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 30
and 45 minutes and performed under general anesthesia. Normally, the young
patient will remain at the hospital or clinic for about four hours after surgery
for observation. An overnight stay may be required if there are complications
such as excessive bleeding or poor intake of fluids.
When the
tonsillectomy patient comes home
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. The following guidelines are recommended:
Drinking: The most important requirement
for recovery is for the patient to drink plenty of fluids. Milk products
should be avoided in the first 24 hours after surgery. Offer juice, soft
drinks, popsicles, and Jell-O (pudding, yogurt, and ice-cream after 24 hours).
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).
Eating: Generally, there are no food restrictions (other than milk
products) after surgery. 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.
Fever: A low-grade fever may be
observed several days after surgery. Contact your physician if the fever is
greater than 102º.
Activity: Bed rest is recommended for several days
after surgery. Activity may be increased slowly, with a return to school after
normal eating and drinking resumes, pain medication ceases, and the child
sleeps through the night. Travel away from home is not recommended for two
weeks following surgery.
Breathing: The parent may notice abnormal
snoring and mouth breathing due to swelling in the throat. Breathing should
return to normal when swelling subsides, 10-14 days after
surgery.
Scabs: 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.
Bleeding: 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 is required.
Pain: Nearly all children
undergoing a tonsillectomy/adenoidectomy will have mild to severe pain in the
throat after surgery. Some may complain of an earache (because stimulation of
the same nerve that goes to 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).
Pain control: Your physician will prescribe
appropriate pain medications for the young patient such as codeine,
hydrocodone, Tylenol with codeine liquid, or Lortab (hydrocodone with
Tylenol). Generally, an acetaminophen (Tylenol, Tempra, Panadol) teaspoon
solution is recommended for regular administration to the patient for three or
four days after surgery.
If you are troubled about any phase of your
child’s recovery, contact your physician
immediately.
