What are Tonsils?
The tonsils are two clusters of tissue in the back of the throat on either side of the uvula. They are made of lymphoid tissue, which is meant to fight off infection in childhood. They begin to grow at age 1, peak in size at age 4-5, and should shrink and go away by our teenage years.
Why Are Tonsils Removed?
- Adults most commonly undergo tonsillectomy for frequent throat infections. These infections are due to bacteria and/or fungus that live deep inside the tonsillar tissue and flare up when the immune system is stressed. Rarely, one severe infection or abscess can be enough to require surgery. Although tonsillectomy will not prevent the common cold or every sore throat, it does remove a source of infection and ultimately leads to a better quality of life.
- Tonsils can also be removed because they are too big and block breathing passages. Tonsils are meant to dissolve in childhood, but they can remain enlarged and cause airway obstruction. This can lead to snoring, shortness of breath, and/or food getting stuck in the throat.
- Sometimes tonsils produce frequent tonsil stones. This can result in frequent sore throats and bad breath. The only permanent solution is tonsillectomy.
What Are My Instructions Before Surgery?
- Tonsillectomy is performed in the hospital as an outpatient surgery, which means you come in and go home the same day. You may arrive at the hospital by yourself, but someone must accompany you home because you will be too lethargic to get home safely on your own.
- Before surgery, you must have a physical exam by your primary care doctor. This must be done within 30 days of surgery to make sure you are in good health, and your doctor needs to complete the History and Physical form provided by our office. We must receive the completed form at least 1 week before the day of surgery. Alternatively we can arrange for you to go to presurgical testing at the hospital.
- Medicines like Motrin, Advil and Ibuprofen should be strictly avoided for 7 days before and 14 days after surgery because they decrease the body’s ability to clot blood. Tylenol is safe to take. Many over-the-counter products contain aspirin, so be sure to read labels carefully.
- You cannot eat or drink anything after midnight the night preceding surgery. An empty stomach prior to anesthesia prevents stomach contents from leaking into your breathing passages while you are asleep.
- The night before surgery someone from the hospital will call to let you know when to arrive.
On the Day of Surgery
You must arrive at the hospital at least 2 hours prior to surgery. You will be taken to the holding area where you will meet the anesthesiologist and speak with Dr. Dahl before surgery.
How are the tonsils removed?
Tonsillectomy is a surgical procedure requiring general anesthesia. It usually takes 20-30 minutes. The tonsils are removed through the mouth by shaving them out with a device called a microdebrider. This technique spares the underlying muscle, resulting in a less painful recovery and decreased risk of post operative bleeding. Electrocauterization is used to burn the surface of the muscle to control bleeding. Using this technique, there is much less scarring and the normal throat architecture is maintained. There is the possibility that tonsillar tissue will grow back, but this is rare. The biggest risks of surgery are bleeding (less than 1%), infection, and the risks of general anesthesia.
What can I expect after surgery?
When surgery is over, you are taken into the recovery room. It may take 1-2 hours for you to fully wake up. After you are drinking fluids, your IV will be removed, and you can be discharged home with your escort. You must have someone accompany you home. You will be given prescriptions for antibiotics and pain medicine.
What should I expect when I go home?
- An upset stomach and vomiting are common for the first 24 hours after surgery (due to anesthesia).
- This procedure can be very painful. The pain is usually worst on day 3, but it can last for up to two weeks. As soon as you get home, take Celebrex to reduce the inflammatory pain. Celebrex should be taken every 24 hours for the first 10 days. Vicodin can be taken every 4-6 hours for the first 3-4 days to stay ahead of the pain then as needed after that. Once the pain sets in, it is harder to “chase” it. Keep in mind that pain medication, like Vicodin, (which contains hydrocodone) can cause nausea and constipation, so do not take it on an empty stomach.
- It is common to have neck soreness, bad breath, white patches on the back of the throat, tongue pain, fever, and ear aches as the throat is healing. The back of the throat will look dark grey or white and have an open, raw surface. There will also be a bad smell. This is normal and due to healing scabs and not from an infection. During the first two post-operative weeks the scabs slowly fall off with normal swallowing.
- Do not take any medicines that have not been prescribed or recommended by your doctor. Medicines like aspirin, ibuprofen, and many others will increase the risk of severe bleeding for 2 weeks after surgery. Only Tylenol is safe If you are not sure if a medicine is safe, please call your doctor.
- You can resume normal activity as soon as you feel up to it, but you cannot perform sports or heavy exercise for the first 7-10 days. You may return to work when ready. Most patients return 5-7 days after surgery. Do not travel out of reach of your doctor before this time.
What can I eat and drink after surgery?
Cool liquids such as apple juice, water, popsicles, and jello are soothing. You may also try soft foods such as ice cream, milk shakes, smooth yogurt, pudding, applesauce, cooked cereal, fruits, cottage cheese, mashed potatoes, scrambled eggs, and pasta. You should avoid foods that are crunchy or have hard edges such as corn chips, pretzels, and popcorn. Also avoid foods that are very hot in temperature, spicy, or have citrus juices, including tomato sauce, because they will cause pain. It is very important that you drink plenty of fluids to avoid dehydration.
What else do I need to know?
Blood tinged saliva is common during the first few hours after surgery. It may occur again 10 to 14 days after surgery as the scabs in the back of the throat come off. If you cough up, throw up, or spit out bright red blood or blood clots you should call Dr. Dahl immediately. Although rare, this type of bleeding can occur up to 2 weeks after surgery and may require additional surgical treatment. Also, you MUST schedule a post-operative visit in the office 1-2 weeks following surgery. This visit is very important to make sure your throat is healing properly.