What is a tonsillectomy?

Tonsillectomy is the removal of the tonsils. Sometimes the adenoids are removed as well. Tonsillectomy is a common throat operation that provides relief of breathing obstructions, throat infections, and recurrent childhood ear disease.

Read more about tonsils and adenoids.

Though tonsillectomy is a safe and effective procedure, as with all surgeries, there are some risks involved, including -- on rare occasions -- anesthetic complications.

How are the tonsils removed?

Tonsils and adenoids are removed through the mouth. Methods of removal include electrocautery, coblation, or microdebrider removal. Bleeding is controlled by thermal sealing of the blood vessels, usually at the same time.

In some cases of enlarged tonsils, they may be partially removed (intracapsular tonsillectomy) enough to improve breathing.

Does a tonsillectomy hurt?

Yes, for one to two weeks after surgery the throat can be very sore. This is why we prescribe strong pain medicines.

You may use liquid ibuprofen after a few days to alternate with the prescribed pain medicine. This will help the inflammation and provide longer pain relief. The first three to five days are the most painful with gradual improvement afterward for up to 14 days.

Dehydration can occur if there is not enough fluid intake. Dehydration is most often a problem in the first few days and may require hospital admission for IV fluids.

In addition to the sore throat, ear or neck pain may be present. 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 also go to the ears, 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 you or your child has any trouble turning the head.

What helps ease the pain?

Chewing gum can be helpful as it exercises the muscles of the jaw that are often sore after the tonsillectomy, therefore contributing to throat pain. (Please avoid aspirin gum.)

An ice pack on the neck may also help. Gargling with salt water can minimize the growth of bacteria on the scabs in the back of the throat.

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 recovery?

• Nausea/vomiting: There are several factors that can contribute to nausea and vomiting. Some people are sensitive to anesthesia medicines, which can last for 24 hours after surgery. Sometimes swallowed blood makes people sick to the stomach. If you or your child 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 people 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.
• Bleeding: Postoperative bleeding occurs in about 2 percent of cases. Bleeding after tonsillectomy is most common five to seven days after surgery, though it can occur at any time in the first two weeks. Bleeding is usually treated in an outpatient procedure but in severe cases a blood transfusion may be recommended.
• 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 part of the healing process.
• Stinky breath: All patients 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. Salt-water gargles can help with this. If the foul smell becomes totally repulsive, please call the doctor’s office.
• Fever: Most people will have a low-grade temperature (up to 100°F) after tonsillectomy and some will even have a fever (up to 101.5°F). Report any fever of 102°F or more to your doctor’s office.
• Diet: Avoid crunchy food such as chips, tacos, pizza, or fried chicken for the first two weeks. Please make sure to drink 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. Avoid orange juice or other citrus drinks, spicy foods, and hot broth for the first few days because they may be less comfortable on the throat.
• Activity: When you or your child feels well enough to return to daily activities, then you may. Some people are ready in a few days; others need two weeks. It is recommended that children 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 seven and 10 days after surgery when the wet scabs in the back of the throat are sloughing off. Usually this is a brief bleed that is not significant. However, sometimes this bleeding can precede more severe bleeding and is a warning sign.

Call your doctor if you experience any of the following:

• A temperature of more than 102°F
• Ear pain that lasts more than three days or severe ear pain
• Neck pain associated with a stiff neck or fixed head position