What to Expect When ENT Recommends Tonsillectomy
To understand a tonsillectomy, it’s important to understand what is impacted by the surgery. The tonsils are located on both sides of the back of the throat and are two clusters of tissue. The adenoids are high in the throat behind the nose and the roof of the mouth. If an ear, nose and throat professional (ENT) mentions removing your child’s tonsils or adenoids it is to improve your child’s health and quality of life.
The most common reason the ENT recommends removal of tonsils or adenoids is because of recurring infections. One case of tonsillitis generally isn’t enough to warrant surgery. However, if your child has three or more episodes a year for several years, or five or more episodes in one year, the ENT may discuss removal of tonsils or adenoids as a way to stop these recurring infections. When recurrent infections begin to cause deterioration in the quality of life due to difficulty sleeping, airway obstruction, sleep apnea or missed time from school or work, don’t be surprised if the ENT makes this recommendation.
What Happens During a Tonsillectomy
Most ENTs perform tonsillectomy surgery on an outpatient basis; however, if your child is very young an overnight stay in a hospital may be required. The actual surgery is short, only lasting about 30-45 minutes.
The tonsils can be removed using different surgical procedures:
Cold scalpel uses an ultrasonic scalpel to completely remove the tonsils. It is the most common method, requires general anesthesia and results in minimal post-operative bleeding.
Electrocautery removal uses an instrument with a very hot tip to releasing electric currents. These currents produce heat that destroys swollen tissues. The ENT uses this procedure to remove tissue and cauterize the blood vessels to control the bleeding. This method has an increased risk of tissue damage. This damage may make the post-operative period a little more uncomfortable.
Microdebriders are used by the ENT to remove only the part of the tonsil that is blocking the airway. This surgical tool is shaped like a rotary shaving device and usually results in less pain and a faster recovery.
Laser tonsil ablation uses a handheld carbon dioxide laser to vaporize the tonsil. ENTs find this method to be quick and result in a recovery with little discomfort or bleeding.
After the ENT Sends You Home
Regardless what method is used to remove the tonsils, there will be a recovery period. For most kids this is about a week to a week and a half. During this time, there are certain protocols that can expedite recovery:
Liquids: Starting immediately after surgery, your child can have liquids such as water or apple juice. Drinking plenty of liquids is an important part of the recovery process. Occasionally, children may experience nausea or vomiting after the surgery. This usually occurs within the first 24 hours as a result of the anesthesia and will go away once it wears off. Call the ENT if you see signs of dehydration, such as urination less than two to three times a day or crying without tears.
Food: ENTs generally recommend a soft diet during the recovery period. The quicker a child eats and chews, the sooner they recover. Some children may be reluctant to eat because of throat pain and could lose a little weight. This is normal and should be gained back after a normal diet is resumed.
Fever: You may notice a low-grade fever the night of the surgery and for a day or two afterward. Call the ENT if the fever goes over 102ºF or persists longer.
Activity: Slowly return to normal activity. Your child can return to school after they are eating and drinking normally, they don’t need medication for pain and can sleep through the night. Don’t travel on airplanes or far from a medical facility for two weeks following surgery without discussing it in advance with your ENT.
Breathing: You may notice some snoring and mouth breathing. This is due to swelling in the throat. Things should return to normal when swelling subsides about 10-14 days after surgery.
Scabs: Scabs will form where the tonsils were removed. This is normal and they can appear as thick, white spots. They may cause bad breath. Most scabs break into small pieces and fall off around five to 10 days after surgery
Bleeding: You might see a few specks of blood from the nose or in the saliva, but you should not see bright red blood. If you child experiences bright red bleeding call the ENT right away or take the child to the ER.
Pain: Almost all children will have mild to severe pain in the throat after surgery. Additionally, some may also complain of an earache or pain in the jaw and neck. The ENT will monitor and prescribe medication to control this pain. It may be in liquid or suppository form.
It’s natural to be worried about your child after surgery. Remaining calm will help your child remain calm. If you have questions or concerns about the recovery process, don’t hesitate to call your ENT.