Tonsillectomy

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What are tonsils?

The tonsils are two masses of tissue located in the back of the mouth. Tonsils are a very small part of your child’s immune system.

 

Why does my child need their tonsils taken out?

Most commonly, children have their tonsils removed to help them breath and sleep better. When tonsils are large enough, sometimes they block a portion of the child's airway during sleep resulting in symptoms (snoring, pausing, gasping, restlessness, daytime fatigue, etc.) that are concerning for obstructive sleep apnea. Removing the tonsils (and adenoid) allows them to breathe more comfortably resulting in safe and healthy sleep.

The other major reason children have their tonsils removed is due to very frequent throat infections involving the tonsils (otherwise known as tonsillitis. Removing the tonsils for this reason will dramatically lower the rate of throat infections.

 

How are tonsils removed?

A “tonsillectomy” is the surgical procedure where tonsils are removed from the back of the throat (through the mouth). It is performed by an Ears, Nose, and Throat (ENT) surgeon in the operating room under general anesthesia. Our surgeons use electrocautery (a device that uses electricity to cut the tonsils out and stop bleeding at the same time) to remove the tonsil tissue.

 

Are there any instructions I need to follow before surgery?

• Your child must have a physical examination performed by a pediatrician or family doctor within 30 days of surgery to make sure your child is in good health. Your provider’s note should be faxed to our ENT Clinic and you should bring a copy with you the morning of surgery.
• You should not give your child any pain or fever medication except Tylenol® (acetaminophen) for at least 3 days before surgery. Medicines like Children's Motrin® (ibuprofen) should be avoided before surgery, as it could increase the bleeding risk and, therefore, cause surgery to be rescheduled.
• Make sure to follow the eating and drinking guidelines provided to you by our pre-operative team 2-days prior to surgery. Eating or drinking too close to surgery, will result in the procedure being cancelled.
• Review the diet recommendations below and stock up on drinks and soft foods for your child to have at home following surgery.

What can I expect after surgery?

• Throat pain for up to 2 weeks which can be worse in the morning and again in the evening when often dry.
• Throat pain that worsens between days 5-10 when scabs come off from the tonsil beds.
• Ear pain (referred pain from throat) and sore neck muscles.
• Fevers up to 102.0 F are considered normal after surgery. Call your provider for fevers over 102.0 F that do not come down with acetaminophen (Tylenol) and/or Ibuprofen.
• Upset stomach and possible vomiting.
• Bad breath can last for 2-3 weeks.
• Nasal congestion and snoring.
  • Snoring is common and should go away within four weeks after surgery. Elevating your child’s head and using a cool humidifier can help.
• Voice can sound different.
• Your child may participate in regular activity with the exception of contact sports. Teenagers and young adults should avoid any strenuous activity AND contact sports for 2 weeks after surgery.
• It is not recommended to travel out of reach of a hospital for 2 weeks after surgery.
• Children usually return to school or daycare on average of 7 days after surgery, but may return when they are feeling well and not requiring regular pain medication.

How do I care for my child after a tonsillectomy?

• Diet Recommendations
  • Clear, bland liquids are MOST important:
    • Encourage lots of fluids (at least 2-3 ounces an hour while awake) to decrease pain and prevent dehydration. Examples: apple or grape juice, Gatorade® or other non-diet sports drinks, Kool-Aid®, Jell-O®, popsicles, flat pop, water.
    • If your child has an upset stomach give small amounts of liquid often.
  • Regular diet; although many children may prefer softer foods.
  • Citrus foods or spicy foods may cause discomfort.

• Tips for Pain Management
  • In order to stay ahead of the pain, acetaminophen and ibuprofen should be given on a regular schedule (every 6 hours) the first 5 to 7 days after surgery. Narcotics* may be prescribed as needed for severe pain.
  • Keep a record of your child’s pain score and the time & dose of each medicine given on the attached form.
  • Apply cold packs to the neck or forehead.
  • Use a cool humidifier to decrease throat dryness.
  • Chewing gummy snacks or gum (depending on your child’s age) can help alleviate ear pain.
  • When using a syringe to squirt liquid medications into your child’s mouth, aim the medication along the inside of the cheek.
  • To improve taste, you can ask your pharmacist to add flavoring to your child’s medication or you can add the dose of medication to a very small spoonful of something your child enjoys (like jelly).
  • Pain medication suppositories (rectal acetaminophen) are available without a prescription for children who refuse to swallow medication. You may have to ask the pharmacy staff for help as these are usually kept refrigerated in the pharmacy.
  • Regular narcotic use can cause constipation. Pear juice, prune juice, or MiraLAX can help prevent this.

• When to Call the Surgeon
  • Refusing to drink or not urinating at least twice a day.
  • Fever higher than 102°F (38.8°C) which doesn’t decrease with acetaminophen, ibuprofen, and cool towels or ice packs.
  • Pain that is not well-controlled by recommended pain medications.
  • Bright red bleeding from nose or mouth (anything more than a streak in the saliva) which doesn’t stop within a few minutes of rest, elevation of head, and ice chips.
  • Vomiting bright red blood.
  • Upset stomach or repeated vomiting beyond the first 24 hours after surgery.

Questions?

This information is not specific to your child but provides general information. If you have any questions, please call Children's ENT & Facial Plastic Surgery at 612-874-1292.

Reviewed 10/2022

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