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 products (including Pepto Bismol) or products containing Ginko Biloba or St. John's Wort should be given for two weeks prior to surgery. No ibuprofen products (Advil, Motrin) or anti-inflammatory medications (Aleve, Celebrex, Naprosyn) should be given for one week prior to surgery. None of these 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 your doctor is there is a family history of bleeding tendencies or if your child tends to bruise easily.
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. 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.
Nausea and Vomiting
Some children experience nausea and vomiting from the general anesthetic. This usually occurs during the first 24 – 36 hours after surgery.
If there is nausea or vomiting, give Phenergan suppositories as directed every 4 hours. Please call the office nurse if you did not receive a prescription for Phenergan or if vomiting continues after giving Phenergan.
Fever
A low grade fever is normal for several days after surgery and should be treated with acetaminophen or acetaminophen with codeine, whichever your doctor has prescribed. Please call the office nurse if the temperature is over
102°F.
Pain
Most children experience a fair amount of throat pain after surgery. Some children complain of jaw pain and neck pain. This is from positioning in the operating room. Many children also complain of earache several days after surgery. An ice collar to the neck, chewing gum, or a humidifier in your child's room may also help relieve pain.
The same nerve that goes to the throat goes to the ears and stimulation of this nerve may feel like an earache. Many children have trouble eating, drinking and sleeping because of pain. Severity of pain may fluctuate during recovery from mild to very severe and pain may last up to 14 days.
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 to be examined by the ENT doctor on call. 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.
Drinking
The most important part of recovery is to drink plenty of fluids. Some children do not want to drink because of pain. Frequently offer and encourage fluids such as juice, soft drinks, popsicles and Jello.
After 24 hours, milk products such as pudding, yogurt and ice cream may be offered. 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).
If your child absolutely will not drink, bring your child to the Cincinnati Children's Emergency Room for IV fluids. Some children may have a small amount of liquid come out of the nose when they drink. This should stop a few weeks after surgery.
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 up to a week. Some children lose weight, which is gained back when a normal diet is resumed.
Activity
Most children rest at home for several days after surgery. Activities may be resumed with no restrictions if 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 on average 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 your child is resuming normal activities. Please do not travel away from the Cincinnati area for 2 weeks after surgery.
Follow-up
Some of our doctors recommend a post operative appointment 2 – 3 weeks after surgery. If so, call for an appointment. Some of our doctors recommend a postoperative phone call 2 – 3 weeks after surgery.
If so, a nurse will call you. If there are problems or questions before that time, call the office nurse.
For emergencies after office hours, contact Cincinnati Children's 513-636-4200, and ask for the ent resident on call.
Rev: 6/08
