Recovery from Tonsillectomy and or Adenotonsillectomy

What should I expect after surgery?

Recovery from surgery is different for everyone, however, one thing for sure is recovery from having your tonsils out is very painful and will most likely take two to three weeks for full recovery.  Immediately after surgery and the following day is usually fairly tolerable. It’s when the healing starts that the level of pain and discomfort increases. The toughest time is between day four and day eight.  During that period the pain level will increase considerably and that’s quite normal. Furthermore, it will be extremely painful and difficult to swallow and pain management most likely less effective.  From about day eight onwards the pain usually starts to reduce and you will recover more rapidly, however, expect some pain on yawning or stretching of the jaw for at least a few weeks after this.

How painful will this procedure really be?
Pain thresholds are very individual and vary considerably; however, most people will experience a severe degree of pain following a tonsillectomy (and or adenotonsillectomy).  Before surgery it is difficult to imagine or anticipated the level of pain and discomfort therefore, after surgery the pain experienced can be interpreted as a complication or something wrong, in most cases the healing is progressing normally. What is important is to take pain relief medication regularly and continue to eat and drink.

How can I manage the pain?
When you leave hospital you will be sent home with some pain relief medication.
It is important to take this regularly, at least every four to six hours. Taking the pain medication about 20 minutes before eating will help with swallowing. Eating and drinking are essential to a successful recovery. As time passes the level of pain medication can be reduced to maintain comfort.  If there is persistent pain despite regular pain medication, a local anaesthetic spray such as Diflam Forte Spray can be used, available (without prescription) at your local pharmacy.

My breath is very smelly in fact really bad.
Yes it is common to have bad breath for a few weeks after surgery.  This is due to accumulation of bacteria within the sluth.  Sluth is material that collects at the area where the tonsils have been taken from and is quite normal.  By eating and drinking as much as possible, particularly rough foods, the amount of sluth will be reduced and this will lead to better breath.

My ears are really sore and I have an earache.

Quite commonly pain is referred to the ears and predominately noticed in children tugging, pulling and complaining of sore ears.  This is due to both areas having a common nerve supply.  It is not unusual for the ear ache to be more severe than the throat pain.  Usually, this does not indicate any problem with the ear itself but is just referred pain. There is no immediate solution as this will resolve with the healing process.

If I’m vomiting what should I do?

If vomiting persists it is important to try and maintain as much fluid as possible.  The vomiting may well be related to the anesthesia and should settle down within twenty four hours.  Nausea and vomiting may also be a side affect of the pain medication, therefore, see your GP for alternative pain medication. If the vomiting persists and you are unable to maintain fluid intake you will need to present at the hospital emergency department to be assessed for possible re admission and hydration.

I’ve noticed some bleeding?
The main risk of adenotonsillectomy is bleeding. Bleeds can vary and stop and start over the first few days of recovery and usually involve only small amounts of blood.  Bleeding usually settles down by itself and sucking on some ice will help.  If bleeding persists, with excessive amounts of blood for periods of time you should present at the emergency department for evaluation.

How long before I start feeling better?
As mentioned days four to eight are the hardest days and you should anticipate experiencing high levels of pain. After about eight to ten days the pain will begin to ease and recovery will start to improve.  Typically things have healed up completely by fourteen days after surgery.

When can I start getting back to school, sport and work?
As a guide we advise two weeks off school or work following an adenotonsillectomy.  Sporting activity should be avoided during this recovery period as this may increase the risk of bleeding.  Usually after two to three weeks patients can ease back into their usually activities.

When can I fly and are there any precautions I should take?

We do not recommend flying for the first two weeks after surgery due to the risk of bleeding.  At your post operative visit you can get clearance.  Should there be a specific reason why you need to fly during the first two weeks after surgery discuss this with your surgeon before booking your surgery.

What can I eat and drink?

Eating and drinking is recommended as soon as the anaesthetic has worn off.  We encourage as normal diet as possible.  The rougher the food, the less sluth collects in the back of the throat.  This will lead to a faster and less painful recovery.  It is important to try and maintain a high food and fluid intake if possible as this reduces the risk of bleeding.  There are no restrictions with the type of food that can be eaten.
A good idea is to prepare in advance and stock up with foods that you/patient enjoy. Consider a variety of foods and some favorite treats; they help to encourage eating and drinking especially with the younger patients

I really having trouble getting my child to eat or drink?
It’s common for children to resist eating and drinking after tonsillectomy surgery. You can help them by preparing small amounts of food they can nibble on throughout the day. Anything is better than nothing. It may be necessary to entice them to eat and drink by preparing more of their favorite food.  Rejecting food and not eating for a couple of days (resulting in weight loss) is not unusual.  However, it is important to maintain fluid intake, otherwise this may lead to dehydration and increases the risk of bleeding.  Sucking on small amounts of crushed ice is helpful for fluid intake and soothing to the throat area. Pain management is an important step, try giving the medication about twenty minutes before eating to make swallowing easier.  If your child is resisting pain medication you may need to use some creative strategies to get them to take it. Most important don’t be distressed by their rejection; you will need to keep persisting with your most persuasive techniques for at least the first 10 days post surgery.

Typical symptoms after surgery?
Fever: It is quite common for patients to have a slight fever after surgery.  This does not indicate an infection and is usually associated with the anaesthetic and the removal of the tonsils.

Pain: Generally patients don’t anticipate the level of pain they will experience after tonsillectomy surgery and become concerned that something is wrong. In most cases recovery is on track. As well as extreme discomfort when swallowing, expect to feel generally unwell and lethargic.  Not being able to maintain a normal diet, reduced physical activity and the surgery procedure all contribute to a general feeling of being unwell and lethargy.  Be kind to yourself, rest as much as possible, keep up the pain management routine and maintain food and fluid intake.

Should  I be taking antibiotics?
Antibiotics are not given routinely following tonsillectomy.  If there are signs of infection at the time of surgery you may be discharged home on oral antibiotics.  If you suffer a post operative bleed which is most commonly due to a post operative infection then antibiotics may be required following this.  This decision will be made by your doctor after assessment.