What is a Tonsillectomy?
The tonsils are two pads of tissue located on either side of the back of the throat. Tonsils can become enlarged in response to recurrent tonsil infections or strep throat.
They can also become a reservoir for bacteria.
Reasons for Tonsillectomy
Infection
Recurrent tonsil infections or strep throat despite treatment with antibiotics.
Upper Airway Obstruction
Enlarged tonsils can block the airway and cause trouble breathing.
Preoperative Care
Avoid the following medicines and products before surgery.
For two weeks before surgery do not give:
- Aspirin or aspirin-containing medicines (Pepto-Bismol)
- Ginkgo Biloba
- St. John’s Wort
For one week before surgery do not give:
- Ibuprofen or ibuprofen-containing medications (Advil, Motrin)
- Anti-inflammatory medications (Aleve, Naprosyn)
Avoid the following medicines for two weeks after surgery:
- Aspirin or aspirin containing products (Pepto-Bismol)
- Ginkgo Biloba
- St. John’s Wort
- Anti-inflammatory medications (Aleve, Naprosyn)
Your child may take ibuprofen or medicines containing ibuprofen (Advil, Motrin) after the surgery.
The Surgery
Tonsillectomy is performed under general anesthesia either as an outpatient or with overnight observation (spending the night in the hospital). Tonsillectomy is often performed with an adenoidectomy. The surgery takes 30–45 minutes and children remain at the hospital two to four hours afterwards or overnight for observation.
Postoperative Care and What to Expect
It takes most children 7–10 days to recover from a tonsillectomy. Some children feel better in just a few days and some children take as many as 14 days to recover.
Breathing:
Snoring and mouth breathing are normal after surgery because of swelling. Normal breathing should resume 10–14 days after surgery.
Scabs:
A membrane or scab forms where the tonsils were removed. This looks like two separate scabs or sometimes the whole back of the throat is scabbed. The scabs are thick and white and cause bad breath. This is normal. The scabs usually fall off a little at a time five to 10 days after surgery and are swallowed.
Bleeding:
If there is any bleeding at all from the mouth or nose go immediately to Cincinnati Children’s Emergency Department at the Burnet Campus to be seen by the ENT doctor on call. Do not go to Liberty Campus or Urgent Care as there are no ENT doctors there. Bleeding usually means the scabs have fallen off too early and this needs immediate attention. Every reasonable attempt will be made to control the bleeding in the Emergency Department. Some children need to be taken to the operating room to control the bleeding.
Speech:
If tonsils are very large, the sound of the voice may be different after surgery.
Nausea and Vomiting:
Some children have nausea and vomiting from the general anesthetic. This should stop within a few hours. Call the office nurse if nausea and vomiting continue for more than 12–24 hours.
Fever:
A low-grade fever is normal for a few days after surgery. Acetaminophen (Tylenol) can be given every six hours for fever. Please call the office nurse if your child’s temperature is over 102° F.
Pain:
- Most children have moderate to severe throat pain after surgery. Many children also complain of earache. The same nerve that goes to the throat goes to the ears, and stimulation of this nerve may feel like an earache.
- Some children also complain of jaw pain and neck pain. This is from positioning in the operating room.
- Many children have trouble eating, drinking and sleeping because of pain.
- The amount of pain your child has may vary during recovery from mild to very severe. Pain may last up to 14 days.
Pain Control:
- Give your child acetaminophen (Tylenol) as prescribed for pain. For children who cannot take liquid pain medicine, acetaminophen (Tylenol) also comes in a rectal suppository as well as an orally disintegrating tablet.
- If pain is not relieved by acetaminophen (Tylenol) alone, ibuprofen (Advil / Motrin) may be added and given as prescribed.
- Your doctor may also prescribe a steroid (Decadron).
- Prescription pain medicine may be prescribed as well. If so, give as directed.
An ice collar to the neck, warmth to the ear and jaw, chewing gum, and a humidifier in your child’s room may also help relieve pain. If at any time, your child shows symptoms of severe drowsiness or other concerning behaviors, call the office nurse immediately.
Diet after Surgery
Drinking
The most important part of recovery is to drink plenty of fluids. Some children do not want to drink because of pain. Offer and encourage fluids every hour or so while awake, such as juice, soft drinks, popsicles and Jell-O. Milk products such as pudding, yogurt and ice cream may be offered. Some children may have a small amount of liquid come out of their nose when drinking. This should stop a few weeks after surgery.
Please call the office nurse if there are concerns that your child is not drinking enough, or if there are signs of dehydration (urination less than two to three times per day, crying but no tears). For children who refuse to drink and who are showing signs of dehydration, go to Cincinnati Children’s Emergency Department at the Burnet Campus for evaluation. Do not go to Liberty Campus or Urgent Care
Eating
Children can return to their normal diet after surgery. The sooner they begin to eat and chew, the quicker the recovery. Many children may not want to eat because of pain. As long as your child is drinking well, don’t worry about eating. Many children are not interested in eating for at least a week after surgery. Some children lose weight, but gain it back when a normal diet is resumed.
Activity after Surgery
Most children rest at home for several days after surgery. They can return to normal activities when they feel up to it. Generally, children may return to school when they are eating and drinking normally, off of all pain medicine and sleeping through the night. This is seven to 10 days after surgery for most children and can be less or more for some. Even though children may be feeling well, they are at risk for bleeding for up to 14 days after surgery. Keep this in mind as activities are resumed. Please do not travel away from the Cincinnati area for two weeks after surgery.
