Key points about tonsillectomy, adenoidectomy or adenotonsillectomy
- tonsillectomy is an operation to remove the tonsils
- adenoidectomy is an operation to reduce the size of the adenoids
- adenotonsillectomy is an operation to remove the tonsils and reduce the size of the adenoids
You may find it useful to read the page on tonsillectomy and adenoidectomy first. This has information about what tonsils and adenoids are and why they may need to be removed.
Who does tonsillectomies and adenoidectomies
The surgeon doing this surgery is called an ENT (ear, nose and throat) surgeon or is sometimes called an ORL (otorhinolaryngology) surgeon.
What happens on the day of a tonsillectomy or adenoidectomy
Your child's surgeon will explain the operation and any other treatment needed. You can ask the surgeon any questions you have when your child is being booked for the surgery. You can also ask questions on the day of the surgery.
You will need to sign a consent form before the surgery. Make sure you ask the doctor questions and discuss any concerns you may have before you sign the consent.
Fasting
Your child needs to have an empty tummy at the time of the surgery. Please check your appointment letter for instructions on when they need to stop eating food and drinking.
After stopping all food, your child can only have clear fluids. This includes:
- water
- lemonade and lemonade ice blocks
- cordial
- clear sports drinks or oral rehydration drinks
Milk and fresh fruit juice are not clear fluids.
General anaesthetic
Your child will have a general anaesthetic, which means they are fully asleep during the surgery. The anaesthetist (specialist doctor giving the anaesthetic) will explain this to you and will answer any questions you may have.
Operation
The operation usually takes less than an hour. The surgeon will do the operation through your child's mouth. There are no stitches and no cuts on the outside of your child’s face or neck.
Recovery
As soon as your child is awake after the surgery, your child will go to a recovery area. You can join them there. They will be allowed to eat and drink when they feel able to.
They will be kept for observation for a minimum of 4 hours. After this time, if they have recovered well after their surgery, many tamariki (children) will be able to go home. A prescription will be given for the medicines needed to help manage their pain at home.
Some tamariki, such as those with severe breathing problems before the operation or other medical problems, may need closer monitoring in hospital after the operation. These tamariki may need to stay in hospital overnight. If this is needed, one whānau (family) member will be able to stay the night with them in the hospital.
What to expect after a tonsillectomy, adenoidectomy or adenotonsillectomy
After the surgery
After surgery, your child will need to rest and take things quietly for two weeks. Your doctor will recommend that you don’t travel (or go away on holiday) with your child during this recovery period.
If you look in your child’s mouth, it is normal to have white patches, like a graze, on each side of your child's throat, where the tonsils were removed.
It is normal for your child to:
- have a sore throat, that is worse with swallowing, for up to 2 weeks after the operation
- often the pain is worse around 5 to 7 days after the surgery
- not like eating certain foods or brushing their teeth
- have bad breath
They may also have:
- sore ears
- a change in their voice - which will improve
- a runny or blocked nose
- snoring, which could take up to 1 month to settle
After general anaesthetic
Rangatahi (young people) should not operate machinery, drive or make important decisions for the rest of the day after their procedure.
Caring for you child after their surgery
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 if needed. Days 5 to 7 after surgery, their pain often can be a little worse. After this, their pain usually improves gradually over the second week. It can be helpful to write down when each type of pain relief has been given, to help keep track over the two weeks.
Tamariki need good pain relief to keep them comfortable and able to eat and drink well. Some tamariki may get a prescription for stronger pain relief, to use if the regular paracetamol and ibuprofen are not enough to manage their pain well. Do not give any other pain medicines than the ones that are prescribed for your child.
Eating and drinking
Encouraging your child to eat and drink as normally as possible is important. This helps with healing of the throat, helps reduce pain and reduces the risk of bleeding. If they are struggling to eat because of pain, make sure they keep hydrated, taking regular sips of fluid, chilled water, lemonade iceblocks, or chips of ice to suck on. Make sure they are taking their pain medicines regularly.
It can be helpful to give your child’s paracetamol dose 30 minutes before mealtimes to help reduce the pain when eating. Ibuprofen (brufen) can then be given with food when they are eating.
Soft foods such as yoghurt, smoothies and ice cream can be comfortable to eat when they are having pain swallowing. It is really good to include hard or crunchy foods when they can manage these, as this helps healing and reduces the risk of bleeding. Avoid hot temperature food, spicy food or acidic foods until they are able to manage these without pain.
Brushing teeth
It is recommended that your child continues with brushing their teeth both morning and night. Doing this will keep the mouth clean and will also freshen your child’s mouth, particularly if they are not eating very much.
School and activities
Most tamariki will take a week to 10 days to recover from surgery and to return to eating normally. Some tamariki take the full 2 weeks to recover.
Your child should:
- rest as much as possible for the first few days after surgery
- not go to school, kura or daycare for 2 weeks after they leave hospital
- not participate in sporting or strenuous activities for 2 weeks after surgery
- not swim for 2 weeks
- avoid sniffing and 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.
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.
Possible complications
Bleeding
This is the most serious risk after the surgery. Bleeding after a tonsillectomy can happen in up to 4% of tamariki, any time in the 2 weeks after surgery. Your child is most at 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, take them straight to the emergency department at your local hospital.
If you do not have transport or if this is a large bleed, call 111 (in New Zealand) for an ambulance.
Sometimes, the bleeding will settle without treatment but some tamariki may need to stay overnight in hospital for observation. Some tamariki may need antibiotics and medicine to help stop the bleeding. Sometimes, an operation to stop the bleeding may be needed.
Fever
If your child looks well but has a fever, take them to see a health professional.
You know your child best. If you are concerned, seek medical advice.
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).
