Tonsillectomy (cont.)

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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 the patient drinks, they will have less pain overall. Try to drink thin dilute, non-acidic drinks or frozen popsicles. Soft foods such as gelatin, ice cream, custards, puddings, and mashed foods are helpful to maintain adequate nutrition. Hot, spicy, coarse, and scratchy foods such as fresh fruits, toast, crackers, and potato chips should be avoided because 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. At one week following surgery, patient's will often 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 time pain will be experienced. Overall, most patients will have recovered fully by two weeks after surgery. However, the patient will occasionally have throat tenderness with hot or spicy foods for up to 6 weeks postoperatively.

The patient will notice white patches in the back of the throat where the tonsils were formerly located. 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 and no attempt should be made to remove them. They will give the patient bad breath which will resolve once the area is fully 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. The patient 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.

Bleeding occurs in 1%-3% of patients' after a tonsillectomy. Although it may occur at any time, it almost always occurs 5-10 days after the surgery. Dehydration and excessive activity increases the chances of postoperative bleeding. If bleeding occurs, the patient should try to remain calm and relaxed. Rinse the mouth out with cold water and rest with the head elevated. If the bleeding continues, call the doctor. Treatment of bleeding can be simple. Rarely it may require a trip back to the operating room for cauterization of the bleeding area 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 the doctor.

Most patients require at least 7-10 days off from work or school. After3 weeks exercise and swimming can usually be resumed, but no diving for 6weeks. The patient should plan to stay in the local area for at least 2-3 weeks to allow forpostoperative care and in case you have bleeding.

When to call the doctor

Notify the doctor if the patient 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 F (38.6 C) that persists despite increasing the amount of fluid they drink and administration of 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.

Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care


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