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What Happens During Tonsillectomy?
A tonsillectomy is usually indicated for patients who have recurrent bacterial infections of the tonsils and are not managed adequately by medical means. It is also performed in cases when tonsils are so enlarged that they cause obstruction to eating or severe snoring and sleep apnea.
Tonsillectomy is a common surgical procedure done mostly in children and occasionally in adults. It involves the removal of the soft tissues called tonsils at the back of the throat. Other soft tissues, called the adenoids, which are also often infected and enlarged in children and located around the tonsils, are sometimes also removed during tonsillectomy. These procedures are done under general anesthesia and may last for 20 to 60 minutes.
Although it is a relatively short, simple and safe procedure, post-operative pain may be severe, and children often have difficulty eating and swallowing. Other possible complications of tonsillectomy are nausea and vomiting, bleeding, difficulty breathing and other complications related to anesthesia. For these reasons, patients are usually confined to the recovery room for a few hours until fully awake and recovered from the effects of the anesthesia and surgery. Patients and parents are also given meticulous instructions for home care, since the patients are usually sent home immediately (in a day or so), if no complications are experienced.
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After Care for Tonsillectomy Patients
After care for this surgical procedure mostly involves instructions on what to eat after tonsillectomy, pain medications and activities that are allowed in the first few days of recovery. The following are general instructions and guidelines for care in post-tonsillectomy patients:
- In approximately 2% of patients slight bleeding may be noted in the patient’s saliva. This is expected to be short-lived and will stop by itself. If bleeding is greater than expected and does not stop after a few minutes, emergency medical assistance may be needed. Stay upright and relaxed until medical help arrives.
- In the first day after surgery, the patient should stay in a reclined position and restrict activities. He may still feel sedated from the effects of anesthesia. Likewise, he must spend most of the next few days just resting. He may be able to return to school or work in about 7 to 10 days.
- Bad breath may be noted, which is expected from the blood and dried secretions of the mouth and throat. Gentle mouth rinsing may be done.
- Fever and ear pain may be felt by some children. Antibiotics and medications for pain and fever are usually prescribed to relieve these, so they may be given orally.
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What to Eat After Tonsillectomy
Food after tonsillectomy may be slightly restricted after surgery, as will drink, but both will be gradually shifted until tolerated. On the first day, the throat may be quite sore, making eating and drinking difficult, especially in children.
- Cool clear liquids are started on the first day. These include ice cold water, milk, sodas, Kool-Aid, Gatorade, and apple or grape juice. Avoid hot, citrus or sour drinks, since they can worsen the pain. The patient should be able to drink up to one quart of fluid per day, to avoid dehydration.
- Very soft foods may then be started, like custard, apple sauce, popsicles, sherbets, yogurt, ice cream, pudding and the like, as tolerated by the patient.
- Starting on the second day, the patient may be able to tolerate soft sandwiches (but not grilled or toasted), eggs, soups, oatmeal and pancakes.
- Foods in the diet are then gradually increased as tolerated, and pasta, soft vegetables, mashed potatoes and other foods may be tried. Foods that must be avoided are those that are crispy, crunchy or brittle, as they may irritate the throat.
- Patients may experience constipation, which can be treated with prune juice at night and an increase in fluid intake.
- According to some, chewing gum increases saliva secretion, which is good for healing and eliminating bad breath; however, some physicians do not advise it.
- One must remember to maintain adequate hydration, and fluid intake must be monitored. This will also help speed the recovery of the patient.
Full recovery after tonsillectomy usually takes three weeks. During this period one must take care not to engage in strenuous activities like sports, although normal activities are allowed. Food intake must also be regulated to soft foods, avoiding those that are dry and hard. Medical follow-up is usually done after 2 to 4 weeks.
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Texas Pediatric Surgical Associates. "Post operative Instructions: Tonsillectomy and Adenoidectomy," http://www.pedisurg.com/PtEducENT/Post-tonsillectomy.htm.
Head & neck Specialty Group of New Hampshire. "Instructions for Home Care After Tonsillectomy/Adenoidectomy," http://ent-surgeon.com/preps/tonsillectomy.htm.