Tonsillectomy

Instructions

BEFORE SURGERY

1. Nothing by mouth after midnight the evening before surgery except medications as instructed by the anesthesiologist at the pre-operative evaluation.
2. Notify your doctor if cough, fever, or other symptoms of respiratory tract infection develop prior to surgery.
3. Aspirin, aspirin containing products, ibuprofen, or other non-steroidal anti-inflammatory medications should not be taken for 2 weeks prior to surgery.
4. Plan to remain in town for 2 weeks after the surgery.

AFTER SURGERY

1. Soft diet for 10 - 14 days. Encourage intake of fluids.
2. Limit physical activity for 10 - 14 days.
3. Complete course of antibiotics as prescribed.
4. Liquid Tylenol, or other prescribed medication for pain every 4 - 6 hours as needed.
5. No aspirin, aspirin containing products, ibuprofen, or other non-steroidal anti-inflammatory medications for 2 weeks after the surgery.
6. Throat and ear discomfort is common after tonsillectomy. These symptoms can be severe and last for 10 - 14 days.
7. Bad breath and a whitish-gray coating in the throat is typical after tonsillectomy.
8. Low grade fever after tonsillectomy is common and should be treated with Tylenol.
9. Return for follow-up office visit 2 - 3 weeks after surgery.

WHEN TO CALL THE DOCTOR

1. Call for any bleeding
2. Call for any difficulty breathing (except for nasal congestion).
3. Call for persistent vomiting or inadequate intake of liquids.
4. Call for fever over 101.5 degrees if the fever does not respond to Tylenol. Fever is often a sign of inadequate fluid intake.

Risks and Complications

Tonsils and adenoids are lymphoid tissue of the pharynx. The tonsils are in the oropharynx (the part of the throat between the palate and the tongue base). The adenoid pad is in the nasopharynx (the part of the throat that extends into the back of the nose). Although the tonsils and adenoids are considered to be part of the immune system, there is no evidence to suggest that removal of this tissue has any adverse effects on the immune system and the ability to fight infection.

Tonsillectomy is performed for a number of reasons including chronic infections, airway obstruction or an asymmetric enlargement of tonsillar tissue. Adenoids are removed for a number of reasons including chronic infections, nasal obstruction and chronic ear infections. The tonsils are sometimes removed without adenoids, and adenoidectomy is occasionally performed without tonsillectomy, depending on the indications for surgery.

The risks of adenoidectomy include: bleeding, infection, risk of anesthesia, as well as nasal regurgitation. Nasal regurgitation can cause difficulty swallowing as well as change in voice quality. Nasal regurgitation is a rare complication of adenoidectomy and is usually temporary. The risks of tonsillectomy include bleeding, infection, changes in voice quality, change in taste sensation, as well as the risk of anesthesia. Approximately 2% of people will have bleeding after tonsillectomy. This usually occurs between five and seven days after surgery. Patients with bleeding may have to be taken back to the operating room for control of bleeding.

Post-Tonsillectomy Instructions

After tonsillectomy, it is important to maintain a light level of activity and a soft or liquid diet for a period if ten days to decrease the likelihood of postoperative bleeding. Although most soft foods can be tolerated after tonsillectomy, the primary goal is adequate liquid intake. Adequate liquid intake will prevent dehydration and - prevent the throat from drying gut and becoming more painful. It will also decrease the likelihood of bleeding.

It is often helpful to administer pain medication prior to taking liquids of soft solids.

The following are minimum daily requirements for liquids based on the patient's weight.

Under 25 pounds	1.5 pints	Three 8-ounce glasses
25-60 pounds	1 quart	Four 8-ounce glasses
60-120 pounds	1.5 quarts	Six 8-ounce glasses
Over 120 pounds	2 quarts	Eight 8-ounce glasses

Liquids should generally be cool, but warm liquids are also - permitted. Citrus juices should be avoided, as should red or orange colored beverages. Gatorade, sweet iced tea, apple juice, ginger ale, Seven-Up, or Sprite, milk, Jell-O, and ice pops are excellent. Sherbet and ice-cream are soothing to the throat.

Almost any solid that is soft can be tolerated. It is important to remember that liquid intake is much more important than solid intake . A person can tolerate the absence of solid foods for seven to ten days without any detrimental effects; however, liquids are essential to maintain adequate hydration.

Examples of soft foods that are well tolerated after tonsillectomy include:

* Smooth cooked lukewarm cereals (Such as grits)	* Cooked or canned soft fruit
* Warm macaroni and cheese	* Fresh, ripe bananas
* Warm pasta	* Baked apple
* Warmed mashed potatoes	* Fruit cocktail
* Soft bread products	* Soft cooked vegetables
* Boiled, poached or scrambled eggs	* Broth
* Cottage cheese	* Cream or noodle soups
* Custards and puddings	* Meats that are stewed or creamed to desired tenderness
* Applesauce

** Fried foods including chicken should be avoided, as should salads, apples, potato chips, pretzels and other snack food that are crunchy and likely to irritate the throat.

Back to Patient Education and Services...