After discussing the medical history and examining you or your child it has been decided to perform a tonsillectomy and possibly an adenoidectomy. This is usually done when enlarged adenoids are blocking the nasal passages or when they may be contributing to ear or sinus problems. Adenoids, like tonsils, are tissue made up of white blood cells which are the type of cells that help the body fight infection. The adenoids are behind the nose. Although experiments do show increased activity of the infection fighting cells in the adenoids during infection, this activity seems to be lost when the adenoids become large or frequently infected. Studies have not shown any evidence that removing the tonsils or adenoids increases a person’s risk for infection, other diseases or health problems. (The adenoids usually absorb in the teen years and are thus absent in adults.) As with any surgery there are some risks including a very small chance for bleeding, problems with anesthesia, or changes in voice or swallowing. If you have questions about these please call the office.
Prior to Surgery
It is very important that the patient avoid taking aspirin or aspirin like products such as Motrin, ibuprofen, Advil, Aleve, etc. for 2 weeks before and several days after surgery. These medications will thin the blood and increase the amount of bleeding at surgery and the chance for, as well as the severity of, bleeding after surgery. Tylenol (acetaminophen) may be taken as this does not thin the blood. Please follow the bottle directions.
Some children will benefit from watching a video tape in our office or reading a booklet about the surgery. Since you know your child best, it is up to you whether you want to make use of either of these items. Please ask the office staff if you are interested.
The Day of Surgery
On the day of surgery the patient should have nothing to eat or drink after midnight. An exception to this would be any medications the doctor has instructed you to take that morning. Failure to follow these guidelines will likely result in the cancellation of surgery.
You will need to arrive at the surgical facility well before the scheduled time of surgery. A day or two before surgery you will be called by the doctor’s nurse or someone from the facility and told specifically what time to arrive. After you arrive some information will be taken by a nurse and someone from the anesthesia department will talk to you.
Once in the operating room, young children will go to sleep by breathing gas through a mask; they will then have an IV started. Older children and adults will have an IV started first and then go to sleep by medication given through the IV. Sometimes this IV line will be placed before going to the operating room. Once asleep, a breathing tube will be placed through the mouth. During surgery the patient will be kept completely asleep by breathing gas given through this tube under the supervision of an anesthesiologist. The surgery takes about 30 minutes; it is performed through the open mouth. The doctor will talk to you after the surgery is done. Please stay in the waiting room the whole time the patient is in surgery. After surgery the patient will be in the recovery room for about 30 minutes. Parents may be able to sit with their child for part of this recovery time. After this, the patient and family will stay in another recovery area or hospital room until ready to leave, usually 3 to 4 hours after surgery.
Once you are Home
It is most important for the patient to take enough liquids. Good things early on include fruit juices, pop, popsicles, gatorade, ice cream, milkshakes, instant breakfast, yogurt, pudding, jello, applesauce, scrambled eggs, etc. Any soft food is OK but sharp or hard foods should be avoided for 10 days. Children will require frequent, consistent, firm yet loving encouragement to eat and drink for 7 to 10 days after surgery.
The patient will have significant pain in the THROAT as well as in the EARS for up to 10 days following surgery. The amount of pain can vary quite a bit from day to day. The “ear” pain occurs because the tonsils sit straight in from the ears, not because there is a problem with the ears. The patient should take either Tylenol (acetaminophen liquid, chewable, tablets or suppositories–all available over the counter, follow label directions) or the pain medication prescribed at the time of surgery. It is a good idea to take this every 4 hours while awake for the first few days to “stay ahead” of the pain. After that it should be taken as needed. It is sometimes helpful to take the medication 30 minutes before mealtime. As discussed above do not take aspirin or aspirin like products such as Motrin, ibuprofen, Advil, Aleve, etc. for two weeks after surgery as these will thin the blood and increase the chance for, as well as the severity of, bleeding after surgery. Usually a single dose of steroids is given IV at the time of surgery to decrease pain and swelling early on. Pain often worsens when this wears of in 2 to 3 days.
Pain can sometimes be or seem worse at night. It is good to take some pain medication at bedtime. If children have trouble sleeping a dose of benadryl (follow label directions) may be helpful. It may also help to elevate the head of the bed by placing a pillow between the box spring and mattress, and this may also decrease the chance for bleeding. Due to the swelling of the uvula (see diagram) it is common to snore or have a rattling sound while breathing for a while.
Strenuous activity should be avoided for 1O days after surgery as this will increase the risk of bleeding. It is ok to go to a movie, mall, or be up and about the house during this time. Avoid driving during this time. Plan to miss a week or so of school, day care, or work after surgery. It is common to have some blood tinge in the saliva or mucous after surgery. It is possible for the patient to bleed significantly for up to 10 days after surgery. Should any significant bleeding occur (spitting out clots or constant dripping), have the patient rinse his or her mouth out well with ice water and sit tight for five minutes or so. The bleeding will usually stop on its own. If the bleeding persists call the off ice day or night and your surgeon or another Ear , Nose and Throat specialist will return your call. In the unlikely event that you are unable to contact the doctor, and if bleeding is significant, then go to the emergency room. Because of the possibility of bleeding it is best to stay “in town” for 2 weeks after surgery.
Due to the bacteria in the throat there is always a low grade infection present during the healing phase of tonsillectomy. You will notice a fever (up to 1 01 F), some bad breath, and a yellow or white build up in the tonsil area for about ten days after surgery. Tylenol will help with the fever. Although this will resolve on its own, if the patient is not allergic, he or she will probably be given a prescription for an antibiotic.
You may also notice some voice changes after surgery due to swelling and the removal of enlarged tissues. This will resolve on its own, usually in three to four weeks. If the voice seems abnormal for more than two months please call the office. If you have questions or problems please call the office (during regular business hours if at all
possible). Please make an appointment now for your surgeon to check you in the office 3 to 4 weeks after surgery. There is no charge for this initial follow-up visit. Usually no further follow-up is needed.