PDF Download: Postoperative Instructions for Tonsillectomy and Adenoidectomy
What are Tonsils and Adenoids?
Tonsils and adenoids are lymphoid tissue located in the upper airway. There are two types of tonsils: palatine tonsils and lingual tonsils. Palatine tonsils are in the back of the throat and are the type most refer to when discussing tonsillectomy. Lingual tonsils are in the base of tongue and can be obstructive in some people requiring removal. The adenoids are in the back of the nose in an area called the nasopharynx. They tend to grow fast in young kids, often starting at a few months of age, and tend to shrink down by the teenage years. Most adults no longer have adenoids. The tonsils and adenoids act like a net and capture viruses, bacteria, and allergens and present them to the immune system. They don’t fight off the infection. Therefore, removing the tonsils and adenoids doesn’t necessarily weaken the immune system, which is a commonly held misconception.
When are Tonsils and Adenoids Removed?
Tonsils are primarily removed for three main reasons: 1) sleep disordered breathing. 2) recurrent strep tonsillitis and 3) swallowing difficulties with foods. There are other relative indications as well that could depend on the discretion of you and your physician.
Kids that snore loudly and/or have apneic pauses at night, sleep restlessly, and are tired or hyperactive the next day, have “sleep disordered breathing.” A diagnosis of obstructive sleep apnea (OSA) can only be diagnosed by sleep study, also known as a polysomnogram (PSG). A primary cause of sleep disordered breathing or OSA is often from enlarged tonsils and/or adenoids. Kids that don’t respond to conservative measures would be good candidates for removal. Unless the tonsils are unusually large and have documented obstructive sleep apnea, kids under the age of two typically may undergo just an adenoidectomy.
According to the Clinical Practice Guidelines by the American Academy of Otolaryngology-Head and Neck Surgery, if a child has had 6 to 7 episodes of strep tonsillitis in a year, 5 episodes in each of the last 2 years, or 3 in each of the last 3 years they meet criteria for tonsillectomy. Additionally, if these episodes were non-strep tonsillitis, and child has met certain clinical criteria (high fever, poor appetite, vomiting) and missed several days of school, tonsillectomy may also be justified.
Some kids may experience choking on solid foods or avoid large pieces of solids altogether as a result of having very large tonsils. They would be candidates for adenotonsillectomy.
When are Just Adenoids Removed?
Adenoidectomy alone would be performed in very young children (under age of two) who have small tonsils and enlarged adenoids with obstructive breathing. Another reason to remove adenoids would be for chronic adenoid infection (adenoiditis) resulting in recurrent ear infections that are requiring multiple ear tube placements. In fact, many physicians would consider removing adenoids if a child is undergoing their second or third set of tubes. One must always be suspicious of enlarged adenoids or chronic adenoiditis if a child older than age 5 is being diagnosed with recurrent ear infections.
How Is Tonsillectomy and/or Adenoidectomy Performed?
Tonsillectomy and adenoidectomy are both removed under general anesthesia which require a breathing tube and an IV. Adenoids are removed through the mouth underneath the palate. The surgical technique used may depend on surgeon preference and on the individual patient. Common instruments used are the microdebrider (“shaver”), the Coblator™️, curettes, and the suction Bovie®, an electrocautery device. Tonsils are removed from a capsule on either side of the throat with a Bovie electrocautery or a Coblator most often. The procedures are often performed in 10-20 minutes but can be shorter or take longer.
Postoperative Instructions for Tonsillectomy and Adenoidectomy
This instruction sheet is designed to help you care for your child following surgery and to answer commonly asked questions. Please read the entire sheet carefully. Don’t hesitate to call our office 214-494-4150 if you have any questions or concerns. If the nurse cannot answer your questions, the doctor will return your call, or you will be asked to come to the office.
What to Expect
Throat Pain: After tonsil surgery it is normal to have a sore throat for 10-14 days. The pain is often worse in the morning. The sore throat may get worse 5-8 days after surgery since this is when the scabs fall off in the back of the throat. Remember to drink plenty and take your pain medication to decrease discomfort. A full recovery is typically 10-14 days. We recommend to stay home for 7 days.
Ear Pain: Often people will experience pain in their ears. Usually there is nothing wrong with the ears; pain from the tonsil area refers to the ears. This pain may be worse at night.
Do not blow your nose hard for 1 week. Use saline spray in your nose to help healing twice daily for one to two weeks.
Fever: It is normal to have a low grade fever 99° to 101.5° for 1-7 days. If higher than 101.5° call your doctor.
Bad breath: This can occur through the first week from the tonsil and adenoid bed.
Voice Change: Your child may experience a high pitched voice after surgery. This is from the adenoid removal and can cause a change in the resonance of the voice and increase the pitch. This will usually resolve within 6-8 weeks.
Bleeding: Sometimes bleeding can occur from the mouth or nose after the operation. A small streak of blood is okay, but clots or persistent bleeding is not. There is an increased risk of bleeding between days 5-8 after tonsil surgery since the blood vessels are exposed. This can occur 2-3% of the time. Don’t panic, it can be easily managed as long as you don’t ignore it. Contact your doctor or come to the emergency room if any bleeding occurs.
What else can you do to help your child manage his or her pain?
While it is normal to focus on the pain medicines as the primary way to manage postoperative pain, there are several other things you can do without using medicines to help your child with his or her pain:
· Distraction (play games, watch TV, play video games)
· Use a cold or warm pack on the neck or ears for comfort
· Keep your child busy (blow bubbles, do an art project, color, read a book)
Nutrition
Soft diet x 1-2 weeks
While there are no strict dietary restrictions after surgery, it is highly recommended to avoid hard, scratchy, or difficult to chew foods like popcorn, pretzels and potato chips.
· While swallowing will be painful after surgery, the more your child swallows, the better they will feel.
· Try to avoid salty snacks such as potato chips or pretzels for the first two days following surgery. Avoid foods and drinks that are too warm in temperature.
Good foods include popsicles, slushies, yogurts, puddings, mashed potatoes, Jello, soft rice, and pastas. Milk is also okay.
· Some patients have less of an appetite, but it is very important to continue to drink fluids.
· Drinking fluids will help lessen the discomfort.
· Use a humidifier to moisten the air in your child’s room
Activity
No school for 1 week. No sports/physical for 2 weeks.
· Light activity only for 1-2 weeks. After 1 week advance as tolerated.
Safety Information For Giving Medications
· EACH TIME YOU GIVE A MEDICATION READ THE LABEL.
· Do not measure liquid with a kitchen spoon. There are pediatric measuring devices available at the pharmacy. Ask for one when you get your prescription filled.
· Use the exact amount ordered by your surgeon. If you have questions ask your pharmacist.
· Always watch your child take ALL of their medication.
· Store all medications out of reach of children.
Medications
Pain medicine: The first 1-3 days keep your child on an around the clock schedule of pain medicine. Kids under the age of 4 should alternate between Tylenol and Motrin/Advil. Each one can be given every 6 hours such that a medication is given every 3 hours. You may be given a script for Hycet and encouraged to only use it for breakthrough pain and substitute it for the Tylenol if plain Tylenol and ibuprofen are not working by themselves. Kids 4 and older will be given a script for Hycet (Tylenol + hydrocodone). You can alternate this with Motrin/Advil but never give both Tylenol and Hycet together since the Hycet already has Tylenol in it. It is normal for pain to decrease between days 3-5 and then increase again between 5-8 because this is when the scabs fall off in the tonsillar fossa. This is also when there is a risk of bleeding (see below). Every child has a different pain tolerance. Some children may not need any narcotics or may just need a few doses. Make sure your child is drinking plenty of fluids since hydration can help with pain control as well.
Please note: you will be given enough of the prescription pain medicine to last you through the postoperative period. If you feel you need a refill, you need to call BEFORE you run out. For your child’s safety, we will not routinely refill narcotic pain medicine after hours or on weekends. Please try to anticipate your medication needs and call for a refill before you are on your last dose.
Anti-Nausea: You will be given a script for Zofran ODT (ondansetron) for post-op nausea as needed. This is usually given as a tablet that dissolves on the tongue.
Your First Follow-up Appointment
Follow-up in 4-6 weeks to check the throat for appropriate healing.
- Call if you cannot manage your child’s pain
- Call if your child refuses to drink
- Call if your child becomes dehydrated
- Call if your child has any bleeding
*For just an adenoidectomy, recovery time can be shorter, typically 5-7 days at most. Post-op pain is typically limited to neck soreness. Tylenol and ibuprofen is all that is usually needed for pain control but sometimes Dr. Baktha may prescribe steroids if the neck stiffness is persistent. There are no diet or activity restrictions but based on what your child is comfortable doing.