Tonsillectomy and adenotonsillectomy post-operative care.

 

Following tonsillectomy when you examine your own or your child's throat you will notice a white slough on either side of the throat where the tonsils used to be. This is normal and is a normal healing wound. This appearance will persist for a couple of weeks. The uvula (the small dangly bit at the back of the soft palate in middle) may look bruised, swollen or ulcerated but this will heal. After a week or so the area where the tonsils were may appear a little yellow with some redness around the edges and may indeed be a little smelly. This is nothing to worry about. Earache is common following tonsillectomy and is due to referred pain from the throat to the ears. Throat pain will often get worse the first 3 to 4 days after tonsillectomy. It may be moderately severe anything up to 10 days after the surgery especially in an adult but then will settle day by day.

Routinely patients are now not prescribed any antibiotic during or after surgery.

Pain relief is based on the use of paracetamol, nurofen and narcotics.. Children up to and including the age of 12 are recommended to have regular baseline Panadol every six hours to try to stay ahead of the pain and this can be supplemented with nurofen. Beyond age 12 often Endone narcotic is prescribed in addition to these medications. Endone can sometimes result in nausea or constipation so if an adult who is taking nurofen feels that they are becoming constipated they should take a still softening agent such as coloxyl.

 

It is rare for children to require narcotics but occasionally a child who is particularly distressed by the pain may require a narcotic agent and in this instance Oxynorm liquid is usually prescribed. If you feel your child is not managing adequately with Panadol and nurofen medications please let me know.

 

Codeine containing medications such as panadeine, panadeine forte and Painstop should be avoided after tonsillectomy or adenoidectomy surgery.

 

A soft diet is recommended after tonsillectomy for two weeks. This would include soft soggy cereals such as soggy Weet-Bix, scrambled eggs, ice cream, yoghurt, soft fruits, soft pasta and soft sandwiches. Fluids are encouraged. Do not take hard sharp or salty foods such as dry toast or dry chips and avoid foods that take too much chewing such as firm meat. Lukewarm drinks are permitted but not hot drinks. If all child tolerates for several days after removal of the tonsils is ice cream, water and yoghurts then that is fine - in the early post-operative period what really matters is that they get enough fluid and enough calories. It is not essential to rinse the mouth but if you wish to do so simply use a teaspoon of salt in a cup of boiling water and cool this until it is just warm. Rarely a child may dehydrate because they refuse to drink enough following the surgery. Often they may tolerate an icy Pole and this is the first thing usually given to them after the surgery and could be tried. If you are concerned regarding a lack of fluid intake let me know as very rarely a child may need to be readmitted to hospital and placed on an intravenous drip. Brushing the teeth is fine after surgery.

 

The main concern following removal of the tonsils and or adenoids is the risk of bleeding. The risk is very low with regards to adenoids. A small amount of streaky red blood in the mucus is not of any great concern but if you or your child were to spit up tablespoons of bright red blood any time up to 2 weeks or so after surgery you would need to present to your nearest accident and emergency department. Here in the Shire this at Sutherland Hospital.

 

For a week and a half following removal of the tonsils the patient does need to rest and take it easy at home. After 3 weeks vigourous activity such as sport can be commenced. I discourage flying or travelling to a remote area away from large hospitals for three weeks after surgery because of the very small risk of bleeding.

 

For adenoidectomy alone there are no restrictions upon dietary intake. The risk of bleeding following removal of adenoids alone is very small and generally children can be kept at home for two days and then return back to school, preschool or daycare. I do discourage vigourous activity such as sport for two weeks. Occasionally after removal of the adenoids a child may develop a bad breath 5 to 7 days after surgery which may persist for a few days. This is part of the normal healing response and is not of any particular concern. Very rarely after adenoidectomy a child may develop a very stiff and painful neck. This may be due to some post-operative inflammation called Grisel’s syndrome and needs to be treated seriously. Please let me know if you feel this is occurring to your child.

 

Occasionally children may have had a coblation procedure performed on the inferior turbinates at the time of having their tonsils and/or adenoids removed. All that is required for management of this is to use a dollop of nasalate cream on a cotton bud applied twice daily to each nostril rolling the bud approximately 1 cm gently inside the nostril for one week. Rarely a child may have a small amount of nosebleed following this procedure and this can be settled by simply pinching the nose shut for a minute or so.

 

Routinely I see patients at one month following removal of the tonsils and or adenoids and usually this appointment has been arranged for you by my secretary prior to surgery. If a work or carers certificate is required please contact my secretary and one will be sent to you. If there are concerns between your time of discharge and the follow-up appointment please not hesitate to contact my office on 9525 3500. In the early post-operative period if there are concerns after hours you can contact the hospital where the surgery was done and the nurses on the ward can answer your questions or get in touch with me if necessary.