POST OPERATIVE INSTRUCTIONS:

Tonsillectomy and Adenoidectomy

Tell me more about tonsils and tonsillectomy.

What should we expect after anesthesia?

Tonsillectomy involves a brief anesthesia, typically 20 - 60 minutes. Patients may be quite irritable for several hours after surgery. If sedatives were given, some patients will remain sleepy for much of the day. Nausea and vomiting is occasionally seen, and usually resolves by the evening of surgery - even without therapy.

What can my child eat and how active can he/she be after surgery?

Vigorous exercise should be avoided for 12-14 days after surgery. Baths, showers, even light swimming, are acceptable. Many patients have reduced energy levels until their pain decreases and they are taking in more nourishment and calories.

Most patients, because of throat pain, prefer liquids or soft foods for 5-10 days after surgery. Either cool or warm foods are acceptable. Dairy products may be taken, if desired. If the patient desires more solid food, that is also fine, although crispy or brittle foods should be avoided until healing is complete. Favorite foods include popsickles, ice cream, frozen drinks (slushees, etc.), and gatorade. Chewing gum or bubble gum encourages swallowing and saliva flow, and may even speed up the healing. Avoid acidic or citrus products such as orange juice - they burn!

Almost everyone, even slender patients, lose 5 -10 lbs. after tonsillectomy (regaining that and then some back in the 2nd or 3rd week). As long as the patient is drinking liquids, they will recover. Adequate liquid intake probably speeds recovery.

What medications are used after surgery?

Antibiotics are often given - they may be beneficial and improve healing. However, if a dose or two is missed, there should be no cause for alarm. If a rash develops, stop the antibiotic.

Tonsillectomy is a painful procedure. Pain medications help, but do not completely alleviate the discomfort. Something like Tylenol with codeine is often (but not always) prescribed. If nausea or stomach pains develop, the codeine may be the cause; so stop the codeine and take plain Tylenol (acetaminophen). Do not use ibuprofen (Advil, Nuprin), naprosyn (Aleve), or aspirin (Bayer’s, Goode powders, Excedrin) - they may increase the chance of bleeding. Continue other medications that the patient may have been on prior to surgery. If the patient is a diabetic, make sure you have discussed medication use with the physician.

What should we expect after surgery?

As previously mentioned, most patients have a significant amount of pain after tonsillectomy, with pain resolving 5-12 days after surgery. Older children and adults seem to have more discomfort. Most patients can go home the day of surgery.

• Ear pain: Many children will complain of ear aches after tonsillectomy. This is caused by pain coming from throat and not the ears. Give pain medications and encourage liquid intake.
• Fever: Many patients have a low-grade fever after tonsillectomy - up to 101.5 degrees (38⁰ C.). Give Tylenol and plenty of fluids. Higher prolonged fever should be reported to your surgeon.
• Bad looking (and bad smelling) throat: Most tonsillar areas (after surgery) are covered with a white exudate - sometimes with bad breath - for up to 12 days. There be some redness and swelling as well. The uvula (the thing hanging down in the middle) is occasionally swollen.

When should we call the doctor?

• Bleeding: Significant bleeding is rare. More than two tablespoons of fresh blood should be reported. If bleeding persists, ice water mouth washes may help. For severe bleeding, go to the nearest emergency room.
• Dehydration: If there has been little or no liquids taken for 24 hours, notify your surgeon. Signs of dehydration include lethargy, and reduced or very concentrated urine output.
• High Fever: Temperatures greater than 102⁰, or when accompanied by cough or difficulty breathing, should be reported

When should we make an appointment?

We try to see most patients 2-4 weeks after surgery - to make sure healing has been complete and normal.

Acknowledgement:  Written by Michael Poole MD, PhD, Houston, TX