Tonsillectomy and Adenoidectomy
Overview
Tonsils and adenoids are lymphoid tissues at the back of your throat and nose. They are a non-essential part of your immune system.
Sometimes your tonsils or adenoids can get infected, become enlarged, inflamed, or sore. In this state they can interfere with breathing or swallowing and the infection can travel to your ears.
You can take antibiotics to try to treat the infection. If you have trouble breathing or swallowing you might need a tonsillectomy to remove your tonsils or an adenoidectomy to remove your adenoids.
Symptoms and Diagnosis
The following symptoms and conditions are possible indications for removal of tonsils or adenoids:
- Sinus and throat problems
- Frequent ear infections
- Snoring
- Shortness of breath
- Frequent episodes (4 to 6 per year) of strep throat or tonsillitis
- Significant obstruction of breathing that affects your sleep
- Possible abnormal growth on one of the tonsils
If you have a history of recurring middle ear infections, and if you have already had a tube inserted to drain the infection, we might try an adenoidectomy to stop fluid from behind the ear drum from draining into the top of your throat.
Tonsil plugs, also known as tonsil stones or tonsilloliths, are not an indication for tonsillectomy. Tonsil plugs are cream-colored formations, with the consistency of cottage cheese, that sometimes collect on the surface of the tonsils. Although they might smell bad, or be alarming when they come loose, they are harmless. The best treatment for tonsil plugs is to pay attention to throat hygiene, such as gargling after meals, to keep the back of the throat clean.
How to Prepare
Do not take aspirin or non-steroidal anti-inflammatory pain medicine 1 week before surgery and no aspirin for 2 weeks after surgery. These medicines can cause blood thinning and because bleeding is the most common complication of tonsillectomy and/or adenoidectomy, it is important to avoid blood thinning medications prior to surgery.
We will ask that you not eat anything several hours before your procedure.
How it is Performed
Tonsillectomy and adenoidectomy are among the most commonly performed surgeries in the country. The operation is done in the operating room, under general anesthesia.
Tonsillectomy and adenoidectomy are usually performed as out-patient surgeries, without an overnight stay. The exception is for children under 3 years old, who will stay in the hospital for observation.
The tonsils and adenoids are removed through the mouth. A special retractor holds the mouth open. The tonsils are usually removed with a device that simultaneously cuts and cauterizes to seal blood vessels. The adenoids are usually removed with a special cutting instrument designed to reach up behind the soft palate. You can learn more by reviewing Preparing for your Procedure (Emmi) for tonsillectomy.
Usually the tonsil beds are left open to heal naturally, without being closed (sutured).
Your tonsillectomy or adenoidectomy will not produce scars, and there will be no change in the appearance of your face or neck after either procedure.
Patients are often observed in the recovery room for several hours after surgery and before being discharged, because of the risk of post-surgical bleeding.
Risks
The most common complication of tonsillectomy and adenoidectomy is bleeding, either within the first 24 hours after surgery or about 7 to 10 days after surgery. This happens in only about 3 to 4 percent of cases.
Most bleeding appears as a small amount of blood in coughed-up phlegm. Only in very rare circumstances is the bleeding severe or life-threatening. However, if you see persistent bleeding (more than 1 tablespoon) during the first 2 weeks after a tonsillectomy, please call us immediately or go to the Emergency Room to be evaluated.
Rinse your mouth with cool water before eating and before sleeping. If bleeding occurs, rinse with cool water. If bleeding persists, call your doctor or go to the Emergency Room to be evaluated.
Other risks of tonsillectomy and adenoidectomy include subtle changes in voice or swallowing, chipped or dislodged teeth, tongue numbness, and jaw joint pain or dislocation. Younger children may be at risk for dehydration if they refuse to drink fluids. If your child’s mouth is dry, and they are not urinating regularly, you may need to bring them into the Emergency Room to help with an IV for hydration.
After your Procedure
Having your tonsils removed hurts. Having just your adenoids removed also hurts, but typically less than if the tonsils are also removed. The sore throat after tonsillectomy can feel like "the worst sore throat of my life." Some patients lose weight the first 1 to 2 weeks after tonsillectomy because it hurts so much to eat, even with the use of narcotic pain medication.
A low grade fever (99 or 100 degrees Fahrenheit) is to be expected for the first couple of days after surgery.
Ear pain is also common after tonsillectomy and/or adenoidectomy. However, that does not mean you have an ear infection. Moving your jaw may help decrease ear pain.
Since a dry scab cannot form in an area wet with saliva, a white film forms in the back of the throat in the tonsil beds. This white film is part of the body's healing process and usually lasts for 1 to 2 weeks. A mouth odor may be associated with the film.
Managing pain
- Pain medications (such as codeine or Vicodin) will be prescribed for you during the post-operative period. These medications will be in liquid form. Children are no longer given Codeine due to the saftey risks of this medication.
- Take the prescribed pain medication at regular intervals for the first few days, and then start taking smaller doses or start alternating with over-the-counter acetaminophen (Tylenol).
- Stay ahead of the pain the first few days by taking your medication at regular intervals. This will help you get through the rest of the week.
- Remember that constipation is a common side effect of narcotics. You may want to take a stool softener or gentle laxative while taking narcotics.
- Pain medication should be taken as needed approximately 20 minutes before eating and sleeping.
- Drink lots of fluids, especially during the first week after surgery. Getting dehydrated only seems to make the pain worse.
- Younger children may have a difficult time taking the liquid Vicodin, and may need to take childrens Tylenol and children’s Motrin for their pain. These can be given every 3 hours alternating: this means start with Tylenol, then in 3 hours you can give Motrin, then in 3 hours Tylenol again. Talk to your doctor about the correct dose for your child depending on the weight.
Recovery
During the recovery process we recommend that you:
- Stay home and rest for a full week after tonsillectomy. Avoid other commitments during this time. Plan to stay home from work, school, extracurricular activities, or social functions during this first week. Do not plan on any travels, car trips or plane rides until the recovery process is complete.
- Return to school or work during the second week after surgery, as long as no strenuous activity is required.
- Avoid contact sports, vigorous exercise, or lifting more than 20 to 25 pounds for an additional week.
- Eat soft foods like mashed potatoes, soup, scrambled eggs, or pudding for the first 2 weeks after surgery.
- Drink plenty of fluids such as water and non-carbonated juice.
- Popsicles are recommended.
- Do not eat chips, pizza crusts, deep fried or breaded foods, dry cereal, toast, or any food that might scratch your throat. You will find bland foods easier to digest.
- Do not eat or drink spicy or acidic foods (like orange juice, lemonade, and tomatoes) or carbonated beverages. They will probably make you feel uncomfortable or cause you pain.
Depending on your condition, we might also advise that you avoid milk products that can increase phlegm, coughing, and the risk of bleeding.
Disclaimer
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.