Tonsillectomy With or Without Adenoidectomy

Postoperative Instructions

After surgery, you can expect a sore throat for about 10-14 days. Although the discomfort usually improves over the first few days, many patients notice that it actually seems a little worse around 5-7 days. This is due to the healing process and it should not be a cause for alarm, as it will continue to improve after this.
There is frequently pain in the ears (referred otalgia), which is really just pain from the throat that is felt in the ears. The throat will have a thick white coating where the tonsils used to be. This is the normal healing process and does not indicate infection. There may also be bad breath until the throat completely heals in about two weeks.

BLEEDING

The patient may have small amounts of blood or blood-tinged secretions from the mouth or nose for the first 24 hours. This is normal and should not cause alarm. Substantial bleeding is uncommon, but if it is going to occur, it usually takes place either right after surgery or about 7 to 10 days after surgery when the scab comes off the throat. A significant amount of bleeding would be bleeding that is continuous or fills up more than an inch of the bottom of a glass. Likewise, if the patient vomits up a comparable amount of blood clots, it indicates the patient is swallowing this amount of blood. If this amount of bleeding occurs, please go to the emergency room so we can assess the situation.

NAUSEA/EFFECT OF ANESTHESIA

The after effects of general anesthesia can occasionally cause patients to be groggy and/or nauseated lasting up to 24 hours. If nausea and vomiting occur, this can be improved by taking the Phenergan, if prescribed by your doctor. Please follow the directions on the medication bottle. Once again, although it is unlikely, swallowed blood can cause nausea as well. This nausea is not controlled by Phenergan and if the material vomited up contains large amounts of blood or clots, this should be treated as postoperative bleeding.(see above)

FEVER

A low grade temperature of 100-101 F is common the first 48 hours after surgery. This is the body’s response to surgery anesthesia and is not worrisome.

LIQUIDS

It is very important to drink adequate liquids, both to make sure you stay hydrated and because it make the throat feel better. Swallowing is the most painful at first when the patient has not swallowed for a long time, but the more they drink, the easier and less uncomfortable it will become, so it is important to keep drinking frequently. It may also be helpful to wake the patient up once or twice the first night to let them drink some liquids. Cold, non-carbonated beverages are usually best (Gatorade^tm, Kool-Aid^tm, popsicles or Jell-O^tm). Drink at least 3 large glasses of liquid per day.

Another way you can tell if the patient is getting enough to drink is by the color of their urine. The urine should be clear. If the urine is dark orange, it is too concentrated and they need to drink more. If the patient refuses to drink enough liquids, we may need to place an IV to administer fluids as needed, but this is rarely needed.

SOLID FOODS

Soft, smooth foods (pudding, mashed potatoes or ground meat, etc.) are best for the first 10 days, as they are less likely to scratch the throat. Patient may not feel like eating much solid food for the first few days, but those who eat well early on will do significantly better than those who don’t. It is not unusual for patients to lose some weight after surgery. This is okay, but once again, it is mandatory that the patients drink enough fluids. Dairy products may thicken saliva and may be difficult to eat for the first 24 hours, but are okay if they can be swallowed.

ACTIVITY/SCHOOL

The patient should rest at home for the first week. The sore throat may last as long as 2 weeks, but they may return to school if they feel up to it. No strenuous work, exercise, sports or physical education for at least 14 days or until the throat heals.

PAIN MEDICATION

The doctor has prescribed a pain medicine with a narcotic. This is a very potent medicine and will help relieve the throat pain substantially, but it can cause nausea if a high dose is taken or if the patient is moving around too much after taking the medicine. If the patient is having enough pain to take medicine, they should probably do so at bed rest and/or not be too active. Please remember that the narcotic pain medicine will often have Tylenol (acetaminophen) already mixed in. Do not supplement the pain medication with more Tylenol unless directed by the doctor. Later, during the healing period, changing the patient over to plain Tylenol when the pain has decreased will allow the patient to feel better and more alert in most cases. Unless advised by your doctor, please do not use non steroidal (NSAID) medication (Motrin^tm, Advil^tm, Ibuprofen, Aleve^tm), as this may cause a tonsillectomy bleed.

ANTIBIOTICS

An antibiotic may be prescribed for a period of 10 days after surgery. This helps the throat to heal faster.

ADDITIONAL ITEMS: 

- Cool Air vaporizer at bedside
- Ice Packs to the neck

FOLLOW UP

Office visit after surgery may be scheduled two or three weeks after surgery. Please call the office at 512-320-9915.