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Tonsillectomy and Adenoidectomy

Indications

History - one required

a) Patient with 3 or more infections of tonsils and /or adenoids per year despite adequate medical therapy.

b) Hypertrophy causing dental malocclusion or adversely affecting orofacial growth documented by orthodontist.

c) Hypertrophy causing upper airway obstruction, severs dysphagia, sleep disorders, or cardiopulmonary complications.

d) Peritonsillar abscess unresponsive to medical management and drainage documented by surgeon, unless surgery performed during acute stage.

e) Persistent foul taste or bad breath due to chronic tonsillitis not responsive to medical therapy.

f) Chronic or recurrent tonsillitis associated with the streptococcal carrier state and not responding to beta-lactamase-resistant antibiotics.

g) Unilateral tonsil hypertrophy presumed neoplastic.

h) Recurrent suppurative or otitis media with effusion. (Adenoidectomy alone. Tonsillectomy added requires one of the indications listed above).

Instructions

Pre-Operative (Before):
Take multi-vitamin for 2 weeks prior to surgery.

Hospitalization: Ambulatory procedure - discharged the day of surgery.

Post-Operative:

• Moderate to severe throat pain for 2-3 days.
• Painful swallowing and throat discomfort for 7-10 days
• Ear discomfort and/or pain for 7-10 days.
• May have low-grade fever for 2-3 days
• First few days adequate intake of fluids necessary: apple juice, soda, ices, ice cream, jello, pudding, yogurt, soup, etc.
• Advance to cereal, pasta, cottage cheese, soft foods as tolerated.
• Regular diet in 12-14 days.
• Avoid citrus for 14 days; avoid red dyes for 3-4 days.
• The best time to eat or drink is 20-30 minutes after pain medicine if necessary.
  

** NO MOTRIN OR ADVIL FOR 3 WEEKS**

Medications:

Antibiotics: Ten days post-op to improve healing.
Analgesics: Liquid medication, such as Tylenol with codeine, will be necessary for the first few days. May be renewed at Pharmacy.
Topical Anesthetics: Cepacol Spray, Sucrets (spray or lozenges) may be used, although it may burn when first applied.

Office Follow-up:

• CALL FOR AN APPOINTMENT
• Requires only one visit in approximately 10-14 days.
• No school or daycare before postoperative visit.
• Avoid people, except immediate family, for 7 days.
• Call office if fresh bleeding occurs or a rash develops from medication.
• Blood tinged saliva is normal.
• The mouth and pharynx heal by forming a fibrin clot, which is later sloughed off. This forms a whitish coating around the surgical site. This is normal healing and no attempts to remove it should be made.
• If an Adenoidectomy is performed, the patient's voice will sound nasal and higher pitched for up to 2-3 months. As the soft palate becomes accustomed to the wider space, this will resolve. Only Tylenol is necessary post Adenoidectomy discomfort. Neck stiffness may occur after Adenoidectomy and usually resolves without any treatment.

Complications

1. Anesthesia: The most common problem with anesthesia is post op nausea and vomiting. Medication will be given to help alleviate this complication. If there have been problems with anesthesia in the immediate family please notify us and the anesthesia team.

2. Bleeding: Post operative bleeding occurs most frequently in adult Tonsillectomy patients. It may occur in up to 5 % of patients and approximately 2% in children as reported in the world literature. Our practice has a much lower rate. Most bleeding occurs 4-8 days post operatively. This is often controlled by staying calm and drinking/rinsing with cold water. Occasionally the patient may be treated in the office or the operating room.

3. Pain: Motrin, Advil, Aspirin, etc. are not used for 3 weeks post op. Only Tylenol is necessary for Adenoidectomy. Tylenol or Tylenol with codeine type medications are often used after Tonsillectomy Surgery. Ear pain may occur on post op day 5-7 and resolves on it's own.

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