The tonsils are two clusters of tissue located on both sides of the back of the throat. Adenoids sit high in the throat behind the nose and the roof of the mouth. Tonsil removal and adenoid removal often occurs when they become enlarged and block the upper airway, leading to breathing difficulty. They are also removed when recurrence of tonsil infections or strep throat cannot be successfully treated by antibiotics. The surgery is most often performed on children.
The procedure to remove the tonsils is called a tonsillectomy; excision of the adenoids is an adenoidectomy. Both procedures are often performed at the same time; hence the surgery is known as a tonsillectomy and adenoidectomy, or T&A.
T&A is an outpatient surgical procedure lasting between 30 and 45 minutes and performed under general anesthesia. Normally, the young patient will remain at the hospital or clinic for several hours after surgery for observation. Children with severe obstructive sleep apnea and very young children are usually admitted overnight to the hospital for close monitoring of respiratory status. An overnight stay may also be required if there are complications such as excessive bleeding, severe vomiting, or low oxygen saturation.
When the tonsillectomy patient comes home from their tonsil removal:
Most children take seven to ten days to recover from the surgery. Some may recover more quickly; others can take up to two weeks for a full recovery from tonsil removal. The following guidelines are recommended:
Drinking: The most important requirement for recovery is for the patient to drink plenty of fluids. Starting immediately after surgery, children may have fluids such as water or apple juice. Some patients experience nausea and vomiting after surgery. This usually occurs within the first 24 hours and resolves on its own after the effects of anesthesia wear off. Contact your physician if there are signs of dehydration (urination less than 2-3 times a day or crying without tears).
Eating: Generally, there are no food restrictions after surgery, but some physicians will recommend a soft diet during the recovery period. The sooner the child eats and chews, the quicker the recovery. Tonsillectomy patients may be reluctant to eat because of throat pain; consequently, some weight loss may occur, which is gained back after a normal diet is resumed.
Fever: A low-grade fever may be observed the night of the surgery and for a day or two afterward. Contact your physician if the fever is greater than 102º.
Activity. Activity may be increased slowly, with a return to school after normal eating and drinking resume, pain medication is no longer required, and the child sleeps through the night. Travel on airplanes or far away from a medical facility is not recommended for two weeks following surgery.
Breathing: The parent may notice snoring and mouth breathing due to swelling in the throat. Breathing should return to normal when swelling subsides, 10-14 days after surgery.
Scabs: A scab will form where the tonsils and adenoids were removed. These scabs are thick, white, and cause bad breath. This is normal. Most scabs fall off in small pieces five to ten days after surgery.
Bleeding: With the exception of small specks of blood from the nose or in the saliva, bright red blood should not be seen. If such bleeding occurs, contact your physician immediately or take your child to the emergency room.
Pain: Nearly all children undergoing a tonsillectomy/adenoidectomy will have mild to severe pain in the throat after surgery. Some may complain of an earache (so-called referred pain) and a few may have pain in the jaw and neck.
Pain control: Your physician will prescribe pain medication for the young patient such as acetaminophen, ibuprofen, acetaminophen with codeine, or acetaminophen with hydrocodone. The pain medication will be in a liquid form or sometimes a rectal suppository will be recommended. Pain medication should be given as prescribed. Contact your physician if side effects are suspected or if pain is not well-controlled. If you are troubled about any phase of your child’s recovery, contact your physician immediately.
Frequently Asked Questions
The tonsils are two clusters of tissue located on both sides of the back of the throat, while the adenoids are situated high in the throat behind the nose and the roof of the mouth. They are typically removed when enlarged tissues block the upper airway causing breathing difficulties, or when recurrent infections such as tonsillitis or strep throat do not respond to antibiotics.
A tonsillectomy is the surgical removal of the tonsils, and an adenoidectomy is the excision of the adenoids. These procedures are often done simultaneously and referred to as T&A. The surgery is outpatient, lasts 30 to 45 minutes, and is performed under general anesthesia with several hours of post-op observation.
Most children take between seven to ten days to recover from tonsil and adenoid removal, though some may recover sooner and others may require up to two weeks for full recovery. Recovery duration depends on factors like the child's healing and pain management.
Post-surgery, children should drink plenty of fluids to prevent dehydration and may start with water or apple juice. A soft diet is often recommended, and children are encouraged to eat as soon as possible despite throat pain. Pain medication should be administered as prescribed, and physical activity should gradually increase with a careful return to school once eating and drinking are normal.
Parents should watch for bright red bleeding from the mouth or nose, fever over 102º Fahrenheit, signs of dehydration (such as low urination or crying without tears), severe vomiting, or uncontrolled pain. Any such signs should prompt immediate contact with a physician or visit to the emergency room.
Yes, nearly all children experience mild to severe throat pain following surgery, along with possible referred earache and jaw or neck pain. A scab forms at the surgery site which causes bad breath and falls off within 5 to 10 days. Snoring and mouth breathing due to swelling are also common and typically resolve within 10 to 14 days.
Children can gradually increase activities as they feel better and should return to school once they can eat and drink normally, no longer need pain medications, and sleep well through the night. Air travel or traveling far from medical facilities is generally not recommended for two weeks following surgery to ensure safe recovery.
