Tonsillectomy and Adenoidectomy

 

Purpose:

This guide is an attempt to help patients and families to understand tonsil and adenoid problems and what to expect with a tonsillectomy and/or adenoidectomy. It is not meant to be all-inclusive nor is it any form of guarantee. It is not meant to be a substitute for personal attention to your problem and questions.

Anatomy:

Tonsils are lymphoid tissue in the pharynx or throat. They are on each side of the throat and are in area between the tongue and soft palate. The adenoids are also lymphoid tissue and are in the nasopharynx (very back of the nose and very top of the throat).

Indications (Reasons for Surgery):

Common indications for tonsillectomy and adenoidectomy are:
1) Frequent acute adenotonsillitis. This is a viral or bacterial infection of the tonsils and adenoids. The longer a patient shows the tendency for recurrent frequent adenotonsillitis, the more likely it is to continue to recur. Usually tonsillectomy and/or adenoidectomy is not recommended until the patient has had four to bouts of tonsillitis (sore throats) each year for more then one year. There is usually not other preventative measure other than antibiotic treatment for each occurrence or prolonged use of antibiotics.
2) Peritonsillar abscess. This is a pocket of liquid pus behind the tonsils. It is treated by (1) letting the pus out, (2) the pus spontaneously drains out, and (3) antibiotics. They tend to recur so a tonsillectomy is usually recommended after a peritonsillar abscess.
3) Enlarged tonsils and/or adenoids. If enlarged tonsils and/or adenoids are causing difficulty breathing, severe snoring, difficulty eating or abnormal growth of the facial bones and teeth, and adentonsillectomy (T&A) may be recommended.
4) Tonsilloliths. These are pieces of food and other debris that get caught in the holes or crypts of the tonsils. The particles resemble yellow cottage cheese and have a foul smell. If they cause chronic infection or significant halitosis (bad breath), an adentonsillectomy may be recommended.
5) Adenoidectomy for middle ear disease. Since adenoids sometimes interfere with normal function of the Eustachian tube, an adenoidectomy may be recommended for people with frequent middle ear disease.
6) Tonsillectomy, adentonsillectomy for middle ear disease. Often patients will have recurrent acute otitis media (middle ear infections) associated with a sore throat. If frequent middle ear infections and adenotonsillitis are common, often a tonsillectomy and/or adenoidectomy may be recommended to help prevent middle ear disease.

Risks:

Some of the risks of an adentonsillectomy are:
· Anesthesia (being put to sleep)
· Bleeding
· Infection
· Injury to teeth, tongue, other oral structures
Patients and family should know that nothing goes without risk. In young, healthy people, an adenotonsillectomy carries a small risk.

Prior to surgery:

1) Avoid Aspirin, Motrin, Aleve, Ibuprofen, or aspirin-containing medicines one week before and two weeks after surgery.
2) Laboratory tests may be required before surgery. We will arrange these times as an outpatient prior to surgery.
3) The surgery is usually done as an outpatient.
4) DO NOT EAT OR DRINK ANYTHING FOR 8 HOURS PRIOR TO SURGERY.
5) An anxious or frightened child can be helped in several ways. Most of our young patients handle the truth about surgery far better than deception. The child who believes he is ”going on a different kind of hotel to take a ride on a wheeled bed” will become frightened and distrustful. Truthful statements can prepare the child without stress on the negative aspects. Example: “Yes, your throat will hurt when you wake up but there will be some medicine to make it feel better.” Assurance that Mother and/or Dad will remain close and that a favorite blanket or toy can be brought also to help.
6) Fever, new productive cough, or infection during the one-week period prior to surgery should be reported to our office. It may be necessary to postpone surgery.

Surgery:

1) A sedative may or may not be given prior to the operation. The anesthesiologist will make that decision.
2) Parents are asked to remain in the waiting room while the patient is in surgery.
3) The patient is moved to the recovery room for a brief stay to awaken from anesthesia.
4) A child my become tearful when first seeking the parents but will soon become calm and want to sleep. Let the child sleep. Parents may remain with the child in the recovery room.
5) Vomiting in the immediate postoperative period is not uncommon. The first emesis may be bloody. The color is caused by swallowing mucus and is to be expected.
6) Thirst is expected when the patient first awakens. Small amounts of fluids may be sipped or ice chips allowed to melt in the mouth.
7) Questions about the patient’s condition should be referred to the nurse in charge of postoperative care.
8) The meal served during the evening following surgery is usually a liquid type. The meal is supplemented by 7-Up, Popsicles and other fluids. If desired the patient can eat anything he or she wants.
9) Dismissal depends upon the time of surgery and the speed of recovery. Most patients spend between 1 and 2 hours in recovery room.
10) Numbing medications are used to lessen the initial post operation pain.

Recovery:

1) Throat and ear pain are caused by tonsillectomy and adenoidectomy. The ear pain is referred from the throat and does not indicate an ear infection is present. It is typical for this pain to become less severe by the third or fourth day, only to return between the sixth and the eighth day after surgery. Patients having an adenoidectomy will complain of stiff neck and headache.
2) Unless other medication is prescribed, liquid Tylenol may be used at home. Generally, it is advisable to use the medication 15-20 minutes before each meal, before a nap or bedtime, or during the night if the patient awakens in discomfort. Plain Tylenol doesn’t require a prescription. Often Tylenol with Codeine in a liquid or tablet form is prescribed. The codeine may cause vomiting in some patients. It may also cause constipation. Sometimes stronger pain medications are needed, especially for adults, DO NOT operate equipment or drive while taking pain medication.
3) A temperature elevation of one to three degrees above normal is common during the week following surgery. Often, if more liquids are encouraged the fever will subside.
4) Often, there will be minor bleeding up to 10 days after surgery. Usually this is a small amount of blood mixed with saliva, which will stop on its own. If the bleeding persists, please call my office, paging service or emergency room.
5) Most foods can be safely eaten. Proper intake of fluids-enough to go to the bathroom two to three times a day-is all that is important. Do not worry about poor eating or weight loss.
6) Nightmares may occur for a few nights following surgery. The dreamer should be awakened and discomfort alleviated with pain medication.
7) The parent is the best person to decide when the child can return to school. If a child obviously feels well and is up and about, they may return to school. Strenuous recess activities should be avoided the first 10 postoperative days.
8) A voice change is often noted following surgery. The change is temporary and is caused by trying to speak without moving the mouth and throat muscles. As discomfort diminishes, normal speech returns. The voice usually returns to normal in the first one to six weeks.
9) Normal activities should be resumed as soon as possible to ensure the best emotional and physical recovery. However, swimming and vacation trips are not permitted during the 10 days following surgery.
10) The time for a postoperative examination is in two to three weeks. It is not an absolute requirement. In the meantime, if questions or concerns arise during the postoperative period, our office should be contacted.
11)The area of removed tonsils will be coated with a brownish-yellow membrane. This is normal.
12) Bad breath is common until healing is complete in two to three weeks.
13) A cough is common until healing is complete.
14) A stuffy nose is also common until healing is complete.

 

If you would like to be seen please call for an appointment.

(859) 276-4838 or (800) 432-0994