What does a tonsillectomy cost in the UK?

There are several factors that influence the total cost of having your tonsils removed (tonsillectomy) as a private patient in the UK. The cost can vary significantly depending on whether you have private medical insurance or are self-paying. Tonsillectomy is covered by most insurance policies, but may not be covered in all circumstances, so it is worth confirming this with your insurer. If you do have private medical insurance, there may be an excess to pay, and you may have limits on your cover. If you are self-paying, there are several aspects of the treatment that you need to consider:

Outpatient appointments: your surgeon will want to see you before you have a tonsillectomy on at least one occasion. This is to discuss the problems you have had with your tonsils, examine your throat and talk about treatment options. Sometimes a telescope examination of the throat (nasendoscopy) is required as part of this, which will likely be an extra cost on top of the appointment. If you do decide to proceed with tonsillectomy, your surgeon may also want to see you in the outpatient clinic.

Hospital fees: these usually the most expensive part and form the majority of the cost of tonsillectomy. There can be significant differences in the hospital costs. Many surgeons operate at different private hospitals, so it is worth enquiring about the different costs.

Investigations: whilst they are not usually required, sometimes other tests need to be performed as part of your treatment, for example, blood tests, x-rays or scans or tracings of the heart.

Surgeon’s fees for performing the procedure.

Anaesthesia: The operation is performed whilst you are asleep under a general anaesthetic. The anaesthetic is administered by an anaesthetist who will bill for her services.

Whilst it is unusual, occasionally complications can occur following tonsillectomy. If these are dealt with in a private hospital, there are usually associated fees.

Don’t forget, there are also personal the costs that vary from person to person. For example, if you are self-employed, and not earning whilst recovering or if you need to pay for childcare costs.

When enquiring about costs, make sure that you ask about all of them so you know what the total cost is likely to be. Many private hospitals offer fixed-price packages which can help remove uncertainty around the cost, which it is often worth enquiring about. Financing options to help spread the cost of the procedure are often available.

If you are a UK resident, tonsillectomy is also available as an NHS patient, if you meet certain criteria. These criteria vary from area to area, and waiting list times are variable

 

Should I (or my child) have my tonsils and/or adenoids removed?

This is a common question that I'm asked by patients. There is much mystery and misinformation about tonsils and adenoids; what they do; and whether they should or shouldn't be removed and what having the operation is like. This naturally gives rise to concern about what the right thing to do is. You can read more about tonsillectomy here, here and here or adenoidectomy here

A common anxiety is that the tonsils are useful, and removing them will somehow harm the immune system or body in some way. This is an entirely understandable concern - we have tonsils and adenoids, so they must serve some kind of purpose? 

Yes, that is certainly true. Tonsils and adenoids are made of lymphoid tissue and play a role in the development of the immune system and fighting infections. However, they only really play a role in the development of the immune system in the first year or two of life.  This is certainly a relevant point, however, this benefit needs to be weighed against the harm that tonsils and adenoids sometimes cause in children under the age of two.

After the age of two, there are no adverse effects on the immune system from tonsil removal. The average person has a couple of hundred lymph glands in the head and neck region, and the lining of the mouth and throat is peppered with lymphoid tissue, so there is more than enough surplus lymphoid tissue to fight infections.
 

So when should tonsils or adenoids be removed? 

Sometimes the answer is obvious - if you're having severe tonsillitis every month or your snoring is so bad that you can't breathe properly a night, then the decision may be an easy one. However, in many cases it isn't quite so clear. As a consequence, guidelines have been written, and research performed, to help patients and doctors decide whether tonsils or adenoids should be removed or not. It's important to remember that guidelines are just that, guidelines, and not rules. There may be situations, such as with multiple antibiotic allergies or other health problems, that may make tonsillectomy or adenoidectomy appropriate, even if criteria are not perfectly met. Conversely, if a patient has a bleeding disorder that cannot be controlled or conditions that make a general anaesthetic hazardous, then further observation and medical management rather than surgery may be appropriate.  

Tonsil and adenoid problems can be grouped into obstructive or infective problems, which I will discuss as separate groups. 

Infective Problems

Recurrent Tonsillitis: In the UK, the most commonly followed guidance is that written by the Scottish Intercollegiate Guidelines Network (SIGN), which is broadly similar to the guidance in the United States. In summary, these guidelines recommend tonsillectomy may be an appropriate treatment if the sore throats due to tonsillitis are severe and occur:

  • Seven times in the previous year, if you have only had tonsillitis for one year. 
  • Five times a year if you have had tonsillitis for two years. 
  • Three times a year if you have had tonsillitis for three or more years. 

However, this does not mean that the tonsils should be removed. An acceptable alternative may be to continue monitoring the situation, with further courses of antibiotics being used to treat infections as they occur. Most people will 'grow out' of tonsillitis at some stage, the problem is not knowing when that is going to happen. 

Peritonsillar abscess ("Quinsy"): This is an unusual condition where a collection of pus ( an "abscess") forms next to the tonsil. If it occurs on one occasion, then tonsillectomy is usually not required, unless there is a background history of recurrent tonsillitis or blockage of the airway. If you have had two or more quinsies, then it is likely that you will have further quinsies, and tonsillectomy should be considered as a treatment. 

Tonsillar asymmetry: Occasionally one tonsil can be bigger than the other. In the vast majority of cases, this is due to previous infection, or slight differences in the anatomy of the tonsil bed on each side. Tumours or cancers of the tonsil are very rare. If there is any question or concern as to why one tonsil is larger than the other, it can be removed and sent for analysis. 

Recurrent (middle) ear infections ("recurrent acute otitis media"): These infections commonly cause symptoms of earache, raised temperature and sometimes discharge from the ear. Younger children and babies might pull their ears, or bang their head. The insertion of grommets can be very helpful if the infections are frequent. If the grommets fall out, and the problem continues, then removing the adenoids as well as putting in further grommets can help reduce the frequency of infections. 

Other conditions: There are a number of other situations where tonsillectomy might be appropriate, however good evidence from clinical trials is sometimes lacking. These conditions include:

  • Recurrent tonsil stones ("tonsilloliths")
  • Bad breath ("halitosis"), where other causes have been ruled out. 
  • Chronic tonsillitis
  • Chronic sinusitis in children. If medical treatments, such as topical steroid sprays in the nose, have not worked, then removing the adenoids is often helpful. 
  • PFAPA ("Periodic Fever, aphthous stomatitis, pharyngitis and cervical adenitis") syndrome. This is an unusual condition, that as the name suggests, causes recurrent problems with fever, mouth ulcers, sore throats, and enlarged glands in the neck. It usually settles of its own accord, although occasionally removing the tonsils is appropriate. 

Obstructive Problems

Sometimes tonsils and adenoids can cause problems by virtue of their size. Depending on the circumstances, removal of the tonsils and adenoids can sometimes be helpful. 

Snoring with obstructive sleep apnoea (OSA): Snoring is the noise generated by obstructed airflow through the upper airways whilst asleep. Sometimes, the obstruction can be temporarily complete, that is to say for a short time breathing stops. This caused obstructive sleep apnoea, or "OSA". If this is severe, and the tonsils and adenoids are enlarged, then in most cases, removal of the adenoids and tonsils is advisable. In moderate or mild cases, it is often advisable to remove the tonsils and adenoids if the problem persists, although sometimes a further period of observation may be appropriate, as in many cases, children will grow out of this problem. 

Nasal obstruction: Sometimes in children, and much less commonly in adults, enlarged adenoids can cause a blocked nose. They can also give rise to a change in the quality of the voice, so it sounds as if you have a blocked nose when you speak (this is known as 'hyponasal speech'), and can sometimes affect the sense of smell. Removing the adenoids can be very helpful in relieving such symptoms. However, it is important that other causes of a blocked nose, such as allergic problems, a bend in the middle partition of the nose or chronic sinus infections are also identified and treated if present.

Less common obstructive problems where adenoidectomy or tonsillectomy may be helpful, although there is not good research evidence to support it include:
Swallowing problems ("dysphagia") caused by very large tonsils
Change in voice quality due to large tonsils or adenoids    


When should tonsils and adenoids not be removed? 


Sometimes removing the tonsils or adenoids can be especially risky, or likely to cause more problems than it solves. In these cases, it is often a good idea to avoid surgery. Such situations include:
A severe bleeding disorder: as with most operations, there is a (small) risk of bleeding when removing the tonsils or adenoids. If your body isn't able to clot properly, this can be a serious problem and surgery may be best avoided. 
Developmental problems of the palate or upper airway, such as cleft palate. In these conditions, the tonsils can play an important part in the swallowing mechanism. If the tonsils, and particularly the adenoids are removed, there is a higher risk of developing nasal regurgitation (food and especially drink, entering the nose when swallowing) and a type of nasal speech ('hypernasal' speech, collectively known as 'velopharyngeal incompetence'. Sometimes surgery is best avoided or modified to minimise this risk.
Neurological or muscular problems of the throat: operating in this situation also carries the risk of velopharyngeal incompetence (see above).
Active infection: If the tonsils are actively infected, the risk of bleeding at the time of, or after surgery is increased. In most cases, it is advisable for surgery to be postponed for two to three weeks after an episode of tonsillitis. 


What questions should I ask my surgeon?

As with any procedure, there are several factors that need to be considered:

  • What does surgery involve, and what is the recovery like?
  • What are the benefits and outcomes (ideally the surgeon's own outcomes) of doing the operation, or not doing the operation?
  • What are the risks of the operation, but importantly, what are the risks of not having an operation? When talking about surgery, there is a natural tendency to focus solely on the risks of surgery, which will usually occur within a defined period of time. However, there are also risks of not doing surgery, such as problems developing with the heart and lungs with untreated obstructive sleep apnoea or infections from the tonsils spreading to other parts of the body. 
  • Importantly, what are the alternatives to surgery?

Know your symptoms: when blocked ears or nose or a sore throat get serious

One of the things that makes ENT such an interesting speciality is the wide variety of symptoms that patients present with. However, as a patient this one of the reasons ear, nose and throat symptoms can be so worrying. These symptoms often give rise to anxiety, which can lead to other problems such as poor concentration, sleeplessness and forgetfulness, which makes matters worse.  

National Stop Snoring Week - 25th-29th April 2016

National Stop Snoring Week - 25th-29th April 2016

Snoring. Most of us do it occasionally, and the majority of people see it as just a minor annoyance. However, it can be a symptom of more serious conditions, such as sleep apnoea, so if you are aware that you snore regularly and are worried you might have sleep apnoea (see below) it might be worth seeking expert advice.

Pass the cheese, Grommet

You may be wondering what Nick Park’s lovable plasticine characters have to do with ear, nose or throat conditions – the answer is, very little other than sharing a name with a medical device which can help alleviate ear problems in young children.

Painful ear infections

Children can be prone to suffering from ear infections. These can be very painful, resulting in repeated trips to the doctor and time off school. There is, however, an effective treatment for recurring ear infections, a tiny tube called a grommet that is inserted into the middle ear.

The very short procedure takes place while the child is under general anaesthetic. The grommet’s tubular shape allows air to pass through into the middle ear (behind the ear drum) which helps drain the excess fluids which cause ear infections.

Treatment for glue ear

Grommets can also help treat ‘glue ear’, which is a condition that commonly affects children. It is caused when the middle section of the ear becomes filled with fluid due to the malfunction of the tube that drains the middle ear to the back of the nose (the Eustachian tube). Often the first symptom of glue ear is that children struggle to hear clearly, although it is not usually painful.

If glue ear doesn’t settle of it’s own accord, grommets can help the excess fluids drain away, providing an easy and effective solution to this problem.

Grommets are tiny plastic tubes, a couple of millimetres wide, that come out of their own accord, usually after ten to twelve months. There is no need for a follow up procedure to remove the grommet. As a general rule, children will grow out of conditions such as repeated ear infections and glue ear. Grommets can help alleviate matters whilst this occurs.

Preparing your child for surgery

Going into hospital can be unnerving for people of any age, but is especially so for children. However, the operation is quick and it won’t be long before it’s time to go home – generally patients can expect to go home around two hours after the procedure has been completed. Most children need only one day off school.

Mr Julian Hamann, a father of three, is experienced at putting children at ease before their procedure. He understands that explaining the process in terms they can understand is important in alleviating their anxiety.