Tonsillectomy
Clinical Trials / Research Studies
What are Tonsils?
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 antibiotic therapy.
Upper Airway Obstruction
Enlarged tonsils can block the airway and cause difficulty breathing.
Preoperative Care
No aspirin medications (including Pepto Bismol) or products containing Ginko Biloba or St. John’s Wort should be given for 2 weeks before surgery. No ibuprofen medications (Advil, Motrin) or antiinflammatory medications (Aleve, Naprosyn) should be given for 1 week before surgery. None of these medications or products should be given for 2 weeks after surgery. Acetaminophen (Tylenol) may be given as well
as over-the-counter cold medications and antibiotics. Please notify the office nurse if there is a family history of bleeding tendencies or if your child tends to bruise easily. Five days before surgery, give an antibiotic as directed.
Surgery
Tonsillectomy is performed under general anesthesia either as an outpatient or with overnight observation. Tonsillectomy is frequently performed with an adenoidectomy. The surgery takes 30 – 45 minutes and children remain at the hospital 2 – 4 hours after outpatient surgery, or overnight for observation.
Postoperative Care
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 will form 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 fall off a little at a time 5 – 10 days after surgery and are swallowed.
Bleeding
If there is any bleeding at all from the mouth or nose bring your child to the Cincinnati Children's Emergency Room at the Main Campus to be examined 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.
Speech
If tonsils are very large, the sound of the voice may be different after surgery.
Nausea and Vomiting
Some children experience nausea and vomiting from the general anesthetic. This should stop within a few hours. Please call the office nurse if nausea and vomiting continues for more than 12 – 24 hours.
Fever
A low grade fever is normal for several days after surgery and should be treated with acetaminophen (Tylenol) or acetaminophen (Tylenol) with codeine, whichever your doctor has prescribed. Please call the office nurse if the 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. Severity of pain may fluctuate during recovery from mild to very severe. Pain may last up to 14 days.
Pain Control
Medicate your child every 4 – 6 hours for pain with acetaminophen (Tylenol) or acetaminophen (Tylenol) with codeine, whichever your doctor has prescribed. Do not give more than 5 doses in a 24 hour period.
Codeine can cause nausea, abdominal pain and constipation in younger children and should be used sparingly.
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. For children who will not take liquid pain medication, acetaminophen (Tylenol) also comes in a rectal suppository as well as an orally disintegrating tablet.
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 frequently 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 the nose when drinking. This should stop a few weeks after surgery. Please call the office nurse if you are worried that your child is not drinking enough or if there are signs of dehydration (urination less than 2 – 3
times per day, crying but no tears).
For children who absolutely will not drink and who are showing signs of dehydration, go to Cincinnati Children’s Emergency Department at the Main Campus for evaluation. Do not go to Liberty Campus or Urgent Care.
Eating
There are no food restrictions after surgery. The sooner eating and chewing are resumed, the quicker the recovery. Many children are reluctant 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, which is gained back when a normal diet is resumed.
Activities
Most children rest at home for several days after surgery. Activities may be resumed with no restrictions when your child feels up to it. Generally, children may return to school when they are eating and drinking normally, off of all pain medication and sleeping through the night. This is 7 – 10 days 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 normal activities are resumed. Please do not travel away from the Cincinnati area for 2 weeks after surgery.
Follow-up
Some of our doctors recommend a postoperative appointment 2 – 3 weeks after surgery. If so, please call the office soon after surgery to schedule the appointment.
Please call the office nurse with questions or concerns.
If your child had surgery for snoring or obstructive sleep apnea, a Pulmonary Medicine staff member may call you 6 months after surgery to ask some questions about your child’s breathing.
Rev: 7/10
