Tonsil and Adenoid Surgery

About Tonsils and Adenoids

The tonsils are grape-sized pieces of tissue in the back of the throat on each side. The adenoids are small pads of tissue at the back of the nose above the throat. The adenoids can't be seen when you open your mouth because they are behind the soft palate. Both tonsils and adenoids produce antibodies to fight infections, but they are probably only important to a neonate. They are usually removed if they become so large that they interfere with breathing or swallowing, or if recurrent infections occur.

Recovery Time After Surgery

After removal of the tonsils and adenoids your child may lack energy and tire easily for several days. Your child may be restless at night and not sleep well. These problems gradually get better in 3 to 14 days. Your child may have problems with constipation for several days because of the pain medication, and because he will not feel like eating much.

Discharge Instructions After Surgery

Diet
Liquids are the most important thing for your child to have in the first three days after surgery. This will help lessen problems with fever, constipation, and aid healing. Make an effort to give your child a drink (two to three ounces) every hour during waking hours for the first two days after surgery. Soft drinks, fruit juice, gelatin, custard, popsicles, or sports drinks are good choices. Frequent small feedings of soft foods and cool liquids are usually most comfortable. As your child's appetite gets better, encourage him or her to eat more solid foods. It is wise to avoid spicy or extremely hot foods, as this may worsen the sore throat. Avoid "scratchy" foods for several weeks (e.g., chips, dry toast) as the scabs over the tonsil beds may be traumatized during swallowing and produce bleeding.

Your child may feel sick to their stomach, throw up, or feel tired and cranky after surgery. This should get better within a few hours. Occasionally, nausea and vomiting are due to the narcotic in the pain medication.

Pain Medicines
A very sore throat or ear pain is normal after the tonsils are removed. Expect pain in the ears between the third and seventh days — ear pain is common because the same nerve for your tonsils is connected to the ear. Give regular does of pain medicine (any acetaminophen medicines, such as Tylenol) four to five times a day for a week. If your child has severe pain, use the prescription pain medicine as labeled. Do not use aspirin or ibuprofen, these medicines increase the chance of bleeding. You can use cool compresses or ice packs on your child's neck to help your child feel more comfortable. You can also have your child suck on ice chips or chew gum.

Fever Medicines
It is normal for children to run a fever between 99°F (37°C) and 101°F (38°C) for the first few days after surgery. The fever will be worse if your child doesn't drink enough liquids and becomes dehydrated. Give acetaminophen for the fever.

Bad Breath
This is normal. It comes from a scab that forms over the tonsil surgery site. If you look in the back of their mouth after tonsillectomy you will see the scab — pale grey, yellow, or tan, appearing where the tonsils used to rest — this is normal. You can help your child's breath by giving him or her a mild saltwater mixture to gargle. After gargling, your child may spit up some bloody mucus. The scab breaks off during healing within 5 to 10 days and the bad breath will go away.

Bleeding
There should be no bleeding from the nose or mouth after your child returns home. Get up to check on your child once or twice during the first night after surgery. If there is any bleeding, take the child to the emergency room immediately. The ear, nose, and throat (ENT) doctor on call will check your child. Between the fifth and tenth days after surgery, the scab breaks off the surgery site and your child may spit up some bloody mucus. Streaks of blood in the spit are not worrisome, but if steady bleeding occurs, bring your child to the emergency room.

Activity
It is best for your child to rest at home for the first 48 hours after surgery. Activity may be slowly increased as your child's strength increases. There is no rule for the right time to go back to school, but a guideline is 7 to 10 days after the tonsils are taken out. Rough play and contact sports should not be allowed until 14 days after tonsil or adenoid surgery. Contact your child's school for make-up work.

Call Your ENT Doctor Immediately If:

There is any bleeding from the mouth or nose
The fever rises to more than 102°F (39°C)
There are any signs of dehydration
Your child has vomiting that lasts more than 12 hours

Call Your ENT Doctor During Office Hours If:

A fever lasts more than three days
You have other concerns or questions