The tonsils are two pads of tissue located on both sides of the back of the throat. Adenoids sit high on each side of the throat behind the nose and the roof of the mouth. Tonsils and adenoids are often removed when they become enlarged and block the upper airway, leading to breathing difficulty. They are also removed when recurrence of tonsil infections or strep throat cannot be successfully treated by antibiotics.
The procedure to remove the tonsils is called a tonsillectomy; excision of the adenoids is an adenoidectomy. Both are usually performed concurrently; hence the procedure is known as a tonsillectomy and adenoidectomy or T&A.
T&A is an outpatient surgical procedure lasting between 20 and 40 minutes and performed under general anesthesia. Normally, the young patient will remain at the hospital or clinic for about two to four hours after surgery for observation.
|Minimum Fluid Intake||Eating|
|How can I reach the doctor after hours?|
Most children require seven to ten days to recover from the surgery. Some may recover more quickly; others can take up to two weeks for a full recovery. Younger children often tolerate the procedure very well. Older children may require a longer recovery time and complain of more discomfort.
Snoring, runny, or stuffy nose and bad breath can occur after surgery and last for about 2 weeks: This is normal and will resolve with the healing process. Normal saline nasal spray can be used. Occasionally, the child may have some changes in voice due to the removal of adenoid tissue. They sometimes sound more nasal. This usually will return to normal within four weeks. You may resume previously prescribed nasal medications as needed after 48 hours.
The most important requirement for recovery is for the patient to drink plenty of fluids. Juice, “flat” soft drinks, popsicles, Jell-O, and Gatorade are excellent sources of liquid. Any of the child’s favorites may be offered, however certain citrus fruits may cause pain. Some patients experience nausea and vomiting after the surgery caused by the general anesthetic. This usually occurs within the first 24 hours and resolves on its own. Contact your physician if there are signs of dehydration (urination less than 2-3 times a day or crying without tears).
MINIMUM Fluid Intake for the First 24 Hour Period is:
|Weight of Patient||Minimal Fluid Intake|
|Over 20 Pounds||34 Ounces|
|Over 30 Pounds||42 Ounces|
|Over 40 Pounds||50 Ounces|
|Over 50 Pounds||58 Ounces|
|Over 60 Pounds||68 Ounces|
Generally, there are no food restrictions after surgery but liquids and soft foods may be easier to swallow. The sooner the child eats and chews, the quicker the recovery. Tonsillectomy patients may be reluctant to eat because of sore throat pain; consequently, some weight loss may occur, which is gained back after a normal diet is resumed. It is best to avoid citrus products, sour or spicy foods may also cause some discomfort for the first few weeks.
Low-grade fevers are common after surgery. Your child may run a fever for several days after surgery. If the fever remains over 102 and is not improving 30-45 minutes after Tylenol or prescribed pain medication please call the office. It is important that children drink plenty of fluids after surgery. This will not only make them feel better, but will reduce the chance of fevers.
Children tend to regulate their own activity levels depending on how they feels. We recommend that the child’s activity be limited for 5-7 days. Most children should plan to be absent from school approximately 6 days, but some children may miss up to 10 days of school. No sustained activity (sports, running, heavy lifting, swimming, P.E. class, bounce houses, etc…) for 2 weeks after surgery. Travel away from home is not recommended for 2 weeks following surgery.
A scab will form where the tonsils and adenoids were removed. These scabs are thick, white, and cause bad breath. This is not unexpected. Most scabs fall off in small pieces five to ten days after surgery and are swallowed. It is common for the pain to increase for a few days when the scab on the tonsillar area falls off. Children often complain of more referred ear pain around this time. This can be managed with pain medications as needed. You may notice a small amount of blood when this occurs.
With the exception of small specks of blood from the nose or in the saliva, bright red blood should not be seen. If such bleeding occurs, contact your physician immediately or take your child to the emergency room. Bleeding is an indication that the scabs have fallen off too early, and medical attention may be required.
DO NOT USE ANY IBUPROFEN AFTER ANY BLEEDING IS SEEN.
- Gargle Ice Water: If your child is old enough to gargle and the bleeding is light we recommend having your child gargle 1-2 glasses of ice water and spit until the water is clear. They should not swallow the water after gargling. If the bleeding continues after gargling please contact your physician immediately or take your child to the closest emergency room.
- If time permits, you should call your physician prior to going to the closest emergency room or calling an ambulance.
Nearly all children undergoing a tonsillectomy/ adenoidectomy will have mild to severe pain in the throat after surgery. Some may complain of a headache, earache (because stimulation of the same nerve that goes to the throat also travels to the ear), and a few may incur pain in the jaw and neck (due to positioning of the patient in the operating room). Children complain of differing degrees of throat and/ or ear pain for up to 14 days. Pain is often worse at night and may prompt the need for additional pain medication. Elevation of the head may help reduce this. Pain is more easily controlled if it is treated when it first begins. We recommend that your child take the pain medication prescribed every 4-6 hours while awake for the first 5-7 days. Please be aware that most narcotic pain medications also contain Tylenol (acetaminophen). You should NOT give pain medication and Tylenol (acetaminophen) to your child in the same 4-hour period. DO NOT USE ASPIRIN IN ANY FORM as this may increase the risk of bleeding. Pain control is a trial and error treatment. We ask parents to use prescribed pain medications consistently for the first 5 days after surgery. After the 5th day, ibuprofen can be used as needed; however, it should be discontinued immediately if any bleeding is seen.
Narcotic pain medications (such as Lortab or hydrocodone) may cause nausea and /or vomiting. Taking this medication after drinking or eating may decrease the chance of nausea and/or vomiting. Your physician may give you a prescription for Zofran, a medication that helps to control nausea.
Your child may develop constipation as a result of narcotic use and dehydration. Encouraging fluid intake is the best thing you can do to limit the potential for constipation. If possible, adding fiber to your child’s diet (oatmeal, prunes, apricots, plums, raisins, peas, beans, broccoli, and whole-grains) may help to prevent constipation. In more severe cases your primary care physician may recommend or prescribe a mild laxative such as glucolax (miralax) or enema. Never give your child a laxative or other types of stool-softening medications without first consulting with your primary care physician. If your child has a history of constipation and has previously been recommended a stool softener by their primary care physician, we would recommend restarting this prior to surgery.
It is very common for children to get bad breath for several weeks. The back of the throat will change with healing. Do not be concerned if the throat appears white and foamy. Your child may brush their teeth, but gargling and mouthwash are not recommended. Coughing and throat clearing may be done gently.
Please call to make a follow-up appointment for 4-6 weeks after surgery: 214-494-4150
How can I reach the doctor after hours?
There is a doctor on call 24 hours. If you need to reach us please call the office: 214.494.4150