Preparing for a Tonsillectomy and Adenoidectomy – Adult
This information was prepared to answer your questions about tonsillectomy with or without adenoidectomy. Please keep this information and read it carefully. You may wish to write down any questions to ask the specialist and/or nurse.
When your surgery is scheduled, information about when and where to go will be given to you. You will also be given fasting instructions.
Unless otherwise specified by your specialist, aspirin and non-steroidal anti-inflammatory drugs should NOT be used for at least seven days before the surgery.
Please bring with you to hospital:
Clean pyjamas/night wear
A book or activity as there may be a wait before your procedure starts
On the day of surgery
The surgery will take about 45 minutes. You will spend about 3-4 hours in the Post Anaesthetic Care Unit (PACU)/Daystay unit. Most patients go home after this time. If you are not sufficiently recovered you may need to stay longer and occasionally may need to stay overnight.
If you have surgery for sleep disordered breathing or obstructive sleep apnoea, you may be kept in hospital for longer than 4 hours to observe your breathing. If you have other health issues or do not have a responsible adult to collect you and be with you for 24 hours, an overnight stay is recommended.
Before being discharged home, you will be checked by the specialist and nurse. This is to make sure that there are no signs of bleeding, you are well hydrated and have eaten some food and your pain is adequately managed.
You will have a very sore throat after surgery. The sore throat will last for up tp 10 -14 days. Pain may increase between the 5th and 10th day. Vague discomfort with yawning or eating can persist for several weeks.
You can control the pain by taking the prescribed medications (see “Medication” section).. This should be given regularly rather than waiting for the pain to return. Drinking enough liquid and eating the right food will also help (see “Hydration/Diet” section).
Chewing gum between meals helps to relieve pain from muscle spasm at the back of the throat and jaw muscles and increases salivation and so encourages regular swallowing.
Pain may be worst first thing in the morning when you first wake up. Administer pain relief and wait for 20-30 minutes before trying to eat food or drink, to allow the medication time to work. Paracetamol is the ideal pain reliever to use before food as anti-inflammatories such as Ibuprofen can irritate an empty stomach.
Earache is common after tonsillectomy and/or adenoidectomy. This is because the same nerves that sense pain in the throat also go to the ears. The earache can change from being a little bit painful to being very painful and can also increase between the 5th and 10th day after the operation. Earache should be managed in the same way as the sore throat.
Several methods of pain control are used to keep you as comfortable as possible. These will be discussed with you in the specialist’s rooms and on the day of surgery. Medication will be given in the operating room and the PACU/daystay unit. This medication provides pain relief when you first wake up. It will last four to six hours.
You will be provided with medications on discharge either with a prescription to take home, or medication will be supplied through Ascot Pharmacy prior to your discharge. Usually a combination of 2 or 3 different pain killers will be prescribed that can be taken in rotation, so as not to exceed the safe daily dosages. It is a good idea to hold a dose back in reserve to be taken in the middle of the night if necessary.
Some painkillers (codeine based or tramadol) cause constipation and taking Kiwicrush or prunes or prune juice is recommended to prevent this.
A dose of prophylactic antibiotics is usually given in the operating theatre. Antibiotics are not routinely prescribed to take home, as there is little evidence that this reduces the chance of post-operative infection and is more likely to contribute to post-operative nausea and vomiting. Your surgeon may make an exception to this In certain cases .
Difflam gargle or spray is useful as it contains a local anaesthetic for the back of the throat, especially in the first few days after surgery.
Pain relief next due:_______________________________________________________________
After surgery, start taking clear fluids. This can include: water, apple juice, flat ginger ale or lemonade, ice blocks and jelly. You may prefer cool fluids. Avoid citrus juice as it may sting.
If you vomit, wait a half hour before starting the fluid again.
Adequate fluid intake is needed to ensure good hydration, decrease pain and nausea, prevent stiffening of the throat muscles, stop a crust from forming, and make swallowing easier.
Adequate fluid intake means at least 2-3 litres per 24 hours. You do not need to wake up at night if you have had enough fluids during the day. You have had enough fluids during the day if you urinate at least three times a day.
Diet following tonsillectomy
A normal diet is started the day of surgery and eating well is crucial to making a speedy recovery, reduces the chance of post-operative infection and the act of chewing and swallowing clears the back of the throat to aid healing. There are no restrictions on what you can eat, but very hot food or drinks or spicy food is better avoided.
You will need to be kept in the hospital until your surgeon/ nursng staff are satisfied that you are eating and drinking enough to manage at home.
Bright red blood in your throat or vomit, and/or coffee ground vomitus is a sign of bleeding.
There is a possibility of bleeding after surgery. The risk is about 3-5% after tonsillectomy. The risk is highest on the day of surgery itself and then between the 5th and 10th day after surgery. Blood may come from the nose, mouth, or be seen in spit or vomit. Good hydration and eating well reduces the risk of bleeding. Minor bleeding usually settles with rest and sucking ice chips / blocks.
If bleeding occurs that is anything more than a spot or streaking of saliva, contact your GP or specialist but do not delay attending your local A&E right away if there is significant fresh bleeding that lasts for more than 10 minutes. Rarely patients may be taken back to the operating theatre to control post-operative bleeding.
It is normal for the back of the throat to be covered in a yellow layer where the tonsils have been removed . This is called slough and gradually clears away as the throat heals. It is not a sign of infection. However if patients do not eat and drink properly, this slough can build up and become infected and cause bleeding.
It is strongly recommended not to smoke post-operatively.
If you have chosen to be given back your tonsils after they are removed, it is important that they are handled in a safe manner. They will begin to rot after a few days and should be disposed of or buried in a responsble manner.
Time off work
It is recommended that you rest at home for 2 weeks after a tonsillectomy and strenuous activities / sports during that time. It is normal to feel tired and lethargic .
From an anaesthetic point of view, please do not:
Drive a car as a safety precaution for yourself and other road users; also you may not be covered by insurance during these 24 hours.
Operate machinery; this includes some everyday items: e.g. kitchen appliances, lawnmowers.
Sign any legal documents or make important decisions.
Drink alcohol for 24 hours following your anaesthetic.
Your follow up appointment in the specialist rooms will be 3-4 weeks following your surgery. This visit should be scheduled prior to or at the time of your surgery. If you do not have an appointment made please contact Nicky at the specialist rooms on 09 6235644.
Contact your specialist if:
Persistent vomiting, more than three times in a day.
Pain that does not lessen even after taking your prescribed medication.
You have a high temperature, above 37.5ºC for longer than four hours.
A sore throat or earache that lasts longer than 10 days after surgery and is not improving.
You become generally unwell.
The Day Stay nurses are available 730 am-6.00pm, Monday to Friday, to answer any enquiries regarding discharge advice.
Phone: 520 9500 (operator) 520-9575 (Daystay reception.)