A post-operative survey of 291 children was conducted to assess morbidity found at home in the first five days post-tonsillectomy. Analgesic requirement (92.4 per cent), signs of distress (90.4 per cent), otalgia (69.1 per cent), halitosis (66.7 per cent) were common. Physical or behavioural changes (36.8 per cent) and secondary haemorrhage (8.9 per cent) were also prominent features. Nausea was reported in 59 children (20.3 per cent) and delayed return to a normal diet which in turn predisposed to secondary haemorrhage. Return to normal diet was independent of pain. General Practitioners were consulted by 60.6 per cent and more than half were prescribed drugs. The presence of an organized clot in the tonsillar fossa (3.45 per cent) post-operatively did not delay discharge from hospital and none of these patients re-presented with secondary haemorrhage. Based on their child's experience in this study, only one third of the parents approved of day-case tonsillectomy in principle, a finding which has implications for the instigation of day-case tonsillectomy procedures.

A prospective audit study was undertaken to assess the effect of two different management policies following tonsillectomy in children in this hospital, one of which requires a prophylactic five-day course of oral antibiotics and the other does not. A total of 95 children were entered into the trial: 54 received post-operative antibiotics and 41 did not. The post-operative recovery was assessed by completion of a parent questionnaire which included the following parameters: degree of patient distress, nausea and vomiting, otalgia, halitosis, pharyngeal bleeding, analgesic requirement, day of return to a regular diet and General Practitioner consultation. There was no significant reduction in any of the morbidity measures in patients treated with antibiotics. In fact, the analgesic requirement and the incidence of otalgia and irritability on Days 6 and 7 and secondary haemorrhage were significantly higher in the antibiotic-treated patients. Although the number of patients included in this study are small, the results suggest that post-operative antibiotics do not improve the outcome of uncomplicated tonsillectomy. Our previous practice of routinely administering antibiotics to post-tonsillectomy children has been discontinued as the consequence of this audit.