Tonsillectomy (cont.)

What happens after surgery?

After surgery, you or your child will be taken to the recovery room where a nurse will monitor you or your child. You will probably be invited into the recovery room as your child becomes aware of their surroundings and starts looking for you. You, or your child, will be able to go home the same day as the surgery once you, or they, have fully recovered from the anesthetic. This usually takes several hours. You will need a friend or family member to pick you up from the surgical facility to take you home. They should spend the first night after surgery with you.

When you arrive home from the surgical facility, you or your child should go to bed and rest with the head elevated on 2-3 pillows. By keeping the head elevated above the heart, you can minimize edema and swelling. Applying an ice pack to the neck may help decrease swelling. You, or your child, may get out of bed with assistance to use the bathroom. Visitors should be kept to a minimum since they may unknowingly bring infection and cause over excitement. Avoid straining, if you are constipated, take a stool softener or a gentle laxative.

It is best for you, or your child, to eat a light, soft, and cool diet as tolerated once you or they have recovered fully from the anesthetic. Avoid hot liquids for several days. Even though one may be hungry immediately after surgery, it is best to feed slowly to prevent postoperative nausea and vomiting. Occasionally, one may vomit one or two times immediately after surgery, however if it persists, your doctor may prescribe medications to settle the stomach. It is important to remember that a good overall diet with ample rest promotes healing. Weight loss is very common following a tonsillectomy. You need not worry about nutritional requirements during the recovery so long as you, or your child, is drinking an adequate amount of fluid.

You, or your child, will be prescribed antibiotics after surgery, and should finish all the pills that have been ordered. Some form of a narcotic will also be prescribed (usually acetaminophen/Tylenol with codeine), and is to be taken as needed. If you require narcotics you are cautioned not to drive. If you have nausea or vomiting postoperatively, you or your child may be prescribed anti-emesis medications such as phenergan. If you have any questions or you feel that you or your child is developing a reaction to any of these medications, you should consult your doctor. You should not take or give any other medications, either prescribed or over-the-counter, unless you have discussed them with your doctor.

General Instructions and Follow-up Care

An appointment for a checkup should be made 10 to 14 days after the procedure. Call the office to schedule this appointment.

The most important thing one can do after a tonsillectomy to prevent bleeding and dehydration is to drink plenty of fluids. At times it may be very difficult to swallow. If you, or your child, drinks, they will have less pain overall. If it takes one hour to drink a glass of water then do it. Try to drink thin, non-acidic drinks or frozen popcicles. Soft foods like gelatin, ice cream, custards, puddings, and mashed foods are helpful to maintain adequate nutrition. Hot, spicy, rough, and scratchy foods such as fresh fruits, toast, crackers, and potato chips should be avoided since they may scratch the throat and cause bleeding. If dehydration occurs and attempts at home cannot correct the problem, then admission to the hospital for intravenous fluids will be necessary.

Pain is common after a tonsillectomy. It is often hard to predict who will recover quickly or who will have prolonged pain. Immediately after surgery, many patients report only minimal pain. The next day the pain may increase and remain significant for several days. Often times at one week following surgery, patient's will appear to relapse when their pain becomes significant again. They usually report pain in the ears, especially when they swallow. The scabs are often falling off at this time. If bleeding is going to occur, this is the most common time. This pain is usually the last type of pain experienced. Overall, most patients will have recovered fully by two weeks after surgery, however for up to 6 weeks they will occasionally have throat tenderness with hot or spicy foods.

You will notice white patches in the back of the throat where the tonsils were removed. These are temporary scabs which occur during the healing process. They are not a sign of infection, and will fall off within the first two weeks following surgery. No attempt should be made to remove them. They will give the patient bad breath which will go away when everything is healed. It will take up to 6 weeks for the throat to return to the normal pink color. It is not unusual to have nasal stuffiness following surgery. The nasal stuffiness may last for several months as swelling decreases. Saline nose drops (Ocean Spray) can be used to help dissolve any clots and decrease edema. You may notice persistent or even louder snoring for several weeks. A temporary change in voice is common following surgery, and will usually return to normal after several months. They, of course, will sound less "nasal" following surgery.

Bleeding occurs in 1-3% of patient's after a tonsillectomy. Although it can occur at any time, it almost always occurs 5-10 days after the operation. Dehydration and excessive activity increases the chances of postoperative bleeding. If bleeding occurs, try to remain calm and relaxed. Rinse the mouth out with cold water and rest with the head elevated. If the bleeding continues, call your doctor. Treatment of bleeding can be simple, or it may require a trip back to the operating room under general anesthesia. In very rare situations, a blood transfusion may become necessary. Conversely, bleeding is rare following an adenoidectomy. There may be some bleeding from the nose following surgery. If it occurs, pediatric Neosynephrine nose drops can be used. If it is persistent and bright red in color, call your doctor.

Most patients require at least 7-10 days off from work or school. After 3 weeks exercise and swimming can usually be resumed, but no diving for 6 weeks. You should plan to stay in town for at least 2-3 weeks to allow for postoperative care and in case you have bleeding.

Notify Your Doctor If You Or Your Child Has:

1. A sudden increase in the amount of bleeding from the mouth or nose that lasts more than a few minutes.
2. A fever greater than 101.5 degrees F which persistent despite increasing the amount of fluid you or they drink and acetaminophen (Tylenol and others). A child with a fever should try to drink approximately one-half cup of fluid each waking hour, and an adult should drink one cup per hour.
3. Persistent sharp pain or headache which is not relieved by pain medications prescribed.
4. Increased swelling or redness of the nose, neck, or eyes.

Tonsillectomy and Adenoidectomy At A Glance

• Tonsillectomy and adenoidectomy is a surgical procedure performed to
• remove the adenoids.
• The tonsils and adenoids are masses of lymphoid tissue located behind
• the nasal passages.
• All surgical procedures have risks and potential complications.
• Understanding what is involved before, during, and after surgery can help you or your child recover from surgery as comfortably as possible.

Last Editorial Review: 9/27/2002

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