The tonsils are located at each side of the back of the mouth and the adenoids are behind the nose. The adenoids shrink away in late childhood and are absent in most adults. Tonsils and adenoids are tissue made of white blood cells which are the type of cells that help the body fight infection. Unfortunately when they become enlarged or recurrently infected tonsils and adenoids lose their ability to fight infection.
Studies have NOT been able to show any evidence that removing the tonsils or adenoids in-creases a person’s risk for infection, other diseases or health problems. As with any surgery there are some risks including a chance for bleeding, changes in the voice or swallowing, or problems with anesthesia. If you have questions about these please call the office.
Prior to Surgery
It is very important that the patient avoid taking aspirin, Motrin, ibuprofen, Advil, Aleve or naproxen for two weeks before and one month after surgery as these thin the blood and increase the chance for bleeding during and after surgery. You may take Tylenol (acetaminophen).
The Day of Surgery
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On the day of surgery the patient should have nothing to eat or drink after midnight. CLEAR LIQUIDS THAT YOU CAN SEE THROUGH may be taken up to 6 hours prior to surgery, AFTER THAT NOTHING SHOULD BE TAKEN BY MOUTH, NOT EVEN WATER. Please check with your doctor to see if regular medication should be taken the morning of surgery. Failure to follow these directions may cause the anesthesiologist to cancel the surgery. You will need to arrive at the surgical facility well before the scheduled time of surgery. A day or two before surgery you will be called by someone from the surgical facility to tell you what time to arrive. After you arrive the nursing staff will take some information from you and someone from the anesthesia department will talk with you.
Parents, if the anesthesiologist allows, may go with their children to the operating room and stay with them while they go to sleep but not during the actual operation. If interested in this please request to do so as soon as you arrive to the surgical facility. Once in the operating room young children will go to sleep by breathing gas through a mask, they will then have an IV started. Older children and adults will usually have an IV started first, sometimes before going to the operating room. Once asleep, a breathing tube will be placed through the mouth. During surgery the patient will be kept completely asleep by breathing gas through this tube under the supervision of an anesthesiologist. Heart rhythm, blood pressure and oxygen levels will be closely monitored throughout the operation. The surgery is performed through the open mouth and takes about 45 minutes. The doctor will talk to you after surgery is done. Please stay in the waiting room the whole time the patient is in surgery. After surgery the patient will be in the recovery room for about 30 minutes. Parents may be able to sit with their child for part of this time. After this the family will stay with the patient in another recovery area for about 2 hours after surgery. For some patients with certain medical conditions plans will be made ahead of time to stay overnight after surgery.
After Surgery
It is most important for the patient to take enough liquids. Good things early on include fruit juices, pop, popsicles, Gator-aide, ice cream, milkshakes, Instant Breakfast, yogurt, pudding Jell-O, applesauce, scrambled eggs, etc. Any soft foods are OK but sharp or hard foods should be avoided for 10 days.
Children will require frequent, consistent, firm yet loving encouragement to eat and drink for up to 10 to 14 days after surgery. The patient will have significant pain in the THROAT as well as in the EARS (because the tonsils are straight in from the ears) and the back of the NECK or HEAD for up to 10 to 14 days after surgery. Tylenol (acetaminophen – follow bottle directions) or the prescription pain medicine (which usually contains a narcotic and Tylenol) should be taken every 4 hours as needed for pain. It helps to take it regularly for the first few days to stay ahead of the pain, after that taking it ½ hour before meals is helpful. Remember not to take aspirin, Motrin, ibuprofen, Advil, Aleve or naproxen as these may cause bleeding. Usually a dose of steroids is given through the vein at the time of surgery to decrease pain and swelling early on. Pain often worsens when this wears off in 2 days.
Pain can be worse at night so be sure to take pain medication at bedtime. Benadryl (follow bottle directions) can be given to help the patient sleep as well. Due to the swelling of the uvula it is common to have some snoring and rattling breathing for a while. Elevating the head of the bed by placing a pillow between the mattress and box spring helps keep pain and swelling down and also helps reduce the risk of bleeding.
Avoid strenuous activity for 10 days after surgery as it increases the chance of bleeding. It is OK to go to a movie or a mall and to be up in the house but avoid driving especially when on prescription pain medication. Plan to miss 7 to 10 days of day care, school or work after surgery.
It is common to have some blood tinged saliva but it is possible to have significant bleeding up to 10 days after surgery. Should significant bleeding occur (spitting out clots or continual dripping of blood) the patient should rinse the mouth with cold water and wait for 15 minutes as the bleeding will usually stop on its own. If bleeding persists call the office day or night and your surgeon or another ENT specialist will call you. In the unlikely event that you are unable to make contact with the doctor and significant bleeding persists, go to the ER.
Due to the bacteria in the mouth there is always a low grade infection in the area where the tonsils were removed causing a white to yellow build up, foul breath and a fever of 101 or even 102 for 10 or more days after surgery. This will resolve on its own, however your surgeon may give you an antibiotic to take after surgery to help control this.
You may also notice some voice changes and snoring after surgery for awhile due to swelling and the removal of enlarged tissue. This will resolve on its own usually in 3 to 4 weeks. If you have questions or problems please call the office. Please make an appointment now for your surgeon to check you 3 to4 weeks after surgery. There is no charge for this follow-up visit.
Medications:
- Lortab elixir (Tylenol plus hydrocodone)__________________________ every 4 hours as needed for pain, may cause nausea or drowsiness
- Percocet (Tylenol plus oxycodone) 1 or 2 tablets every 4 hours as needed for pain. May be crushed or broken in half to take. May cause nausea or drowsiness.
- Norco (Tylenol plus hydrocodone) 1 or 2 tablets every 4 hours as needed for pain. May be crushed or broken in half to take. May cause nausea or drowsiness.
- Ultram (tramadol) 1 or 2 tabs every 4 hours as needed for pain, may cause drowsiness
- Tylenol(acetamenophen)only for less severe pain (no aspirin, Advil, Motrin, ibuprofen, naproxen, or Aleve) Maximum dose of Tylenol for adults is 4000mg in 24 hours, for your child it is ________mg every 4 hours. Exceeding these doses may cause liver damage/failure. If you have questions on the dosing of Tylenol call the office or ask your pharmacist
- Amoxicillin __________________ tsp tab twice a day for 10 days
- Other medications as usual.
Regretfully we cannot call in prescriptions for narcotics after hours or on weekends. You’ll need to anticipate the need for refills or medication changes and call during business hours.