surgeon
Tonsillectomy

What are tonsils?

Diagram of tonsil location

The tonsils are 2 masses of tissue located in the back of the mouth, one on either side.

The tonsils are part of our immune system. Our immune system helps us fight germs that cause illness. You can think of the tonsils as germ processing centers. They help our bodies learn to recognize different kinds of germs so that we can fight them better.

Will my child's immune system be weaker if the tonsils are removed?

The tonsils are only a very small part of our immune system. It turns out that our immune system has many different ways of learning to recognize germs. Children who have their tonsils removed do not, on average, have any more illnesses than children who “keep” their tonsils. In fact, some children will get fewer illnesses, like strep throat, after their tonsils are taken out.

Why do some children need to have their tonsils removed?

Today, the most common reason that children have their tonsils removed is to help them breathe and sleep better. In some children, the tonsils become too big. This may happen for a variety of reasons, but we usually don't know why it happens to a particular child. If the tonsils become too large they can partially block a child's breathing during sleep. This causes a child's sleep to be very restless or fragmented resulting in poor concentration during the daytime, behavior changes, and sometime persistent bedwetting. This is known as "sleep apnea". Removing the tonsils (along with the adenoid) makes this breathing much better and in the majority of children solves the problem completely.

Another common reason that children have their tonsils removed is because of frequent throat infections involving the tonsils (tonsillitis). Although removing the tonsils will not prevent the common cold or even every sore throat, it will stop a child from getting tonsillitis again.

How are the tonsils removed?

Removal of the tonsils (tonsillectomy) is a surgical procedure. It is performed by an ears, nose, and throat surgeon in the operating room under general anesthesia. In this day and age, general anesthesia is very safe and your child will be carefully monitored during the procedure. The tonsils are removed through the mouth and there are no visible scars following surgery.

Diagram of conventional vs. intracapsular tonsillectomy

Currently, there are two basic approaches to tonsil surgery. The most common kind of tonsillectomy (the conventional tonsillectomy) involves the complete removal of both tonsils. This can be done with a variety of instruments, but we prefer a device that uses electricity to cut the tonsils out and stop bleeding at the same time (an electrocautery). The greatest benefit of a conventional tonsillectomy is that all of the tonsil tissue is removed and therefore won't grow back. The biggest problem with conventional tonsillectomy is that it hurts for 7 to 10 days following surgery which makes it hard to eat and drink for a while.

The second kind of tonsillectomy (the intracapsular tonsillectomy) involves removing most of the tonsil tissue but leaves a small amount of tonsil tissue behind to protect the side of the throat. This typically results in much less pain after surgery and a shorter recovery. However, there is the possibility that some tonsils will grow back and possibly become large enough to cause symptoms again. This type of tonsillectomy is usually recommended for very young children with sleep apnea. The intracapsular tonsillectomy is not appropriate for children with lots of strep throat or tonsillitis.

Are there any instructions I need to follow before surgery?

Your child must have a physical examination by his or her pediatrician or family doctor within 7 days before surgery to make sure he or she is in good health. The doctor you see needs to complete the History and Physical form provided by our office. You must bring the completed form with you the day of surgery.

You should not give your child any pain or fever medication except Tylenol® (acetaminophen) for at least 3 days before surgery. Medicines like Children’s Motrin® (ibuprofen) should be avoided before surgery, but may be used for pain control after surgery.

Stock up on foods and drinks for your child to have at home after surgery such as apple juice, Popsicles®, Jell-O®, ice cream, milk shakes, smooth yogurt, and pudding.

For your child’s safety, it is very important that he or she have an empty stomach when anesthesia is given. Please follow our preoperative Eating and Drinking Guidelines. If you do not follow these guidelines, your child's surgery will be cancelled.

What can I expect after surgery?

The procedure itself usually takes 20 to 30 minutes. Your doctor will talk to you as soon as the surgery is over.

Your child will wake up in the recovery room after surgery. This may take 45 minutes to an hour. When your child is awake, he or she will be taken to the Short Stay post operative area to complete the recovery. You can be with your child once he or she has been transferred to this area.

Children usually go home the same day after surgery, but in some cases your doctor may recommend keeping your child in the hospital overnight (e.g., your child is under age 4). If your child does stay overnight, one parent is required to stay overnight too.

An upset stomach and vomiting (throwing up) are common for the first 24 hours after surgery.

Your child’s throat will be very sore for quite a while after surgery. Most children will have throat pain for 10 to 14 days after a tonsillectomy. The sore throat makes it difficult and painful to swallow. However, it is very important that your child drink plenty of fluids after surgery. Your child will be given prescription pain medicine for the sore throat but it will still take lots of encouragement to keep him or her drinking at home.

Your child may have a fever for 3-4 days after surgery. This is normal and is not cause for alarm.

Your child may complain of an earache in one or both ears. This does not mean your child has an ear infection. The ear pain is actually caused by the throat surgery and goes away when the sore throat gets better.

Neck soreness, bad breath, and snoring are also common after surgery. These symptoms will also go away during the first 3 weeks after surgery.

How should I take care of my child after surgery?

It is important to encourage your child to drink plenty of liquids. Keeping the throat moist decreases discomfort and prevents dehydration (a dangerous condition in which the body does not have enough water).

Give your child pain medication as prescribed by your doctor. Give it before bedtime and first thing after waking in the morning. It should be easier for your child to eat and drink about 30 minutes after taking the pain medicine so these are the best times to encourage drinking and eating.

Do not give your child any pain medicines that your doctor has not prescribed or recommended. However, recent studies have not demonstrated any increased bleeding risk when children use Children's Motrin® (ibuprofen) after tonsillectomy. If you are not sure what medicines are safe, please call your doctor.

Antibiotics are no longer routinely prescribed after tonsillectomy.

If your child has trouble taking the pain medicine or is throwing up, ask your doctor about using pain medicine suppositories.

You can place a humidifier or cool mist vaporizer next to your child’s bed at night. Keeping the air your child breathes moist will help decrease pain and help prevent dehydration.

Prevent your child from coming into contact with other people who have colds, flu, or infections.

What can my child eat and drink after surgery?

For the first day or two after surgery you should offer cool liquids such as apple juice, water, Popsicles®, Jell-O®, and pop that has lost its fizz. You may also offer soft foods such as ice cream, milk shakes, smooth yogurt, and pudding.

Picture of common clear cool liquids

As your child starts to feel better you can add other foods that your child wants such as applesauce, cooked cereal, fruits, cottage cheese, mashed potatoes, scrambled eggs, and pasta. Be sure your child is drinking plenty of fluids.

You should avoid foods that are crunchy or have hard edges such as corn chips, pretzels, and popcorn. Also avoid foods that are very hot in temperature or spicy hot.

What else do I need to know?

Most children will be out of school or daycare for 7 to 10 days after surgery. Your child should not participate in vigorous physical activity (such as gym class) for 2 weeks after surgery.

Do not travel out of reach of your doctor for 14 days after surgery.

Upset stomach and vomiting are common during the first 24 to 48 hours after surgery. If vomiting continues for more than 1 or 2 days after surgery, call our office.

Signs of dehydration include sunken eyes, dry and sticky lips, no urine for over 8 hours, and no tears. If your child has these signs you should call our office.

Streaks of blood seen if your child spits up are common during the first few hours after surgery and may occur again in 7 to 10 days after surgery as the scab in the back of the throat comes off.

If your child coughs up, throws up, or spits out bright red blood or blood clots you should bring him or her to the emergency room at Children’s Hospital immediately. Although rare, this type of bleeding can occur up to 2 weeks after surgery.

If you have any questions or would like further information specific to your child, please call our office at (612) 874-1292.

This information is provided as a service to our patients. The information is for educational and informational purposes only and should NOT be used as a substitute for the advice of your child's physician.