Tonsillectomy is a surgery in which the tonsils are removed. Healthcare providers may consider removing the tonsils if they are large and causing trouble with breathing at night, or if they lead to frequent infections (such as strep throat) and painful sore throats.
In some cases, most often in children, a tonsillectomy is performed at the same time as an adenoidectomy (surgical removal of the adenoids) in what’s dubbed a T&A.
What Is Tonsillectomy?
A tonsillectomy is performed under general anesthesia. The surgeon takes out the tonsils through an open mouth so there’s minimal cutting and no scarring.
There are two types of tonsillectomies:
- Traditional tonsillectomy: Both tonsils are completely removed.
- Intracapsular tonsillectomy: The surgeon removes the affected tonsil tissue but leaves a small layer to protect the throat muscles underneath.
A tonsillectomy is usually a scheduled surgery and is rarely performed on an emergency basis. Most tonsillectomies are performed as a same-day procedure in a hospital, but in some cases, you may need to stay overnight.
Both adults and children have tonsillectomies. But patients younger than 2 years old may have a higher risk of respiratory complications with this surgery. To determine whether the procedure is truly needed, your child’s healthcare provider may require more preoperative testing, such as polysomnography (a sleep study).
Given the fact that bleeding is a potential complication of this surgery, patients with risk factors like bleeding disorders or malignant hyperthermia should be evaluated for these conditions before the procedure.
Another relative contraindication is the presence of a bifid or double uvula (the flesh that hangs down in the back of the throat).
Complications of tonsillectomy are rare, but when they occur, they can include:
- Bleeding, which can be severe and occur up to 14 days after surgery
- Prolonged pain
Removing the tonsils doesn’t affect your body’s overall ability to fight infections because your immune system can do that in other ways. Still, infection post-surgery can occur.
This is in addition to general risks of any surgery of this nature, including those related to the use of anesthesia.
Purpose of Tonsillectomy
The tonsils are glands on both sides of the back of the throat that help protect against infections.
Your healthcare provider may suggest a tonsillectomy for one of the following reasons:
- Enlarged tonsils and trouble breathing at night: The swollen tonsils can cause snoring and the cessation of breathing for short periods while asleep, a condition called obstructive sleep apnea.
- Frequent infections: Frequent is defined as seven or more times in a year, or five or more infections a year for the past two years; or three or more infections a year for the past three years.
The American Academy of Otolaryngology-Head and Neck Surgery Foundation strongly recommends watchful waiting for recurrent throat infections if these criteria are not yet met.
Call your healthcare provider if you or your child has had a sore throat for more than two days, pain when swallowing, or feels very sick or weak. Call 911 if you have trouble breathing, start drooling, or significant trouble swallowing.
How to Prepare
Before a tonsillectomy, a healthcare provider may recommend a physical exam as well as blood tests (complete blood count, electrolytes, and clotting factors) to make sure that surgery can be tolerated.
Both kids and adults may feel anxious about this surgery prep and the procedure itself. Your healthcare provider can help answer any questions that you or your child may have, which may ease concerns.
If your child is having a tonsillectomy, talk to them about any worries they have. Reassure them that the procedure will make them better and that they won’t look any different afterward. You might tell them that their throat will be sore for a little while post-surgery, but they will be able to take medicine afterward to help it feel better.
A tonsillectomy usually occurs in an operating room at a hospital or a surgery center. In either case, you’ll likely go home the same day.
What to Wear
Comfortable, loose-fitting clothes that are easy to change are ideal, since wearing a hospital gown for the procedure is required. Leave any jewelry at home so you don’t worry about losing it at the hospital or surgery center.
Food and Drink
Patients are usually instructed to refrain from eating or drinking anything after midnight the night before the surgery. Follow your healthcare provider’s instructions to make sure your stomach is empty.
For children, you might try giving them their favorite foods the night before so they fill up and aren’t as hungry in the morning, or ask for an early morning surgery to reduce the amount of time they have to go without food.
Your healthcare provider may recommend the cessation of certain medicines the week or two before surgery, including Advil (ibuprofen), Aleve (naproxen), Coumadin (warfarin), and other drugs that may affect bleeding risk.
Ask the healthcare provider if there are any drugs you or your child should keep taking on the day of the surgery.
To avoid complications, be sure the healthcare provider is aware of any medications or supplements you or your child are using before the procedure. This includes over-the-counter products, prescriptions, vitamins, and herbs.
What to Bring
Be sure to bring your health insurance card and any paperwork you’ve been given to fill out.
If you know that you’ll be spending the night, bring a small suitcase for you or your child with a change of clothes and comfort items. Your child might like to bring a blanket, toy, or stuffed animal.
If you’re the one having the tonsillectomy, remember to make arrangements for someone to take you back home.
What to Expect on the Day of Surgery
When you arrive, the anesthesiologist and nursing staff will meet with you to go over important medical history. You or your child will then put on a gown in a changing room and be brought on a gurney into the operating room.
Once there, general anesthesia will be given. Parents can usually stay with their child until the anesthesiologist gives medicine, at which time they are asked to go to the waiting room until the surgery is over.
During the Surgery
Intravenous fluids are usually given during and after the surgery. The anesthesiologist will keep you or your child safely asleep while undergoing the procedure.
The surgeon will place a small tool in the mouth to hold it open. They will take out the tonsils by cutting, burning, or shaving them away. These wounds heal naturally and don’t require stitches.
The tonsillectomy procedure will usually take about 20 to 30 minutes but may take up to an hour.
After the Surgery
You or your child will wake up in the recovery area. The staff will provide close observation for several hours. Easy breathing, coughing, and swallowing are all milestones that must be met before discharge.
An overnight stay may be recommended if your child is younger than 3 years old or has serious sleep problems like sleep apnea. An overnight stay might also be possible if you or your child has complications.
Adults usually recover more slowly from tonsillectomies than kids. Children tend to have less pain a week after surgery, while adults tend to have pain for about two weeks. Children are also more likely to return to a regular diet faster than adults.
Though pain and discomfort can make it hard to eat and drink, especially for kids, it’s important to avoid dehydration. Be sure to take in lots of fluids or offer your child a drink often. Water, grape juice, apple juice, and sports drinks are all good choices after a tonsillectomy.
Your healthcare provider will likely suggest sticking to soft foods like lukewarm soup, mashed potatoes, or treats like pudding, ice cream, or gelatin until pain subsides. (The latter choices may be considered a silver lining to some kids that you might mention even before surgery.)
Allow for up to a week of rest time after tonsillectomy. You should avoid blowing your nose forcefully for two weeks after surgery and encourage your child in kind.
Also avoid any strenuous activities or sports for two weeks. The healthcare provider will let you know when light activities are OK.
Let your healthcare provider know immediately if there is any bleeding from the mouth or nose. Also, let them know if your child won’t drink any fluids after the surgery.
Pain in the throat will probably last for several to 10 days. Your healthcare provider may suggest taking Tylenol (acetaminophen) or will give a prescription for Tylenol with Codeine at the time of surgery.
Avoid taking any medication containing aspirin, ibuprofen, or other anti-inflammatory medication to reduce the chance of bleeding.
A Word From Get Meds Info
After a tonsillectomy, you’ll likely deal with short-term throat pain, but it should lead to fewer sore throats and better breathing at night in the long term. Ask your healthcare provider if you have any questions about what to expect before and after the tonsillectomy. They’ll discuss the risks and benefits and help you determine whether a tonsillectomy is the best treatment for you.