Having A Tonsillectomy Or Adenotonsillectomy

Key points about tonsillectomies and adenotonsillectomies

• a tonsillectomy is an operation to remove the tonsils
• an adenotonsillectomy is an operation to remove both the adenoids and tonsils

You may find it useful to read the page on tonsillectomy and adenotonsillectomy first. This has information about what tonsils and adenoids are and why they may need to be removed. 

Read about tonsillectomy and adenotonsillectomy

Who does tonsillectomies and adenotonsillectomies?

The surgeon doing this surgery is called an ENT (ear, nose and throat) surgeon, sometimes called an ORL (otorhinolaryngology) surgeon. 

What do I need to know before a tonsillectomy or adenotonsillectomy?

Your child will only need to spend a few hours at the hospital and usually won't need to stay the night.  

Your child will have a general anaesthetic. The anaesthetist will talk with you about this and you should feel free to ask them questions. 

Your child will not be allowed to eat or drink anything before the operation. You will get instructions about this from your local hospital. 

Your child's surgeon will explain the operation, and any other treatment needed. You should also feel free to ask the surgeon any questions you have.

You will need to sign a consent form before the surgery.

What happens to my child during a tonsillectomy or adenotonsillectomy?

The operation usually takes less than an hour.

The surgeon will do the operation through your child's mouth.

There are usually no stitches.

Do some children need to stay overnight after a tonsillectomy or adenotonsillectomy?

In some centres, your child will be able to go home the same day as their operation. In other centres, your child will stay in hospital overnight. 

Some children with severe obstructive sleep apnoea before the operation may need closer monitoring of their breathing in hospital after the operation. These children may need to stay in hospital longer.

What can I expect after my child's tonsillectomy or adenotonsillectomy?

There will be a small raw patch, like a graze, on each side of your child's throat where the tonsils were.

After surgery your child will need to rest and may not feel like doing much.

Do not plan a holiday away with your child during the 2 week recovery period.

It is normal for your child to:

• have a sore throat for the first 1 to 2 weeks
• have difficulty with swallowing.
• not like eating certain foods or brushing their teeth
• have bad breath
• have white patches where the tonsils used to be

They may also have:

• sore ears
• voice change which will improve
• a runny nose
• snoring, which could take up to 1 month to settle

How can I care for my child after a tonsillectomy or adenotonsillectomy?

Pain relief

After surgery it is important to give regular pain relief (paracetamol and ibuprofen) for at least 5 days and possibly up to 2 weeks.

It may help to set a reminder alarm for yourself on a clock or a phone.

Children need good pain relief to stop them having to go back to hospital.

Some children may get a prescription for stronger pain relief such as tramadol.

Days 4 to 7 after surgery can often seem a little worse. After this, a child gradually gets better. 

Make sure you don't give your child any aspirin or aspirin-containing medicines (such as Aspro, AsproClear or Codis). If you are unsure, check the label and see if it mentions the words aspirin or salicylic acids. Aspirin may increase the risk of bleeding during or after the operation and may increase the risk of a serious and rare disease named Reye syndrome.

Eating and drinking

Encourage your child to eat and drink as normally as possible.

Give your child pain relief 30 minutes before mealtimes to help reduce the pain when swallowing. 

It is important for your child to eat and drink as this helps to clean and heal the throat and reduces pain and bleeding.

Soft foods such as yoghurt and ice cream are comfortable to eat.

It's good to include hard or crunchy foods as the chewing and swallowing helps healing. 

Avoid spicy and acidic foods for a few days.

If your child is not eating much in the first few days, give them plenty of fluid to drink.

Brushing teeth

It is important to continue brushing teeth both morning and night.

It may be a challenge to get your child to brush their teeth after surgery.  Please keep trying. Doing this will keep the mouth clean and will help the painful areas heal more quickly. 

It will also freshen your child’s mouth, particularly if they arenot eating very much.

Nausea and vomiting 

If your child starts vomiting, stop giving food. Wait one hour, then trial fluids, if they can drink without vomiting, they can start trying to eat.

If your child continues to vomit and cannot drink fluids after 2 to 3 hours, seek medical advice.

School and activities

Most children will take a minimum of a week to recover from surgery and to be eating normally. 

Your child should:

• not go to school or daycare for 10 days after they leave hospital
• rest as much as possible for the first few days after surgery
• not participate in sporting or strenuous activities for the first 2 weeks
• not swim for 2 weeks
• avoid sniffing/nose blowing for 2 weeks 
• avoid contact with people who are sick with coughs and colds 

Your child will be completely healed when they are eating and drinking normally without needing regular pain relief.

What are the complications from a tonsillectomy or an adenotonsillectomy?

Bleeding

Bleeding after a tonsillectomy can happen in up to 4 out of 100 children for up to 2 to 3 weeks after surgery.

Your child is at most risk of a bleed around day 7 after surgery. 

If your child coughs or spits out more than a teaspoon of blood, has a nosebleed or vomits blood, please take them straight to the emergency department at your local hospital. 

If you do not have transport or if this is a large bleed, please dial 111 (in New Zealand) for an ambulance. 

Sometimes the bleeding will settle without treatment, but some children may need to go back to hospital.  Sometimes, an operation to stop the bleeding may be necessary.

Fever

• if your child looks well but has a fever, take them to your GP
• if your child looks very unwell and has a fever, take them to the emergency department at your local hospital or call 111 (in New Zealand)

You know your child best. If you are concerned, seek medical advice.