Center for Advanced Subspecialty Care and Otolaryngolgy providing otolaryngology services for Plymouth County and surrounding southeastern Massachusetts.

Tonsillitis and Tonsillectomy

The tonsils are part of a larger system of similar tissue in the back of the throat called Waldeyer’s ring. This concentration of similar tissue in this area (called lymphoid tissue) responds to various infections and so doing enlarges in size. In some cases the tissue it self can be the harbinger of the infection. Untreated infections of the tonsils may lead to complications such as rheumatic fever (which can result in heart disease), post streptococcal glomerulonephritis (which can result in kidney failure), Scarlet fever, peritosillar abscesses and deep neck abscesses. In addition the enlargement of the tissue in and of itself may create problems due to compromise of the airway. Tonsillar enlargement is the most common cause of obstructive sleep apnea in children.

A single enlarged tonsil may be a sign of a growth in that tonsil (tumor) and removal of that tissue may be necessary for biopsy purposes.

For any number of the reasons mentioned above tonsillectomy (surgical removal of the tonsils) may be indicated. Once the decision has been made to proceed with surgical excision our goals revolve around two points in particular. The first is to decrease the risk of post operative bleeding. The second is to decrease the post operative pain. To accomplish these goals the wounds are closed primarily and the dissection performed using “cold” dissection techniques which impart very little thermal injury to the surrounding tissue. In this way the pain and debility experienced in the post operative period can be minimized. In some cases leaving a portion of the tonsil behind may also  further limit the post op pain.

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The adenoid tissue or (pharyngeal tonsil) is (like the palatine tonsil ) part of a larger accumulation of similar tissue located in the back of the nose and throat that responds to infectious agents, usually viral or bacterial and in so doing enlarges in size . Since the adenoid tissue is located directly behind the nose and above the palate it can not be easily seen on physical examination. Enlargement or (hypertrophy) of this tissue in this location can easily result in obstruction of the nasal airway leading to nasal congestion, chronic nasal infection and obstructive sleep apnea. The close proximity of the Eustachian tubes to the adenoids also leads to a variety of middle ear problems associated with enlarged adenoids.

In some cases when medical management has failed an adenoidectomy or (surgical excision of the adenoids) my be appropriate. Adenoidectomy is usually associated with very little morbidity and usually done on an out patient basis. The tissue is accessed through the mouth. The tissue is vaporized and the suctioned away resulting in very little bleeding or injury to the surrounding tissue, recovery time is usually on the order of one or two days.

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In the immediate post operative period, and for three or four days thereafter, we would encourage you to be very aware of your fluid intake. It is very important that you remain well hydrated throughout your post-operative course. Icy cold, and slush filled fluids with electrolytes such as Gatorade are best, but avoid other sports drinks which have a high sugar content as these my be irritating. A good measure of the adequacy of your hydration is the need for frequent urination. Adequate hydration is key to a quick recovery following your surgery.

You can expect to experience some pain on swallowing for at least the first 7-10 days after surgery. How long your post operative pain lasts, depends on a number of factors including the size of the tonsils, the amount of infection present, and the method used to remove the tonsils.

You will be prescribed adequate pain medication in a liquid form as well as pain gargles in most cases. The gargles can be used on an "as needed"� basis, and will make eating and drinking easier. We would suggest that you avoid citrus juices, or spicy foods that my irritate your wounds. Smoking, or close proximity to those that smoke, will delay wound healing and increase your risk of post operative bleeding. Daily mouth care with cool saltwater mouth rinses will help keep the wounds clean. This solution can be made at home by mixing a tablespoon of salt in eight ounces of cool tap water, with a quarter teaspoon of baking soda. This solution should be used as a gargle two or three times daily.

Another critical part of your post operative care is adequate care of your lungs after general anesthesia. You should not be lying in bed during the post operative period during daylight hours. You should be up walking or sitting in a chair. You will be given an incentive Spiro Meter and instructed in its use by the nursing staff. This device should be used religiously at least every hour while you are awake. We would also encourage you once or twice a day to walk for short distances i.e. around the block, and to be up and mobile indoors. We suggest that you avoid any strenuous or jarring physical activity, as this will increase the chance that you may experience bleeding post operatively. The riskiest time for bleeding after your surgery is between 7-10 days after surgery. You should be particularly careful about your activity level during this time. You will need to take a short walk once or twice a day.

It is not unusual to experience some blood tinged mucus in the early post operative period. However, any heavy bleeding where clotting blood is present, and does not subside quickly after rinsing with cold water, should be reported to the physician on call.

Since the main risk after tonsillectomy is post operative bleeding, we would ask that you take only the pain medication that we have prescribed for you. There are many over the counter medications that will increase your bleeding risk including aspirin and Advil, and these should not be taken.

There has been some controversy in recent years regarding the texture of the post tonsillectomy diet. For many years a variety of soft diets were used in an effort to reduce bleeding. However, recent evidence based medicine has revealed no advantage for soft textured diets over any other. The ingestion of crispy, or rough textured foods such as pizza, or chips, if tolerated, does not seem to cause any problem. We would encourage you to use chewing gum on a regular basis throughout your post operative course as soon as possible. This speeds the rehabilitation of you oral muscles.

A low grade fever after surgery is not unusual, and may occur for several days post operatively. This usually is a reflection of inadequate lung expansion, and will quickly resolve with use of the incentive Spiro Meter and walking as described earlier. In most cases, antibiotics will be prescribed during the post operative course. Any prolonged or significantly elevated temperature (greater than 1020 taken orally) should be reported to the physician on call.

For those of you having had an adenoidectomy in addition to a tonsillectomy, we would encourage the use of saltwater nose drops in an effort to keep the adenoid bed (located at the back of the nose) clean.

Just a last word concerning post operative nausea. Many patients can experience some nausea following surgery for a variety of reasons. In most cases, you will be given some anti-nausea suppositories to use should this occur. However, you should be aware that nausea is a potential side effect of all narcotic based pain medication. Severe post operative nausea may mean temporarily stopping your liquid narcotic pain medication.

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