Ear Center: Postoperative Instructions for Tonsillectomy & Adenoidectomy (T&A)

Postoperative Instructions for Tonsillectomy & Adenoidectomy

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Activity
Restrict activity at home for the first two days, resting as much as possible. Light indoor activity is best. You may usually return to school or work within a week but avoid strenuous activity and sports for two weeks. Sleep with your head elevated on 2-3 pillows for 3-4 days to help decrease swelling.

Diet
Due to tissue swelling and throat discomfort, you may have little desire to drink for several days. However fluids are very important to prevent dehydration. You will find that non-acidic juices, soups, popsicles, Jell-O, custard, puddings, and any soft or mashed foods taken in small quantities can be swallowed fairly easily. Try to increase your fluid and food intake as the discomfort subsides. It is recommended that a child receive 1-1/2 quarts of fluid in a 24-hour period. Adult require twice this amount. Foods such as potato chips, popcorn, pizza, and toast should be avoided for at least two weeks.

Discomfort
Your sore throat may be relieved by applying an ice collar to your neck and/or by taking Tylenol®. Do not take aspirin, aspirin-containing medications, or ibuprofen (Motrin®, Aleve® etc.) since they may cause bleeding. You may experience an earache, which is due to referred pain from the throat. Referred ear pain is commonly felt at night when trying to rest.
Bleeding: Although rare, there is risk of having some bleeding during the first 2 weeks after having a T&A. This usually happens between days 7-10 postoperatively. If you or your child should have any bleeding, try to remain calm. We recommend sitting up quietly in a chair and gently spitting out the blood into a bowl. For adults and older children, gargling gently with ice water may help. If the bleeding does not stop after a short time (5 minutes), is more than 1 teaspoonful, or if you become worried, please call our office at (336) 273-9932 or go directly to the nearest hospital emergency room. Do not eat or drink anything prior to going to the hospital as you may need to be taken to the operating room in order to control the bleeding.

GENERAL CONSIDERATIONS

  1. Brush your teeth regularly. Avoid mouthwashes and gargles for three weeks. You may gargle gently with warm salt-water as necessary or spray with Chloraseptic®. You may make salt-water by placing 2 teaspoons of table salt into one quart of fresh water. Warm the salt-water in a microwave to a luke-warm temperature.
  2. Avoid exposure to colds and upper respiratory infections if possible.
  3. If you look into a mirror or into your child's mouth, you will see white-gray patches in the back of the throat. This is normal after having a T&A and is like a scab that forms on the skin after an abrasion. It will disappear once the back of the throat heals completely. However, it may cause a noticeable odor; this too will disappear with time. Again, warm salt-water gargles may be used to help keep the throat clean and promote healing.
  4. You may notice a temporary change in voice quality, such as a higher pitched voice, a helium-like sound, or a nasal sound until healing is complete. This may last for 1-2 weeks and should resolve.
  5. Do not take or give you child any medications that we have not prescribed or recommended.
  6. Snoring may occur, especially at night, for the first week after a T&A. It is due to swelling of the soft palate and will usually resolve.

WARNING SIGNS

If any of the following should occur, please call our office:

  1. Bright red bleeding that lasts more than five minutes.
  2. Persistent fever greater than 102oF.
  3. Persistent vomiting.
  4. Persistent cough.
  5. Severe and constant pain not relieved by prescribed pain medication.
  6. Rash or unusual side effects from any medications.

TONSILLECTOMY & ADENOIDECTOMY - ADDITIONAL POST-OPERATIVE CONSIDERATIONS

  1. Most patients (95%) are able to go home on the first day after their T&A. You will be given prescriptions for pain medicine and an antibiotic, if indicated.
  2. The most important thing to remember is to drink at least four 8-ounce glasses (32ounces total/day) of liquid a day. We are more concerned about how much you drink than how much you eat.
  3. Although rare, there is a risk of having some bleeding during the first 2 weeks after having a T&A. This usually happens between days 7-10 post-operatively. If you should have any bleeding, try to remain calm. We recommend sitting up quietly in a chair and spitting out the blood gently. For adults and older children, gargling gently with ice water may help. If the bleeding does not stop after a short time (10-15 minutes) or if you become worried, please call our office at (336) 273-9932 or go directly to your nearest emergency room. Do not eat or drink anything prior to going to the hospital as you may need to be taken to the operating room to control the bleeding.
  4. A low grade fever (less than 102o F) is not unusual during the first week after a T&A and is usually due to not drinking enough liquids. We suggest that you use liquid Tylenol® every 4 hours in order to keep your temperature below 102o F.
  5. Do not take Aspirin or any products that contain aspirin or aspirin-like products such as Motrin®, Ibuprophen, Advil®, B.C. powder®, Ecotrin®, Aleve®, etc. 2 weeks before and after a T&A because it can promote bleeding. Please do not take any other medications that have not been prescribed by your doctor during the 2-week post-operative period.
  6. If you look into a mirror, you will see white-gray patches in the back of the throat. This is normal after having a T&A. It is like a scab that forms on the skin after an abrasion. It will disappear once the back of the throat heals completely. However, it may cause a noticeable odor; this too will disappear with time. Warm salt-water gargles may be used to help keep the throat clean and promote healing.
  7. You may experience ear pain after having a T&A. This is called "referred pain" and comes from your throat but is "felt" in the ears. Ear pain is quite common and expected and will usually go away after 10 days. There is usually nothing wrong with your ears. Use either the prescribed pain medicine or Tylenol® as needed.
  8. You should notice a gradual decrease in pain during the end of the first week. However, you may then experience
    1-2 days of increased pain toward the end of the week. The pain is secondary to losing the "scabs" that were protecting the operated area and will disappear once complete healing has occurred.
  9. We encourage limited "indoor" activity during the first week. Avoid heavy lifting, straining, sports, bike riding, etc. for at least 2 weeks after a T&A.
  10. Please call our office at 336-273-9932 if you have any questions.

 

Growth Following Adenotonsillectomy

Czechowicz & Chang have studied patterns of change in weight ands stature percentiles in children after adenotonsillectomy. They found definite weight gain in patients who were smaller and younger at the time of operation. Weight percentiles increased by 6.3 percentile points. Body mass index percentiles increased by 8.0 percentile points.

The greatest increases were in children who were betweeen the 1st. and 60th percentiles for weight preoperatively and children who were younger than 4 years of age at the time of operation. An increase in weight percentile was not seen in children who were above the 80th percentile in weight preoperatively. There was no increase in rates of obesity in the study group.

Click here to download a copy of the Czechowicz & Chang article as a pdf file and print.

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Last revised June 25, 2014