What are tonsils and adenoids?

Tonsils are masses of tissue -- similar to lymph nodes of the neck -- located on the sides of the throat. Adenoids (or the adenoid) are a pad of similar tissue located in the back of the nose. These tissues can get large with an sudden infection, like the Epstein-Barr virus (the virus that causes “mono” or infectious mononucleosis) or they can become repeatedly infected with Streptococcus pyogenes (the “strep throat” organism).

As we grow from babies through childhood, the tonsils and adenoid tissue should shrink away, but sometimes this fails to happen and they remain large causing snoring with or without sleep apnea, problems with swallowing like choking on solid food, frequent mouth breathing, and sometimes a muffled voice. For any of these reasons, tonsils and adenoids may be removed under general anesthesia as an inpatient or an outpatient, depending upon the patient.

How are they removed?

Tonsils and adenoids are removed through the mouth. Using a mirror, we can see the back of the nose through the open mouth. An electrocautery knife is used to remove them; this uses electricity to create a small burn at the raw edge of the tissue and seal the blood vessels closed to prevent bleeding.

Does it hurt?

Yes, for one to two weeks after surgery the throat can be very sore. This is why we prescribe strong pain medicines to help with the pain. You should never use aspirin or an aspirin-like non-steroidal anti-inflammatory drug (NSAID) such as Motrin™, Advil™, Alleve™, ibuprofen, or naprosyn, because these medications can thin the blood and make it difficult to control bleeding when the scabs start to fall off.

In addition to the sore throat, your child may complain of ear pain or neck pain. Ear pain is quite common and is called “referred pain.” The ears are not usually infected, but the nerves that transmit pain sensations in the throat and the ears overlap some, causing the pain to feel like it is in the ears. Neck pain may be from the position in the operating room, but it should be reported to the doctor’s office if your child has any trouble turning his or her head.

What else makes it feel better?

Chewing gum can be helpful; it helps to exercise the muscles of the jaw that are often sore after the surgery and contributing to the throat pain. (Please avoid aspirin-gum.) An ice pack on the neck may help. Gargling with salt water can help to keep down the growth of bacteria on the scabs in the back of the throat. But most importantly, taking in plenty of fluids and regularly using the pain medication for the first few days will make it easier to recover.

What should I expect during my child’s recovery?

• Nausea/vomiting: There are several factors that can each contribute to nausea and vomiting. Some children are sensitive to the anesthesia medicines and this can last for 24 hours after surgery. Sometimes swallowed blood may make your child sick to his or her stomach. If he or she vomits blood, note if it is clumpy and purple or brown, or if it is bright red. Please report this to the doctor’s office. Some children get sick from the pain medicine or from the antibiotics. It is important to note the time between giving a medicine dose and the vomiting. Report this to the doctor’s office.
• Whitish-gray patches in the back of the throat: These patches are simply scabs that are bathed in saliva, and so are soft and swollen and whitish-gray. They are not a sign of infection but rather part of the healing process.
• Stinky breath: All children will have foul smelling breath after this surgery. The scabs in the back of the throat serve as home base for bacteria living in the mouth and throat. They are full of nutrients that the bacteria live off of. The antibiotics prescription that we usually give after surgery helps to reduce the number of organisms living in the scabs. Also, salt water gargles can help with this. If the foul smell becomes totally repulsive, please call the doctor’s office.
• Fever: Most children will have a low-grade temperature (up to 100°F) after this surgery and some will even have a fever (up to 101.5°F). If your child has a fever of 102°F or more, please report this to the doctor’s office.
• Diet: Your child can eat anything that he or she wants, but please make sure that he or she is drinking plenty of liquids. Some thickened foods like Jell-O™, apple sauce, pudding, yogurt, ice cream, popsicles, Flavor-ice™, Italian ice, and fruits like watermelon have a lot of water in them and are easier to swallow with a painful throat than plain water. You may want to avoid orange juice or other citrus drinks, spicy foods, potato or corn chips, and hot broth for the first few days because they may be less comfortable on the throat.
• Activity: When your child feels well enough to return to daily activities, then he or she is permitted. Some children are ready in a few days. Others need two weeks. It is recommended that they avoid heavy playground activities, physical education class or sports teams for two weeks.

What problems should I report to the doctor’s office?

• Report any bleeding immediately. Bleeding usually happens between days seven to 10 after surgery when the wet scabs in the back of the throat are sloughing off. Ninety-eight percent of the time this is a brief bleed that is not significant. However, in one in 1,000 children, this bleeding can precede more severe bleeding and is a warning sign.
• Report a temperature of more than 102°F.
• Report ear pain that lasts more than three days or severe ear pain.
• Report neck pain associated with a stiff neck or fixed head position.

Who do I call?

Monday – Friday, 8:30 a.m. to 4:30 p.m., call the doctor’s office at: 919-684-3220. After 4:30 p.m. on weekdays and on weekends or on holidays, page the on-call doctor at: 919-684-8111.