Adenoidectomy | Tonsillectomy | Tonsillectomy (Spanish)

Tonsillectomy (removal of tonsils)

You or your child is going to undergo the surgical procedure known as tonsillectomy.  Following is much of the information that you will need to understand what is going to happen and what to expect after the surgery.

What are tonsils? Tonsils are structures in the back of the throat, one on each side, that are made of lymphoid tissue.  Lymphoid tissue is made up of white blood cells - the cells that recognize “foreign invaders” and trigger a response from the immune system.  This helps to fight off infection.  Lymph nodes are similar structures that are found throughout the body, and they replace the function of the tonsils when the tonsils are removed.  For this reason, the body does not “miss” or need the tonsils.

Why do tonsils need to be removed?  Tonsillectomy is typically performed for one of two reasons.  One is if they become large and cause difficulty breathing - snoring, disrupted sleep, sleep apnea, etc.  The second reason is if they become repeatedly infected, such as with recurrent Strep throat, or chronically infected, sometimes with white debris build-up found within the “pockets” on their surface.

How are tonsils removed? Tonsillectomy is performed under general anesthesia (completely asleep and unaware), in an operating room.  This may be performed in the outpatient surgical center or in the hospital.  Your ENT physician performs the surgery, and there is an Anesthesiologist (Dr.) and an Anesthetist (Nurse) who will administer and monitor the anesthesia.  The procedure is performed through the mouth - there are no visible scars.  A cautery device is used to stop any bleeding during the surgery, and these days, bleeding is extremely rare during the surgery.

What happens immediately after surgery?  After surgery, the anesthesia is stopped and you are allowed to wake up.  You will then go to the recovery room to be monitored for approximately ½ hour to one hour.  When the recovery nurses feel you are doing well enough, you will be moved to the overnight area.  Pain medicine will be administered and vital signs will be monitored.  After about 3 or 4 hours, if you are doing well and can take fluids by mouth and keep them down, you may be allowed to go home.  If you live very far away or if you have any other serious medical problems, you will likely stay the night.

What can I expect when I go home?  It typically takes about 2 full weeks to recover from tonsillectomy.  During this time, there will be significant throat pain.  This is partially controlled with prescription pain medicine that usually contains Acetaminophen (Tylenol) and a narcotic (codeine, oxycodone, hydrocodone, etc.).  In addition to this, you may also use appropriate doses of Ibuprofen (Motrin, Advil, etc.).  You should not, under any circumstances, take any additional Acetaminophen!  Excessive doses can be very harmful.  Remember, pain medicine will not get rid of all the pain in the majority of patients, but they do help.  In many cases, the narcotic pain medicine can cause nausea.  Anti-nausea medicine, in a suppository form, may be prescribed as well.  You are encouraged to use this if you experience nausea.  You may also experience constipation from the narcotic, which can be relieved by drinking apple or prune juice or a gentle laxative.

What can I eat or drink after tonsillectomy?  After you go home, you must drink fluids.  You do not have to eat anything solid if you choose not to, but if you do not drink sufficient fluids, you may become dehydrated.  If you urinate 4-5 times each day, you are drinking enough fluids.  If you urinate 1-2 times or less each day, you are at risk of becoming dehydrated and should call us to let us know.  Avoid acidic drinks, such as orange or grapefruit juice, as they may burn.  Also, avoid drinking too much plain water - you will feel better if you drink something with electrolytes in it such as apple or grape juice, Gatorade, sweet tea, etc.  You may eat anything soft.  Avoid hard or sharp foods, such as pizza crust, hard chips, etc. for 2 weeks.

Should I expect fever?  It is very common to run fever the first 2-5 days following tonsillectomy.  While it is possible to catch a cold or flu while recovering from surgery, fever is common after tonsillectomy just from the surgery itself.  In most cases, the Acetaminophen and/or Ibuprofen in the pain medicines will keep the fever under control.  Increasing fluid intake also helps control fever.  If there are any other worrisome symptoms accompanying the fever, such as cough, shortness of breath, chest pain, painful urination, leg pain or swelling, this may indicate a dangerous infection and you should contact us or go to the emergency room as soon as possible.

What are the complications of tonsillectomy?  The two most common complications of tonsillectomy are dehydration and bleeding.  Dehydration results from insufficient fluid intake for more than one or two days, and is treated by increasing fluid intake, either by drinking more or by coming to the hospital for intravenous (IV) fluids.  Bleeding occurs in 2-4% of cases and when it does happen, is typically 5-8 days following surgery.  If you experience any bleeding, either spitting up or vomiting blood or bloody material, contact us immediately, go directly to the emergency room, or call 911, depending on the severity.  In most cases, bleeding will stop on its own, but sometimes additional surgery is necessary to control it.

What follow-up is necessary?  Your physician will see you in the office in 2 to 4 weeks following surgery.  At that time, he or she will release you to resume normal activities (school, work, sports, travel) if you are sufficiently healed.  If at any time following the surgery, you experience any problems or have any questions, feel free to call our office any time.