Tonsillectomy: Having Your Tonsils Removed

What to expect when undergoing the procedure

Having your tonsils removed is a surgical procedure called a tonsillectomy. Reasons you may need to have your tonsils removed include frequent infections (episodes of tonsillitis, usually seven or more in one year), difficulty breathing or swallowing, sleep apnea, or any growths on the tonsils.

Preparation

Tonsillectomies are performed under general anesthesia. You will be completely asleep and will not be able to feel pain during the procedure. To reduce the risk of vomiting with anesthesia, you will not be able to eat before surgery.

Your physician or nurse will give you exact instructions about when to stop eating and drinking. In addition to not eating or drinking, you should not smoke, chew gum, or suck on mints or candy.

Tonsillectomies are mostly performed as a same-day surgery. This means that you will go home the same day that you have your tonsils removed. You should wear loose comfortable clothing to the surgical center. Arrive on time.

If you have other health problems, your doctor may order blood work or other tests before the surgery. If you are a woman of childbearing age, it is mandatory that you have a pregnancy test before the surgery. This requires a small amount of urine.

If the patient is a child and has a comfort item, such as a blanket or a favorite toy, bring it with you. Also, if your child drinks from a bottle or special cup, bring it along so your child can drink after the surgery. Make sure you bring comfortable clothing and extra diapers or underwear.

You will need to stop any medication that thins the blood one to two weeks before the procedure. These include aspirin, Plavix (clopidogrel), Coumadin (warfarin), and high-dose vitamin E.

Follow your physician's instructions for taking any scheduled medications on the day of surgery, especially if you are on insulin or blood pressure medications.

When You Arrive

Upon arrival, you will be asked to register and provide your insurance details. You'll then be led to a changing room to change into a hospital gown and asked to remove any metal objects from your body. You will also need to remove contact lenses, dentures, and hearing aids.

After the nurse takes your vital signs (blood pressure, pulse rate, and temperature), you'll be lead to the operating table where you'll have a quick consultation with an anesthesiologist. Once you are cleared by the anesthesiologist, an intravenous drip will be inserted into a vein in your arm or hand to deliver the anesthetic.

In some cases, a medication called Versed (midazolam) may be given prior to the procedure to reduce anxiety, especially in small children.

Tonsillectomy Types

There are several types of procedures to remove the tonsils. Risks and benefits vary by each method. You will need to discuss which method is right for you with your surgeon.

  • Cold knife dissection: This is the traditional method of having your tonsils removed, using a scalpel. The tonsils are completely removed, and there is minimal bleeding.
  • Electrocauterization: This method burns the tonsils and surrounding tissue in a way that prevents a lot of bleeding. Unfortunately, this method can cause more pain during the post-operative period.
  • Harmonic scalpel (ultrasonography): This method uses energy from ultrasound to vibrate the blade. This results in a clean cut that also cauterizes the tissue. This method allegedly causes less damage to the tissue than electrocauterization.
  • Radiofrequency ablation: This procedure can be performed in a doctor's office under sedation. It is not a one-time procedure, but rather gradually shrinks the tonsils using radiation after several appointments. This procedure is only recommended for enlarged tonsils.
  • Carbon dioxide laser: This procedure can also be performed in a doctor's office under local anesthesia and only takes about 15 minutes. Post-operative bleeding can occur the first or second post-op day. The advantage of this procedure is decreased pain and morbidity. However, this procedure is not recommended for all patients, particularly children.
  • Bipolar radiofrequency ablation: This method must be performed in an operating room under general anesthesia. It uses a very complex method of action that disrupts the molecular bonds of the tonsilar tissue. It can be used to remove some or all of the tonsils. This method is associated with less pain and post-operative care.
  • Microdebrider: This procedure is used for partial tonsillectomies only. The enlarged or obstructive portion of the tonsil is shaved off. This procedure carries less risk of pain after surgery.

Recovery

You will be monitored by a nurse for a few hours after having your tonsils removed. Before you leave the hospital or surgical center, you will be given exact instructions on how to care for yourself at home. Always follow your doctor's orders, but you will likely receive these instructions:

  • Remain in the care of a responsible adult for at least 24 hours following surgery.
  • Do not drive, sign legal papers, or participate in activities that require you to be awake and alert for at least 24 hours after surgery.
  • Eat and drink clear liquids if you are experiencing post-op nausea and vomiting (clear liquids include apple juice, soda, soup broth, jello, and black coffee).
  • Eat food that is easy to chew and swallow.
  • Elevate the upper body.

You will likely be prescribed oral pain medication to take following surgery. Typical medications used include the opioids oxycodone and hydrocodone.

If a combination painkiller like Percocet (oxycodone and acetaminophen) or Lortab (hydrocodone and acetaminophen) is prescribed, you would need to avoid Tylenol (acetaminophen) to prevent acetaminophen overdose.

You should not drive while taking any of these medications. Your pain should gradually subside within a few days. Make sure to schedule a follow-up appointment and to call your surgeon if you experience any signs of infection or illness.

When to Call Your Doctor

Call your doctor or go to the nearest emergency room if you experience any of the following:

  • High fever (over 100.4 )
  • Extreme nausea or vomiting
  • Severe pain
  • Inability to urinate eight to 12 hours after surgery
  • Bright red bleeding from the tonsils
  • Shortness of breath (dyspnea)
  • Difficulty swallowing (dysphagia)
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Article Sources
  • Tonsillectomy. MedlinePlus. https://medlineplus.gov/ency/article/003013.htm.
  • Tonsillectomy and Adenoids Post-op. American Academy of Otolaryngology - Head and Neck Surgery. http://www.entnet.org/content/tonsillectomy-and-adenoids-postop.
  • Tonsils and Adenoids. American Academy of Otolaryngology - Head and Neck Surgery. http://www.entnet.org/content/tonsils-and-adenoids.