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1. Preparation

WHAT IS A TONSILLECTOMY?

Tonsillectomy is the removal of the tonsils by surgery. The tonsils are two almond-shaped organs found at the back of the mouth on either side of the throat. They are made of lymphoid tissue and their role is to help provide a defence against infection which may enter through the nose or mouth.

tonsillectomy.gif

WHY IS IT DONE?

When the tonsils begin to get inflamed/enlarged it leads to a condition called Tonsillitis. This may be caused from a virus, fungal infection or bacteria. Tonsillitis mainly occurs when you are young, however, it can occur at any age.

If the infection becomes frequent and chronic, your doctor might suggest that it is best to remove the tonsils. There are other areas in the body made of this special tissue, so even though the tonsils are removed the body is still able to fight infection.

There are no medicines that will prevent tonsillitis but antibiotics can help to treat this condition. Should the frequency of infections increase the prolonged use of antibiotics may lose their effectiveness. The only way to prevent the recurrence of tonsillitis is to surgically remove the tonsils.

The symptoms of tonsillitis may include a sore throat, fever, headache, loss of appetite, nausea, vomiting, stomach ache, pain experienced when swallowing and bad breath.

Tonsils may also be removed for the following reasons:

  • Recurrent ear infections
  • Difficulty breathing due to enlarged tonsils
  • Mouth abscesses forming in the throat (Quinsy)
  • A child constantly unwell due to difficulties in swallowing and breathing because of chronic infection and enlargement of the tonsils
  • In rare circumstances, a tumour or growth on the tonsils
  • Very large tonsils that block breathing and cause snoring, breathing through the mouth and in some cases sleep apnoea (irregular breathing)

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a General Surgeon who can perform the procedure.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the Royal Australasian College of Surgeons via their website www.surgeons.org. This is a very informative website.

The list of questions below may help you better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).

To access a list of ENT Specialists who participate in HCF’s Medicover no gap arrangement:


Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

WHAT SHOULD I ASK MY SPECIALIST?

  • Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
  • In addition to what the procedure involves, you should also ask about:
  • Preparation
  • Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Aftercare
  • Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
  • Aspirin (or any related products)
  • Blood thinners (Warfarin, heparin.)
  • Arthritis medication
  • Pain medication
  • Anti-inflammatory medication
  • Insulin

Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.

WHERE IS IT DONE?

A Tonsillectomy is done in a hospital requiring an overnight admission.

HOW LONG IS THE PROCEDURE?

The procedure time for a Tonsillectomy is approximately 30 minutes.

WHO IS INVOLVED?

The people involved in the procedure are:

  • The Ear, Nose and Throat (ENT)surgeon, your Specialist doctor
  • There may be an assistant surgeon
  • Anaesthetist:they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
  • Nurses for the procedure and recovery
  • Radiologist for x-rays
  • Pathologist for blood tests and/or specimen samples

HOW DO I PREPARE FOR A TONSILLECTOMY?

To maximise your procedure and recovery phase there are some things you can do in the weeks leading up to your surgery. This may include reducing your weight if you are overweight or quitting smoking if you are a smoker. If you cannot give up completely, try to reduce smoking in the weeks leading up to your surgery; this may help to lower the risk of post-operative complications such as chest infection.

Should you have problems with blood pressure or your heart and lungs make sure your surgeon is aware of this prior to surgery. Also advise your surgeon if you have any allergies or abnormal bleeding tendencies.

Please inform your doctor if you have a cold or tonsillitis in the week prior to your scheduled procedure as the operation will usually be postponed to a later date, giving you time to recover.

You will be notified of your fasting times prior to theatre. If surgery is scheduled for the morning, you will normally be required to fast from midnight the night before and if scheduled for the afternoon you will be required to fast for at least 8 hours prior to admission.

Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.

Preparing Your Child for Surgery

As a parent, knowing what to expect before, during and after the surgery can lessen your child’s anxiety. It is best to explain the surgery to your child in simple and passive terms.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

  • Do not bring any valuables with you
  • Leave all jewellery at home, a wedding ring is acceptable
  • Wear comfortable clothing
  • Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
  • Bring any relevant x-rays or scans
  • You may also wish to bring something to read whilst you wait

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Tonsillectomy admissions for the financial year 13/14 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $1,687 $0 $1,654
1 Medical Services Component
Anaesthetic Services $562 $187 $175 $372 53.6% $0 46.4%
Ears,Nose and Throat Surgical Services $959 $275 $271 $803 51.2% $0 48.8%
Pathology Services $156 $78 $74 $90 3.6% $0 96.4%
2 Total Average Medical Services $1,415 $435 $421 $899 62.0% $0 38.0%
Hospital and Medical Services Average for Tonsillectomy Admissions $3,102 $435 $2,075 $899 62.0% $0 5 38.0%

tonsillectomy_14.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 3,345 overnight admissions with an average length of stay of 1.0 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 41788, 41789, 41792 and 41793.

  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($1,415) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all tonsillectomies. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL?

When you arrive at the hospital, the admissions clerk will attend to the paperwork associated with your stay.

On admission to the hospital/day surgery a nurse will orientate you to your surroundings and request your medical history, current medication and any known allergies. The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation to discuss your anaesthetic. A general anaesthetic is given which means that you are asleep throughout the procedure. You will also discuss the type of pain relief you will receive after the operation.

An intravenous line will be put into the back of your hand so that you can be given sedation, antibiotics and fluid replacement.

You may be given a pre-medication before leaving the ward, in which case you may already be sleepy once you enter the operating theatre.

WHAT CAN I EXPECT DURING A TONSILLECTOMY?

You will be taken into an anaesthetic bay where a small plastic tube called a cannula will be placed into a vein in your arm or hand. A sedative, the first part of your anaesthetic,, will be put through the cannula. After the anaesthetic has been administered your next memory will be waking up in the Recovery Room.

During the procedure your mouth is held open with a special mouth guard. Using special instruments, the surgeon will secure the tonsils, pulling them towards the centre of your mouth. The tissue around the tonsils is gently cut with either a scalpel, scissors, laser or an electric current (electrocautery), enabling the tonsils to be removed. Because of the amount of blood supply each tonsil has, electrocautery may be used to seal the blood vessels that were cut during surgery.

3. Aftercare

WHAT HAPPENS AFTER A TONSILLECTOMY?

Following the surgery, you will be taken to recovery where you will be closely monitored by nursing staff. Your vital signs will be checked on a continual basis until you are fully conscious.

Following the procedure you can expect:

  • A sore throat as swallowing may cause pain for about 4-5 days. In adults this discomfort may last up to 10 days.
  • You may experience a mild earache, sore tongue, gums and jaw.
  • The nurses will constantly monitor your condition and check on ay signs of bleeding.
  • Your doctor will advise when you can start eating and drinking after your operation. Sometimes you can begin to drink once you are awake. Although in some cases you will be asked to wait for a few hours before having any food or fluids. Ice cream is a sensible first meal after this operation as it is soft and can be soothing to your sore throat.
  • It is important to begin not only drinking fluids but eating soft food as soon as you can after the operation. It may be difficult to do this, but the solid food will actually assist in reducing the soreness in the throat. Solid, chewed food going down the throat keeps it clean and helps the healing process. If you do not eat solid food and only have drinks, you run the risk of infection which can delay the healing process.
  • It is important that pain is minimised after your procedure. You may require intravenous pain relief.

Although the pain will ease in approximately 2 days, i t may increase again up to 6 days after the operation. This can occur because the area is very raw while it is healing. Earaches may also be experienced.

A certain amount of bleeding from the tonsil area is to be expected but in some rare instances heavier bleeding can occur between 7–10 days after surgery. If this happens you should seek urgent medical attention.

Scabs on the wound could give a bad taste in the mouth so check with your doctor to ask if you can use a mouth rinse after the operation.

1. Preparation

WHAT IS A TONSILLECTOMY?

Tonsillectomy is the removal of the tonsils by surgery. The tonsils are two almond-shaped organs found at the back of the mouth on either side of the throat. They are made of lymphoid tissue and their role is to help provide a defence against infection which may enter through the nose or mouth.

tonsillectomy.gif

WHY IS IT DONE?

When the tonsils begin to get inflamed/enlarged it leads to a condition called Tonsillitis. This may be caused from a virus, fungal infection or bacteria. Tonsillitis mainly occurs when you are young, however, it can occur at any age.

If the infection becomes frequent and chronic, your doctor might suggest that it is best to remove the tonsils. There are other areas in the body made of this special tissue, so even though the tonsils are removed the body is still able to fight infection.

There are no medicines that will prevent tonsillitis but antibiotics can help to treat this condition. Should the frequency of infections increase the prolonged use of antibiotics may lose their effectiveness. The only way to prevent the recurrence of tonsillitis is to surgically remove the tonsils.

The symptoms of tonsillitis may include a sore throat, fever, headache, loss of appetite, nausea, vomiting, stomach ache, pain experienced when swallowing and bad breath.

Tonsils may also be removed for the following reasons:

  • Recurrent ear infections
  • Difficulty breathing due to enlarged tonsils
  • Mouth abscesses forming in the throat (Quinsy)
  • A child constantly unwell due to difficulties in swallowing and breathing because of chronic infection and enlargement of the tonsils
  • In rare circumstances, a tumour or growth on the tonsils
  • Very large tonsils that block breathing and cause snoring, breathing through the mouth and in some cases sleep apnoea (irregular breathing)

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a General Surgeon who can perform the procedure.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the Royal Australasian College of Surgeons via their website www.surgeons.org. This is a very informative website.

The list of questions below may help you better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).

To access a list of ENT Specialists who participate in HCF’s Medicover no gap arrangement:


Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

WHAT SHOULD I ASK MY SPECIALIST?

  • Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
  • In addition to what the procedure involves, you should also ask about:
  • Preparation
  • Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Aftercare
  • Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
  • Aspirin (or any related products)
  • Blood thinners (Warfarin, heparin.)
  • Arthritis medication
  • Pain medication
  • Anti-inflammatory medication
  • Insulin

Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.

WHERE IS IT DONE?

A Tonsillectomy is done in a hospital requiring an overnight admission.

HOW LONG IS THE PROCEDURE?

The procedure time for a Tonsillectomy is approximately 30 minutes.

WHO IS INVOLVED?

The people involved in the procedure are:

  • The Ear, Nose and Throat (ENT)surgeon, your Specialist doctor
  • There may be an assistant surgeon
  • Anaesthetist:they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
  • Nurses for the procedure and recovery
  • Radiologist for x-rays
  • Pathologist for blood tests and/or specimen samples

HOW DO I PREPARE FOR A TONSILLECTOMY?

To maximise your procedure and recovery phase there are some things you can do in the weeks leading up to your surgery. This may include reducing your weight if you are overweight or quitting smoking if you are a smoker. If you cannot give up completely, try to reduce smoking in the weeks leading up to your surgery; this may help to lower the risk of post-operative complications such as chest infection.

Should you have problems with blood pressure or your heart and lungs make sure your surgeon is aware of this prior to surgery. Also advise your surgeon if you have any allergies or abnormal bleeding tendencies.

Please inform your doctor if you have a cold or tonsillitis in the week prior to your scheduled procedure as the operation will usually be postponed to a later date, giving you time to recover.

You will be notified of your fasting times prior to theatre. If surgery is scheduled for the morning, you will normally be required to fast from midnight the night before and if scheduled for the afternoon you will be required to fast for at least 8 hours prior to admission.

Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.

Preparing Your Child for Surgery

As a parent, knowing what to expect before, during and after the surgery can lessen your child’s anxiety. It is best to explain the surgery to your child in simple and passive terms.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

  • Do not bring any valuables with you
  • Leave all jewellery at home, a wedding ring is acceptable
  • Wear comfortable clothing
  • Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
  • Bring any relevant x-rays or scans
  • You may also wish to bring something to read whilst you wait

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Tonsillectomy admissions for the financial year 13/14 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $1,687 $0 $1,654
1 Medical Services Component
Anaesthetic Services $562 $187 $175 $372 53.6% $0 46.4%
Ears,Nose and Throat Surgical Services $959 $275 $271 $803 51.2% $0 48.8%
Pathology Services $156 $78 $74 $90 3.6% $0 96.4%
2 Total Average Medical Services $1,415 $435 $421 $899 62.0% $0 38.0%
Hospital and Medical Services Average for Tonsillectomy Admissions $3,102 $435 $2,075 $899 62.0% $0 5 38.0%

tonsillectomy_14.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 3,345 overnight admissions with an average length of stay of 1.0 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 41788, 41789, 41792 and 41793.

  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($1,415) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all tonsillectomies. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

3. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL?

When you arrive at the hospital, the admissions clerk will attend to the paperwork associated with your stay.

On admission to the hospital/day surgery a nurse will orientate you to your surroundings and request your medical history, current medication and any known allergies. The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation to discuss your anaesthetic. A general anaesthetic is given which means that you are asleep throughout the procedure. You will also discuss the type of pain relief you will receive after the operation.

An intravenous line will be put into the back of your hand so that you can be given sedation, antibiotics and fluid replacement.

You may be given a pre-medication before leaving the ward, in which case you may already be sleepy once you enter the operating theatre.

WHAT CAN I EXPECT DURING A TONSILLECTOMY?

You will be taken into an anaesthetic bay where a small plastic tube called a cannula will be placed into a vein in your arm or hand. A sedative, the first part of your anaesthetic,, will be put through the cannula. After the anaesthetic has been administered your next memory will be waking up in the Recovery Room.

During the procedure your mouth is held open with a special mouth guard. Using special instruments, the surgeon will secure the tonsils, pulling them towards the centre of your mouth. The tissue around the tonsils is gently cut with either a scalpel, scissors, laser or an electric current (electrocautery), enabling the tonsils to be removed. Because of the amount of blood supply each tonsil has, electrocautery may be used to seal the blood vessels that were cut during surgery.

3. Aftercare

WHAT HAPPENS AFTER A TONSILLECTOMY?

Following the surgery, you will be taken to recovery where you will be closely monitored by nursing staff. Your vital signs will be checked on a continual basis until you are fully conscious.

Following the procedure you can expect:

  • A sore throat as swallowing may cause pain for about 4-5 days. In adults this discomfort may last up to 10 days.
  • You may experience a mild earache, sore tongue, gums and jaw.
  • The nurses will constantly monitor your condition and check on ay signs of bleeding.
  • Your doctor will advise when you can start eating and drinking after your operation. Sometimes you can begin to drink once you are awake. Although in some cases you will be asked to wait for a few hours before having any food or fluids. Ice cream is a sensible first meal after this operation as it is soft and can be soothing to your sore throat.
  • It is important to begin not only drinking fluids but eating soft food as soon as you can after the operation. It may be difficult to do this, but the solid food will actually assist in reducing the soreness in the throat. Solid, chewed food going down the throat keeps it clean and helps the healing process. If you do not eat solid food and only have drinks, you run the risk of infection which can delay the healing process.
  • It is important that pain is minimised after your procedure. You may require intravenous pain relief.

Although the pain will ease in approximately 2 days, i t may increase again up to 6 days after the operation. This can occur because the area is very raw while it is healing. Earaches may also be experienced.

A certain amount of bleeding from the tonsil area is to be expected but in some rare instances heavier bleeding can occur between 7–10 days after surgery. If this happens you should seek urgent medical attention.

Scabs on the wound could give a bad taste in the mouth so check with your doctor to ask if you can use a mouth rinse after the operation.

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Disclaimer: Information is provided by HCF in good faith for the convenience of members. It is not an endorsement or recommendation of any form of treatment, nor is it a substitute for medical advice, and you should rely on the advice of your treating doctors in relation to all matters concerning your health. Every effort has been taken to ensure the accuracy of this information, however, HCF takes no responsibility for any injury, loss, damage or other consequence of the use of this information.