldn't open my mouth to speak well. Felt ulcers in the mouth, probably due to surgery.
  • Noticed white exudate around the wound. Pretty normal. Really feels like a very bad tonsilitis attack.

    Day 3:

  • Took laksa. Juice. Didn't care hah hah.
  • Still felt weak. Walked around for a lil while. Caught some shows. Too bored at home. Eating was the most difficult task.
  • Still couldn't speak well, cause can't open mouth too big and had to keep the back of my throat from stretching. Speech was as if you spoke with your lips together, mouth closed.
  • Wound area still hurts. Physically recovering though. Slowly. Worst day by far.

    Day 4:

  • Ate more solid food at my dear's place. Hurt a lot but forced it down anyway.
  • Temperature seems normal and stable. Weight did not seem to drop yet. Why?!?
  • Took dear's chincilla to the vet. Breathing difficulties. Probably pneumonia. Bad outlook. As for me, still can't speak well. Still hurts.Bout the same as day 2.

    Day 5:

  • Sitting here typing all these. Same amount of pain still. Bout same as day 2 and 4. Hopefully the peak is over. Have not physically checked my throat yet for exudate.
  • Ate bananas. Mom finally took something right for me. Lychee low fat sorbet! So nice!! I luv lychee and don't like diary ice creams now so..its a treat! Ate bread too, after the morning's medication.
  • Realise cold stuff somehow doesn't really help with the swell (what swell, there are no tonsils already!). But learnt a way to drink without cringing from the pain. Use a straw, push the straw all the way to the back of the throat and suck. Liquid goes beyond the wound and down the throat, so there is no pain.
  • Since day 1, sneezing coughing or anything to do with a reflex action from head to throat hurts. I have never feared sneezing so much before!

    Day 6:

  • No change. Pain still the same..

    Day 7

  • Exudate clearing a little. Swallowing a little easier. Speech still sounds weird but able to open mouth wider now..
  • Ate pizza with friend. Drank choco milk. Trying to scratch the wound with food so it will heal slower. heh..

    Day 7

  • Hiccups hurt. Yanks the back of the throat. Eating seems easier, or is it cuz I am more used to the pain. Swallowing still hard.
  • Wound area still hurts. Which is GOOD! I know I am nuts.

    Day 8-10

  • Throat seems to be better, voice returning. Still a little pain on swallowing. Exudate clearing a little. Sneezing still hurts.

    Day 11-13

    Last Update : Nov 9
  • Exudate still present. Yawning causes discomfort. Speech and pitch normal. A little discomfort on swallowing. Sneezing isn't as terrifying as it was. Extended 3/7 of medical leave.