Tonsillectomy and Adenoidectomy

What is a tonsillectomy and adenoidectomy?

Tonsils are the two round lumps in the back of your throat. Adenoids are high in the throat behind the nose and above the roof of the mouth. The adenoids are not visible through the mouth or nose without special instruments.

Tonsils and adenoids are part of the immune system, similar to lymph nodes. They are the body’s first line of defense and help protect the body from disease. They “sample” bacteria and viruses that enter through the mouth or nose. Unfortunately, sometimes they can get infected or cause sleep apnea from being too large.

What to do BEFORE surgery

Here are a few things you can do before surgery to help things go more smoothly:

  • Eliminate ALL medications that thin your blood for two (2) weeks before surgery, unless directed otherwise by your surgeon. Please see this list--Medications to Avoid Prior to Surgery
  •  Stop smoking at least 3 weeks before your surgery date.
  •  If you/your child gets a chest cold or fever during the 5 days before the surgery, please notify us. A cold may increase the risk from anesthesia. 
  • No food 8 hours prior to surgery. No liquids for 4 hours prior to surgery. 
  • Arrange for a ride home after the procedure 
  • Sometimes blood counts and clotting is checked before surgery to make sure you are not at risk of increased bleeding. Labs need to be drawn the week prior to surgery. Your insurance carrier may dictate the lab where the blood is drawn.

What to Expect During Surgery

Surgery is performed under general anesthesia. With general anesthesia, you (or your child) will be asleep for the entire surgery. Surgery is performed through the mouth--there are no external incisions. Surgery typically lasts less than 1 hour. When your surgery is over, you (or your child) will spend 2 or more hours in the recovery area. Some children are upset, confused when they wake up from the anesthesia. Most tonsillectomies are performed as an outpatient, however you may be admitted to the hospital overnight depending on your age, reason for surgery, and underlying medical problems. Your surgeon will discuss with you if this will be inpatient or outpatient surgery.

What to expect AFTER surgery

  •  Most patients are out of work/school/daycare for 7-10 days following surgery. For adults it may be longer. 
  • Avoid any strenuous activity, exercise, lifting more than 10 pounds, excessive bending or straining for 1-2 weeks following surgery to prevent bleeding. 
  • Do NOT blow your nose for 1 week following surgery. This may cause bleeding.
  • Cough or sneeze with an open mouth. 
  • Only soft foods and liquids are allowed for 10 days following surgery. Other types of foods may cause pain and/or bleeding. Examples of appropriate foods include: ice cream, yogurt, pudding, Popsicle's, cottage cheese, applesauce, scrambled eggs, mashed potatoes, oatmeal, mac and cheese, etc 
  •  Use mild non-aspirin pain relievers (Tylenol) as first line treatment for pain and prescription pain medication as directed by your doctor for breakthrough pain. Drink plenty of fluids. Fluid intake is the most effective pain control. 
  •  A bedside humidifier may be helpful.
  •  As the tonsil area heals, it looks yellow/gray/tan. This is normal. This does not indicate infection. 
  • Bad breath is expected after surgery and can last up to two to three weeks. 
  • It is common to have some swelling after surgery. The palate and uvula may become swollen which can cause the sensation of something stuck in the throat or tickling the throat. This is almost always temporary and usually resolves within 1 week. For severe difficulties breathing call 911.

What are the risks of Surgery?
As with any surgical procedure, tonsillectomy/adenoidectomy has associated risks. Although the chance of a complication occurring is small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.

Pain: Tonsillectomy is an uncomfortable surgery. You can expect 7-14 days of pain or discomfort, and in rare circumstances can last up to 3 weeks. Frequently the pain worsens 2-5 days after surgery. Ear or neck pain may also occur. An earache does not mean that you/your child's ear is infected. This is called "referred pain." Pain can cause difficulty swallowing. Dehydration can worsen pain so make sure you are drinking adequate fluids.

Bleeding: Bleeding can occur in 1-5% of patients after surgery. This most commonly occurs immediately after surgery or 5-10 days following surgery after a scab comes off. BLEEDING IS NOT NORMAL. If the amount of blood is small, i.e., streaks of blood in saliva or less than two teaspoons of blood, gargle with ice water. If the bleeding stops and the throat feels normal, no treatment is necessary. If the bleeding continues or if the volume of blood is concerning to you, go to the nearest emergency room and notify our office in route.

Dehydration: Dehydration is one of the most common complications following surgery. Dehydration can worsen pain, cause low grade fevers, lethargy and headaches. On occasion, patient's have to be admitted to the hospital for IV fluids.

Nasal regurgitation (Velopharyngeal Insufficiency): The soft palate closes off the nose when you swallow. If the adenoids are enlarged the soft palate only has to meet the adenoids to close off the nose. When the adenoids are removed the soft palate has to learn to close farther to adequately seal the nose. The soft palate is also often sore after surgery and does not move well. This can cause liquids can leak into the nose when you swallow. It is not uncommon for this to occur temporarily after surgery. This typically resolves by 6 weeks following surgery. It is very uncommon for this to be permanent. If this persists for greater than 6 months then treatment options exist.

Fever: A low-grade fever is not uncommon for the first week after surgery. This is most commonly due to anesthesia's effects on the lungs, dehydration, or local inflammation at the surgical site. The best treatment is Tylenol, drinking fluids, and walking around.

Scarring: Scarring can occur following any surgery. It is extremely rare for any significant scarring to occur following tonsillectomy/adenoidectomy. If this were to occur this could cause continued sleep apnea or blockage of the nasal passages.

Change in Voice: Patients with large tonsils/adenoids can have a change in voice after surgery. Removal of these large structures can lead to more room in the mouth/throat. This can change the resonance of the voice.

Damage to Teeth: Despite the greatest of care, teeth can be injured (cracked, chipped, knocked loose, or loss of crown) during surgery.

Numbness of tongue: During surgery the tongue is retracted and kept out of the way. This can cause some numbness in the tongue. This is almost always temporary. In rare instances this is permanent.

Continued Snoring/Sleep apnea: If surgery was performed for snoring/sleep apnea, you will not notice an immediate change in symptoms. This is due to swelling from surgery. Symptoms improve as swelling resolves. On occasion, snoring and sleep apnea continue after surgery. If this is the case it is very important to do a sleep study after the patient has healed from surgery to determine other causes and treatment.

Narcotic overdose: A tonsillectomy is a painful procedure and most teenage and adult patients require some form of prescription pain medication. Although narcotic overdose is extremely rare we recommend that all patients receiving narcotics be monitored by an adult. Do not give narcotics to a patient who is sedated or too sleepy to take them on their own.

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