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Tonsillectomy and Adenoid Surgery
Tonsillectomy in Adults          -          Tonsillectomy in Children          -          Adenoidectomy

Tonsils and adenoids are the body’s first line of defense as part of the immune system. They “sample” bacteria and viruses that enter the body through the mouth or nose, but they sometimes become infected. At times, they become more of a liability than an asset and may even cause airway obstruction or repeated bacterial infections. Your ear, nose, and throat (ENT) specialist can suggest the best treatment options.

Tonsils and adenoids are similar to the lymph nodes or “glands” found in the neck, groin, and armpits. Tonsils are the two round lumps in the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth or nose without special instruments.

Tonsillectomy in Adults

Tonsillectomy is one of the most common procedures performed. Physicians may recommend this procedure for chronic obstructive symptoms (snoring), recurrent infections, chronic tonsillitis, abnormal tonsil enlargement, or severe infections. This procedure is generally safe and is usually (but not always) done as a day surgery procedure. Tonsillectomy usually takes about 30 minutes to perform, and it is done under general anesthesia (the patient is asleep). Sometimes other procedures are done at the same time as the tonsillectomy. The trip to the hospital usually lasts about half a day, and the overall recovery takes about two to three weeks.

Tonsillectomy causes a severe sore throat for 7 to 10 days after surgery. Pain medications and antibiotics will be prescribed to help with the recovery. Ear pain, bad breath, difficulty swallowing, a change in voice, and mild weight loss are some of the expected symptoms after tonsillectomy and will improve with time. During the first 1-2 days of surgery, it is normal to have some blood in the saliva. The risks of the surgery include bleeding (in less than 5% of cases) and the risks of anesthesia (very uncommon). An anesthesiologist is in attendance during the entire procedure for monitoring and safety. While precautions are always taken, injury to the lips, teeth, gums, and mouth may sometimes occur. Dehydration can occur easily, so fluid intake is very important during the recovery. Rare risks include a change in voice (if the roof of the mouth becomes dysfunctional), a change in the taste of foods, and narrowing of the nasopharynx (where the throat connects to the nose). It is important to stay in town during the recovery period after surgery (about two weeks) so that you can be treated for emergencies if they occur.

  • If there is continuous bright red bleeding, the office should be notified immediately (ask to speak to a nurse immediately, do not leave a voicemail message)
  • A follow-up appointment should be made about 1 week after surgery.
  • Fever may occur up to 102 F after surgery. The prescribed pain medicine contains Tylenol to help with fever. It is important to encourage liquids to avoid dehydration. If fever persists despite the use of medications, notify the office.
  • Sometimes pain may persist despite the use or the prescribed medications. Please do not use Advil, Motrin or other medications listcd on the instruction shcct, as this m~y lead to bleeding. Continue cool liquids to soothe the throat. There may be an increase in pain 4-6 days after surgery, which is a normal process as the surgical site heals. An ice pack to the neck area may be helpful for treating the pain.
  • Activity should be restricted to quiet rest at home for 7-10 days. Exercise, sports, swimming, and other sports should be strictly restricted until about 2 weeks after surgery.
  • Diet should begin with clear liquids (water, ice chips, Gatorade, Jcllo, popsicles,) on the day of surgery. Soft foods (ice cream, yogurts, scrambled eggs, rice, mashed potatoes) may be begun the next day. One can gradually begin a more normal diet, but scratchy foods such as crackers, carrots, popcorn, and chips should be avoided for 3 weeks.
  • Nausea/vomiting may occur after surgery because of anesthesia and pain medications. Hold food, liquids, and medications for 2 hours, and then resume a liquid diet. If the symptoms persist, notify the office.
  • Please call the office at (972) 402-8404 for questions or concerns, by leaving message with the nurse (unless it is an emergency)

Tonsillectomy in Children

Tonsillectomy is one of the most common procedures performed in children. Physicians may recommend this procedure for chronic obstructive symptoms (snoring), recurrent infections, chronic tonsillitis, abnormal tonsil enlargement, or severe infections. This procedure is generally safe and is usually done as a day surgery procedure. Tonsillectomy usually takes about 30 minutes to perform, and it is done under general anesthesia (while the child is completely asleep). Sometimes adenoidectomy is also done at the same time, to remove blockage at the back of the nose (this is also done through the mouth). The trip to the hospital usually lasts about half a day, and the overall recovery takes about two to three weeks.

Tonsillectomy causes a severe sore throat for 7 to 10 days after surgery. Pain medications and antibiotics will be prescribed to help with the recovery. Ear pain, bad breath, difficulty swallowing, a change in voice, and mild weight loss are some of the expected symptoms after tonsillectomy and will improve with time. During the first 1-2 days of surgery, it is normal to have some blood in the saliva. The risks of the surgery include bleeding (in less than 5% of cases) and the risks of anesthesia (very uncommon). An anesthesiologist is in attendance during the entire procedure for monitoring ofthe child. While precautions are always taken, injury to the lips, teeth, gums, and mouth may sometimes occur. Dehydration may occur easily in children, so fluid intake is very important during the recovery. Rare risks include a change in voice (if the roof of the mouth becomes dysfunctional), a change in the taste of foods, and narrowing of the nasopharynx (where the throat connects to the nose). It is important to stay in town during the recovery period after surgery (about two weeks) so that the physician can treat the child if necessary.

If there is continuous bright red bleeding, the office should be notified immediately (ask to speak to a nurse immediately).
  • A follow-up appointment should be made about Iweek after surgery.
  • Fever may occur up to 102 F after surgery. The prescribed pain medicine contains Tylenol to help with fever. It is important to encourage liquids to avoid dehydration. If fever persists despite the use of medications, notify the office.
  • Sometimes pain may persist despite the use of the prescribed medications. Please do not give the child Advil, Motrin or other medications listed on the surgery instruction sheet, as this may lead to bleeding. Continue encouraging cool liquids to soothe the throat. There may be an increase in pain 4-6 days after surgery, which is a normal process as the surgical site heals. Encouragement of fluid intake is important. An ice pack to the neck area may be helpful for treating the pain. Also it is NORMAL to have "white- gray patches" at the back of the throat for 2 weeks, this is not an infection
  • Activity should be restricted to quiet play at home for 7-10 days. Children can usually return to school after that time, but recess, gym classes, swimming, and other sports should be strictly restricted until about 2 weeks after surgery.
  • Diet should begin with clear liquids (water, ice chips, Gatorade, Jello, popsicles,) on the day of surgery. Soft foods (ice cream, yogurts, scrambled eggs, rice, mashed potatoes) may be begun the next day. One can gradually begin a more normal diet, but scratchy foods such as crackers, carrots, popcorn, and chips should be avoided for 3 weeks. Do not be surprised if your child requires a soft diet for 3 weeks. This will improve slowly.
  • Nausea/vomiting may occur after surgery because of anesthesia and pain medications. Stop food, liquids, and medications for 2 hours, and then resume a liquid diet. Call if not better
  • Please call the office and ask for the nurse at (972) 402-8404 for questions or concern (leave a message unless there is bleeding or it is an emergency).

Adenoidectomy

Removal of the adenoids (adenoidectomy) may be recommended for chronic ear problems, chronic adenoiditis/sinusitis, nasal obstruction, or snoring. The "adenoids" are lymphoid tissues that are at the back ofthe nose. Sometimes this surgery is done at the same time as another procedure (e.g. tonsil and adenoid removal). Additional instructions may be given to the patient regarding the other procedures. The instructions below are only related to recovery from the adenoidectomy.
  • A follow-up appointment should be made for 2 weeks after surgery. It is preferable to stay in town for 1 week after surgery.
  • Diet should begin with liquids but advance confidently to regular after one day. Fluids should be encouraged, especially in children.
  • Strenuous activity should be avoided. Most patients can return to day care, school, or work the day after surgery.

Symptoms that are commonly experienced after surgery are discussed below

  • Anesthesia may cause fatigue, sleepiness, and nausea. Children may be irritable, fussy, and tug at their ears. Ifpain medication has not been prescribed, Tylenol may be used to ease the discomfort.
  • Nausea/vomiting may occur as a result of anesthesia and/or pain medications. This usually improves within 24-48 hours after surgery. If vomiting occurs, avoid all food and liquids for a two to three hours, then begin slowly with ice chips and then clear liquids (Sprite, Gatorade, clear juices). If vomiting persists, call the office to speak with a nurse or physician.
  • Fever is common as a side effect of anesthesia in the first 24 hours and may not signify an infection. If fever persists for 24 hours, then other infections can be present including early pneumonia or throat infection. Fever is usually not serious if not over 101.5 degrees F. Give acetaminophen (Tylenol) for the fever at appropriate doses. Do not give in addition to other medications containing acetaminophen because of possible acetaminophen overdose. This includes Lortab, APAP, or other combination pain relievers. Call our office if in doubt or if the fever persists despite efforts at treatment.
  • Foul-Smelling breath is a common finding for 7 days after adenoidectomy. Nasal drainage until the adenoid site has completely healed is not uncommon for up to two weeks. Antibiotics could be given if breath is very foul.
  • Pain may occur in the neck, throat, nose or top of the head. This occurs often because of referred pain caused by swelling. The prescribed pain medication or Tylenol should be used as needed. If pain is persistent or severe, call the office.
  • Change in voice, such as a nasal voice (talking through the nose) is usually temporary and is caused by swelling and stiffuess ofthe roof of the mouth. If this persists, please call this to the attention of the physician at the follow-up visit.
  • Bleeding may manifest as a nosebleed or couching/vomiting of blood. Avoid strenuous activity and maintain elevation of the head. If bleeding persists, notify the office at 972- 402-8404 and ask to speak to a nurse immediately.

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