Download Tonsillectomy Adenoidectomy

TONSILLECTOMY AND/OR ADENOIDECTOMY: PATIENT INFORMATION
Date:______________________
Dear ______________________:
Please find the following literature informative and helpful with respect to your upcoming surgical procedure.
You (or your child) have been scheduled to undergo the surgical procedure of a Tonsillectomy and/or Adenoidectomy. The tonsils and
adenoids consistent of lymphoid tissue, the first line of defense against infection entering the nose or throat. These structures are
important to the immune system during infancy. Later, after repeated infections, these structures can become the source of disease
themselves by harboring bacteria in the crypts leading to reinfection of the throat. These structures may also become enlarged and
interfere with breathing, facial bone and oral cavity development, cause an abscess, promote obstructive sleep apnea, or harbor a
neoplasm or cancer. Large adenoids can potentiate recurrent sinus or ear infections. The procedure of Tonsillectomy/Adenoidectomy is
performed on an outpatient basis and usually takes 25-45 minutes. The operation is performed through the mouth with the jaws retracted
open with a small instrument (mouth gag) which may lead to chapped lips, limited gum and lip abrasions, and even swelling or numbness
of the tongue. It is common to develop some degree of swelling of the uvula on the roof of the throat. The throat will be uncomfortable
for at least 7-10 days after surgery and pain medication will be prescribed to tolerate the pain. Postoperatively, the patient will be
observed briefly in the Recovery Room until drinking and eating is resumed. Thereafter, the patient will be discharged to home for
recovery. One week after surgery you will be seen for a scheduled follow-up appointment. It is required that all patients be excused from
school or work for one week after surgery and all strenuous activity, sports, and excessive playing be avoided for up to two weeks
postoperatively.
As with any surgical procedure, Risks/Complications can occur. These include any of the following:
1. Fever: It is not uncommon to run a low grade fever for the first few days following surgery; but persistent or recurrent high grade
fevers (greater than 101) should be brought to our attention. The white plaques noted in the tonsillar area shortly after surgery are
scabs and do not represent infection. Fevers should be initially treated with Tylenol.
2. Ear Pain: This is common after surgery and does not indicate an ear infection, but merely referred pain from the tonsil bed area.
The onset of this discomfort is often delayed.
3. Bleeding: Occurs in 2-4% of patients. Bleeding most commonly occurs within the first 24 hours after surgery or at approximately 710 days postoperatively when the healing scabs begin to dissolve. Though vomiting often occurs shortly after surgery and may
contain dark blood, repeated episodes of vomiting bright blood or blood clots are worrisome. If bleeding occurs at home, stay calm
and sit upright, and begin sipping iced liquids. If the bleeding does not diminish, you need to seek immediate medical attention.
Measures to avoid postoperative bleeding is to limit physical activity, chew gum, resume a normal diet as soon as possible, and avoid
all blood thinners.
4. There may be some underlying voice changes or regurgitation of fluids into the nose during swallowing following surgery. This is
due to the anatomical change of the throat. Usually this resolves within 3-6 months and rarely is permanent. Speech and swallowing
therapy may be recommended.
5. There are other problems which can occur after tonsillectomy, but these are less frequent.
Postoperative Instructions After Tonsillectomy/Adenoidectomy:
1.
2.
Activity: The patient should rest quietly with the head slightly elevated for the first 72 hours after surgery. Activities may be
gradually advanced on a day to day basis, but heavy lifting, bending, stooping, strenuous activity, sports and sexual activity should be
avoided for two weeks postoperatively.
Medications: Take prescribed medications as directed. It is important to stay consistent with your pain medication postoperatively.
“Catching up with pain” is often very uncomfortable experience for the patient. Take pain medication every 4-6 hours as needed
after surgery. In adults, steroids may be initiated (Medrol Dosepak) three days after surgery to reduce discomfort and swelling.
Children are to take prescribed medication or Tylenol Elixir for pain. You may use an ice collar over your neck for added comfort if
you desire for the first 24-48 hours. Postoperatively, delayed ear pain is normal. This pain will begin 3-4 days after surgery and is
referred from your throat. It will decrease as the tonsil fossae heal. It is intensified at nighttime and is sometimes worse than the sore
throat. Never utilize aspirin products, medicines containing aspirin, anti-inflammatory medications (i.e., Advil, Motrin, Naprosyn…)
or herbal therapy, high dose vitamin E for at least two weeks after surgery as these medications thin the blood and may promote
bleeding.
3.
4.
5.
6.
It is very important to maintain adequate fluid intake postoperatively to avoid dehydration which can progress to increased pain,
fatigue and lightheadedness. Drinking 7-8 glasses of fluid daily is required.
The throat will demonstrate white plaques where the tonsils were removed. These are areas which were cauterized during surgery to
control bleeding. They will dissolve and disappear with time. The sooner you resume eating, the more quickly these scabs dissolve
and the tonsillar fossae heal. Also, the uvula (structure hanging from the middle of the roof of the mouth) may become swollen and
lead to discomfort with swallowing, mild breathing problems or a foreign body sensation. This will resolve spontaneously with time.
Postoperatively, if you develop persistent bright red oral bleeding please call the office (303) 651-6770, the Emergency Room
(303) 651-5000 or the answering service (303) 684-3043.
Patients who have undergone an adenoidectomy should avoid blowing the nose for the first week.
Post Tonsillectomy Diet:
It is very important to eat during the postoperative period. The act of chewing and swallowing dissolve the scabs away in the
throat area, expedite healing and reduce the risk of bleeding. Chew gum between meals, but avoid any aspirin type products.
Avoid throat antiseptic sprays. You may eat almost anything you desire or that which is tolerable. Recommended
restrictions should be the avoidance of acidic type food/liquids (oranges, lemons, grapefruit, tomato products or salty food).
Avoid excessively hot foods, sharp foods (hard candy, popcorn) and the utilization of straws. One should also avoid
food/liquid products which are red colored as this may simulate postoperative throat bleeding.
Postoperative Meals/Day Of Surgery: Cold/cool or frozen food products.
Cold milk and milk beverages (limited)
Carbonated beverages (i.e., 7-Up)
Iced tea
Koolade (avoid red coloring)
Popsicles
Ice cream, sherbert and ice chips
First Day Meals/Morning after surgery: Tend towards soft foods.
Cereals (cooked and ready to eat)
Broths, soups or ramein noodles
Pudding, custards, Jell-O
Cottage cheese, cream cheese, cheese
Canned fruits and applesauce
Eggs (poached and scrambled)
Mashed potatoes, soft vegetables
Toast and sandwiches on soft bread
Sliced meats
Second Day Meals
By this time you should progress to a regular diet or solid foods which you can tolerate.
Lastly, for any questions or concerns please call the Office at (303) 651-6770 or the Answering Service after hours (303)-684-3043.
The majority of tonsillectomy/adenoidectomy procedures are well tolerated and uneventful. The office personnel, hospital staff and Dr.
Schmid are always concerned about your welfare and are available to assist and support you during your recuperation. Please do not
hesitate to ask for assistance at any time. Please call our office postoperatively to make an appointment for follow-up at one week after
surgery.
After you have read and understand these instructions, please sign the acknowledgment below.
______________________________
Patient Signature
____________________________
Date
______________________________
Witness/Surgeon Signature
____________________________
Date
PMS/rdc-7/1/09
(Tonsillectomy/Adenoidectomy)