Tonsillectomy, Adenoidectomy, Adenotonsillectomy

What are tonsils and adenoids?

The tonsils and adenoids are part of the body called the lymphatic system, which fights infections. The tonsils are in the back of the throat. The adenoids are higher up, behind the nose.

Germs enter your child’s body through their mouth and nose. Tonsils and adenoids trap germs and protect your child from infection. Even though they fight infections, tonsils and adenoids can get infected too. One example is an infection like “strep throat.” Infections can:

• Make the tonsils or adenoids swell and hurt 
• Make it harder to swallow or breathe
• May cause ear and hearing problems

Why surgery is needed

Antibiotics are medicines that fight germs. These medicines usually heal a tonsil or adenoid infection. If your child gets these infections often or has breathing problems, they might need surgery. If your child has a certain number of infections over time, the surgeon may say your child needs a tonsillectomy, adenoidectomy, or adenotonsillectomy. 

• 7 infections in 1 year
• 5 or more infections per year for 2 years in a row
• 3 infections per year for 3 or more years in a row

Surgery to remove the tonsils is a tonsillectomy. Surgery to remove the adenoids is an adenoidectomy. Your child’s doctor may remove either one. Sometimes, the doctor removes both at the same time in a surgery called an adenotonsillectomy. These are common surgeries.

If your child has a bleeding or clotting disorder, or another disease, then tell the surgeon before the surgery.

Tonsil and adenoid removal

The surgery takes 30 minutes to one (1) hour. Plan to be at the hospital for about 5 or 6 hours. The surgery team will give your child general anesthesia. Your child will not be awake during surgery, will have no awareness, and will have no pain. The surgeon usually removes the tonsils, and your child does not need stitches.

After their surgery, your child will go to the hospital recovery room until they wake up. When your child wakes up and can drink clear liquids, you can take them home. Your child may need to stay 1 night or more at the hospital if they are:

• Younger than age 3
• Have other serious illnesses
• Have severe sleep apnea (stop breathing when they sleep)

What to expect after tonsil and adenoid removal

Bleeding

Bleeding is one of the main risks of tonsil and adenoid surgery. Your child should not bleed a lot from the nose or mouth. Sometimes, they might have a small amount of slow bleeding from the nose. Please check on your child 1 or 2 times during the first night after surgery. If you have any questions, please call your primary or ENT clinic.

Pain 

Your child will have severe (very bad) pain in their throat and ear sometime after surgery. Ear pain happens between Day 3 and 7 after surgery. This pain (known as referred pain) is from a nerve that goes to the tonsils and ears. This pain will be at its worst  5 to 7 days after surgery. This is the most important time to make sure your child is drinking plenty of fluids.

Home care after tonsil and adenoid removal

Reducing pain

The doctor will give your child medications to reduce pain and help them feel more comfortable. Carefully follow your doctor’s instructions for giving pain medication for the first week after surgery. You can also reduce pain by:

• Putting cool, wet cloths on your child’s neck 
• Letting them suck ice chips if they are old enough

Caring for other side effects

Your child might have other side effects after surgery, such as:

• Not having a bowel movement (constipation) because of pain medicine or not eating much 
• Bad breath from a white or yellowish “scab” at the surgery site in their throatBad breath is common. Your child can gargle with a mild salt-water solution to help freshen their breath. You can make this solution by mixing 1 teaspoon of regular salt in 8 ounces of cool water. 

Between 5 to 10 days after surgery, the scab breaks off when your child heals. When this happens, they might spit up bloody mucus. If the bloody mucous does not stop in a few minutes, take your child to the nearest emergency room.

Your child will be less active than usual for several days. They might have trouble falling asleep at night or not sleeping well. They should get back to normal in the next few days up to 2 weeks.

Eating and drinking

Start by giving your child clear liquids. Drinking plenty of liquid is important to prevent dehydration, or not having enough fluid in the body. While they are awake, give them small amounts of liquid every hour. Start with cool, clear liquids like:

• fruit juice
• Jell-O® (gelatin)
• popsicles
• Gatorade®
• Pedialyte®

This table shows you how much liquid your child should drink each day. The right amount depends on how much your child weighs. You can use a measuring cup, marked in ounces, to track how much they drink.

If your child does not drink enough liquid, they may need to return to the hospital until they can drink enough.

If your child does not vomit or has a lot of pain, they can also try eating soft foods to start, like mashed potatoes or applesauce. They can move to a normal diet if they are not vomiting or having too much pain. But avoid sharp foods, like chips, pretzels, or crunchy food for 2 weeks after surgery. 

Going back to school

Each child is different. Your child may go back to school when they eat a near normal diet and do normal activities (usually 7 to 10 days after surgery). They should avoid vigorous physical activity for 14 days after surgery as this can cause bleeding. Vigorous activity means running, jumping, rough play, riding a bike fast, or playing sports. Ask the doctor or nurse if you have questions about what your child can do.

Questions? 

If you have questions about your child’s tonsil or adenoid surgery, talk to the doctor, nurse, ENT, or your child’s primary clinic.