Tonsillectomy and Adenoidectomy Postoperative Care

The following instructions will help you care for your child following surgery and to answer many of the commonly asked questions. Please read the entire sheet carefully.

Do not hesitate to call our office at 214-494-4150 if you have a question or concern. If our nurse is unable to answer your questions, the doctor will return your call, or you will be asked to come to the office

T&A

When a child has a tonsillectomy and adenoidectomy (T&A) or adenotonsillectomy, the tonsils and the adenoids are removed at the same time. A T&A is indicated when your child has chronic infections, difficulty breathing, and/or swallowing problems. 

Tonsils are masses of soft tissue located on each side of the throat in the back of the mouth. Adenoids are a mass of soft tissue located above the roof of the mouth, behind the nasal cavity. 

Hydration – Pain – Nutrition – Activities – Medications – Nausea – Nasal Congestion – Bleeding – Fever – White Patches – Bad Breath – Voice Changes – Constipation

Hydration

Pediatric Hydration = Age x 8 oz glasses/day

Encourage your child to drink a minimum number of 8-ounce glasses of fluid equal to their age (maximum of 64 ounces/day). E.g., a five-year-old should drink 5 x 8 oz glasses = 40 oz/day. Dehydration can worsen throat pain, cause low-grade fevers, nausea, lethargy, headaches, and increase the risk of bleeding.

Pain

Throat pain after a tonsillectomy usually lasts for 10 to 14 days while pain following an adenoidectomy usually lasts a few days. Throat pain may be worse in the morning. Ear pain is referred pain from the throat and is more often felt at night. It is normal for pain to change from day to day with an increase in discomfort on days 5 through 8. The more fluids your child drinks, the more it decreases pain and promotes healing. Neck pain or stiffness can occur and can be relieved with a soft ice collar placed on the front of the neck.

Nutrition

When liquids are tolerated satisfactorily, the diet may be advanced to a soft diet and maintained for 1-2 weeks. While there are no strict dietary restrictions after surgery, it is highly recommended to avoid acidic, spicy, hard, or crunchy foods that may cause pain or bleeding.

Physical Activities

Only light physical activity for the first two weeks after a tonsillectomy.

• No school or daycare for at least 1 week
• No gym class (PE), sports, or vigorous activities for 2 weeks
• No out-of-town travel for 2 weeks

Medications and Safety Information

• EACH TIME YOU GIVE A MEDICATION READ THE LABEL

• Dosage: Do not measure liquid with a kitchen spoon. There are pediatric measuring devices available at the pharmacy. Ask for one when you get your prescription filled 
• Use the exact amount ordered by your surgeon. If you have questions, ask your pharmacist
• Always watch your child take ALL of their medication
• Do not exceed the maximum daily dose for each medication
• Store all medications out of reach of children

Medication

Pain Medicine

The nonopioid pain relievers include over-the-counter liquid Tylenol® (acetaminophen) and Motrin® or Advil® (ibuprofen) are used for mild to moderate pain for the first-line pain management. Closely follow the Pediatric Pain-relief Medication 24 Hour Schedule of alternating Tylenol and ibuprofen every three hours around the clock for the first week. Wake them in the middle of the night every three hours as well, give them the pain medicine, and have them drink fluids. Staying hydrated will help your child feel better and promote healing. Leave water by their bedside during the night to make it easier to drink during the night. Do not use aspirin due to the increased risk of bleeding.

Narcotic Pain Medicine

Hycet® is a prescription narcotic pain medication containing an opioid pain reliever hydrocodone and a non-opioid pain reliever acetaminophen (Tylenol®). Hycet should be used for severe pain, that is breakthrough pain not relieved by the alternating Tylenol and ibuprofen. Hycet is used in place of Tylenol since Hycet contains Tylenol. You will continue the ibuprofen alternating with either Tylenol or Hycet. Please follow the Pediatric Pain-relief Medication 24 Hour Schedule.

Steroid Medicine

Prednisolone once-a-day dose on days 3 through 5 and days 7 through 9, as needed. Steroids reduce postoperative pain, swelling, inflammation, and nausea.

Nausea Medicine

Zofran® (ondansetron) or Zofran ODT orally disintegrating tablets that dissolve on the tongue.

Saline Nasal Spray

Use the saline spray in your nose twice daily for one to two weeks. Moisturizing the adenoid bed will decrease pain and promote healing. Avoid blowing your nose forcefully.

Please Note: You will be given enough of the prescription pain medicine Hycet® (or its generic equivalent) to last you through the postoperative period. If you feel you need a refill, you need to call BEFORE you run out. For your child’s safety, we will not routinely refill narcotic pain medicine after hours or on weekends. Please try to anticipate your medication needs and call for a refill before you are on your last dose.

Nonmedical Ways to Help Children Manage Pain

While it is normal to focus on pain medicines as the primary way to manage postoperative pain, there are nonmedical ways used in conjunction with medicines. Distraction, art and play therapy, and cold stimulation to the neck and ear have also been proven effective for treating pain in children and adolescents.

• Distraction: Play games, watch TV, or play video games
• Art and play therapy: Keep your child busy with blowing bubbles, art projects, coloring, or reading
• Use a cold or warm pack on the neck or ears for comfort

Nausea and Vomiting

Nausea or vomiting in children may occasionally occur in the first 24 hours after surgery and resolves on its own after the effects of anesthesia wear off.  Even more rarely as a side effect of the narcotic pain medication.

Nasal Congestion

It is common to have increased nasal congestion and drainage after an adenoidectomy for 7 to 10 days.

• Do NOT blow your nose forcefully for 1 week following surgery
• Open your mouth when you cough or sneeze
• Use nasal saline spray twice daily for 1 to 2 weeks to help with healing and comfort

Bleeding

Sometimes bleeding can occur from the mouth or nose after the operation. A small streak of blood is okay, but blood clots or persistent bleeding is not. If any bleeding occurs, proceed to the nearest Pediatric Emergency Department, and notify our office at 214-494-4150 in route.

Fever

A low-grade fever of 99° to 101.5° is not uncommon for the first week after surgery. It should be treated with Tylenol (acetaminophen) and drinking extra fluids. Should the fever persist or rise above 101.5 (38.6 C) please call our office at 214-494-4150 or physician on call.

White Patches in the Back of the Throat

The two areas in the back of the throat where the tonsils were removed will initially appear raw and then form grayish-white patches (tonsillectomy scabs or eschar). It is completely normal and not a sign of infection or concern. The scabs will fall off in 5 to 10 days and it is normal to have an increase in discomfort when this happens.

Bad Breath

Bad breath after a tonsillectomy is a part of the body’s normal healing process It is not a sign of infection. It will resolve in 7 to 10 days after surgery

Voice Changes

Following tonsillectomy and adenoidectomy surgery, it is normal for patients to have a temporary change in voice quality such as a higher-pitched voice (hypernasal), a helium-like sound, or a nasal sound until healing is complete. This typically resolves by 6 weeks.

Constipation

To prevent opioid-induced constipation from Hycet® your child may take pediatric MiraLAX® daily. It’s important for your child to drink plenty of fluids. Avoid bulk-forming laxatives like Metamucil.

When to Call Your Pediatric ENT Doctor or get Emergency Care?

For questions or concerns, call Dr. John McClay at 214-494-4150 from 8 a.m. to 5 p.m. Monday through Friday. For questions after hours, weekends or holidays, call the emergency on-call provider phone number and ask the operator to page the ON CALL pediatric otolaryngology provider.

• Uncontrolled Pain: Call if you cannot manage your child’s pain
• Dehydration: Call if your child refuses to drink liquids for 8 hours
• Not Urinating: Call if your child has not urinated in 8 hours
• Vomiting: Call if your child has vomited more than once
• Fever: Call if your child has a temperature higher than 101.5° (38.6 C) for more than 6 hours that is not controlled with acetaminophen (such as Tylenol®)
• Bleeding: Call if your child has any bleeding. If there is a lot of fresh bright red blood go directly to an emergency department or call 911
• Breathing Problems: If you or your child is having difficulty breathing, get emergency care

Follow up

You should have an appointment scheduled for a short postoperative checkup about one month after surgery. If you are unsure when this appointment is scheduled, please contact us at 214-494-4150.