Tonsillectomy and Adenoidectomy Surgery

Generally there are multiple indications for tonsillectomy which include, but are not limited to:
• Three or more tonsillitis per year despite medical therapy.
• Large tonsils causing dental malocclusion of other facial growth problems.
• Airway obstruction secondary to size. There may be some association between adult Obstructive Sleep Apnea and failure to remove large or hypertrophic tonsils prior to puberty. For this reason, we recommend removal of large tonsils in children prior to puberty.
• Halitosis or bad breath due to chronic tonsillitis non responsive to medical therapy.
• Bedwetting secondary to tonsillar hypertrophy.
• Chronic “carrier” of Strep throat non responsive to antibiotics.
• Masses or possible cancers or significant difference in the size of the right versus the left.
• Recurrent Otitis Media may require the removal of adenoids if the adenoids are sufficiently enlarged enough to obstruct the natural opening of the Eustachian tube into the region of the nasopharynx where the adenoids are located.
• Daytime breathing through the mouth instead of the nose due to the size of the tonsils or adenoids.
• Nose sounds blocked during speech secondary to the size of the tonsils or adenoids.
• Recurrent ear infections secondary to the size of the adenoids obstructing the nasopharyngeal opening to the Eustachian tube.

Before Surgery
• Do NOT eat or drink ANYTHING after midnight before surgery
• Wear loose, comfortable clothing the day of your surgery.
• Have someone with you to drive you home. You will not be allowed to drive for 24 hours after your surgery.
• Do NOT take any medications with aspirin or blood thinners for TWO WEEKS before your surgery. Any other regular medications prescribed by your doctor for heart, diabetes, blood pressure, etc. are ok to take before surgery. Please bring these medications with you to the hospital on the day of surgery. TYLENOL is ok to take for pain before surgery.
• Please call if you are unable the keep your scheduled appointment for surgery.
• Please pre-admit before your surgery. This avoids timely delays in getting your blood work results before surgery.

IMPORTANT: IF YOUR CHILD IS THE PATIENT:
In addition to the above recommendations, I recommend you discuss the surgery with your son or daughter to help the be aware of the procedure. Assure them that while they are asleep they will not feel pain, nor will they awaken during the surgery. Help your child understand that he/she will feel better once the throat heals, but that they will have a sore throat afterwards. You may need to explain that removing the tonsils and adenoids will not change the way they look.

After Surgery
• You will need to limit your activity with lots of bed rest for the first few days. No strenuous activities or heavy lifting until instructed by your doctor.
• Eat only cool, soft foods such as jello, ice cream, popsicles, pudding, etc. and drink plenty of fluids (at least 8 - 8 oz. glasses per day). Do NOT eat or drink any extremely hot or rough foods or citrus juices. Please do not eat or drink any food with red coloring as this can give the false impression that the patient is bleeding.
• The following symptoms are normal and should not cause alarm:
⋅  Extremely sore throat.
⋅  Low grade fever increasing up to 102 degrees, if this occurs increase fluid intake.
⋅  Spitting up blood streaked mucous for up to ten (10) days after surgery.
⋅  You may experience some nausea and an upset stomach. This usually occurs from the swallowing of blood and pain medications. Try eating before taking the pain medications.
⋅  Ear pain.
⋅  Bad breath.
• Please notify the office if the following occurs:
⋅  Severe bleeding.
⋅  Fever greater than 102 degrees.
⋅  Excessive vomiting
• You may gargle salt water as needed to soothe the throat.
• Schedule a post-op appointment for two weeks after the surgery.

If you experience any symptoms that are not listed that you feel are significant please call immediately.

Possible Complications
Potential complications include, but are not limited to:
• Sore throat, yeast or other infections of the mouth.
• Post operative bleeding, usually 7-10 days after surgery, but may be as early as the day of surgery or as late as 28 days later
• Hyponasality or hypernasality to include possible velopharyngeal incompentency where swallowed liquids come thru the nose.
• Death, brain damage, temporary or permanent loss of an airway, paresthesias, neuralgias, neuropraxia.
• Need for further or additional surgery.
• Scarring, anomalous apppearance of the throat or uvula.
• Injury, accidental burns or other injuries directly or not directly related to the procedure, infections at the site of the surgery or insertion of IVs.
• Adverse or unforseen reactions to medications, drugs or or other agents commonly used for anesthesia or surgery.

For additional information go to AAO-HNS Tonsils and Adenoids.