Tonsillectomy & Adenoidectomy Post-Op Instructions

Anh Q. Truong, MD

Bellevue ENT

1231 116th Avenue NE, Suite 915

Bellevue, WA 98004

Phone: (425) 454 - 3938

Follow-up:

Your follow-up should be scheduled 2-3 weeks after surgery.

Our clinic locations are at:

• Issaquah: 510 8th Avenue NE, Suite #310, Issaquah, WA 98029
• Bellevue: 1231 116th Avenue NE, Suite #915, Bellevue, WA 98004

Please call the Bellevue ENT clinic at (425) 454 – 3938 if you need to reschedule or are unable to make your appointment.

Medications:

Please take Tylenol every 6 hours for the first 3-4 days after surgery. If your child seems to be eating well without significant pain, Tylenol can be administered more infrequently at that point. If s/he has significant pain in spite of the scheduled Tylenol, ibuprofen can be administered every 6 hours (alternating every 3 hours with Tylenol) as needed for breakthrough pain.

Diet:

Maintain a soft diet for 2 weeks with a consistency similar to mash potato. Do not eat any hard, solid, or sharp foods (such as cereal or toast). You can resume a regular diet after 3 weeks unless instructed otherwise at your follow-up appointment. Remember to encourage your child to drink adequate fluid to avoid dehydration.

Wound care:

Avoid traumatizing the throat when you brush your teeth. Rinse your mouth, but avoid gurgling with water or mouthwash.

Restrictions/Precautions:

Avoid straining and heaving lifting of more than 20 lbs. You may go back to school and/or one week after surgery.

Typical things you can expect after surgery:

Sore throat and ear pain is typical after T&A and will continue to get better with time & medications. Your child may have some reflux of fluid into the nose when drinking; this will typically improve with after 2-3 weeks. About 2-3 days after surgery, you may see a thick white coat of tissue over the throat. This is typical fibrinous materials that will dissipate within 2-3 weeks. Referred ear pain can be present during the first week after surgery. This will subside with time.

Signs and symptoms to look out for:

If you develop significant pain, bleeding, high fever, signs of infection, respiratory distress or difficulty breathing, please call for further medical advice.

Bleeding occurs in 1-3% of individuals after a tonsillectomy. Bleeding is most common the first 24-48 hours after surgery and 7-10 days out from surgery. A small amount of blood tinged saliva is normal, and should not raise concern. Significant bright red bleeding from the mouth that does not resolve is a medical emergency, and you should present to the nearest ER right away.

Contact Information:

For any non-urgent medical problems, please call the Bellevue ENT clinic at (425) 454 – 3938 during the daytime on weekdays. If it is after normal work hours or on the weekend, please call the Bellevue ENT operator at (425) 454 – 3938 and ask for the physician on call for ENT. For emergent issues, please proceed immediately to the nearest ER.

PEDIATRIC PAIN MEDICATION CHART

The chart below is a general guideline for the dose of acetaminophen (Tylenol) and ibuprofen (Motrin) base on weight. However, each manufacturer may have their own formulary. Please follow the dose recommended on the bottle. Your child may take the acetaminophen every 6 hours. You may add the ibuprofen every 6 hours if the pain is not adequately controlled. Make sure you stagger the two medications so that your child may be able to take medication every 3 hours. The best way to control the pain is to stay ahead of it.

5 mL = 1 teaspoon

References:

1. Riggin, L., et al. "A 2013 updated systematic review & meta‐analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti‐inflammatory agents on the risk of bleeding after tonsillectomy." Clinical Otolaryngology 38.2 (2013): 115-129.
2. Kelly, Lauren E., et al. "Morphine or Ibuprofen for post-tonsillectomy analgesia: a randomized trial." Pediatrics 135.2 (2015): 307-313.
3. Diakos, E. A., et al. "Dexamethasone reduces pain, vomiting and overall complications following tonsillectomy in adults: a systematic review and meta‐analysis of randomised controlled trials." Clinical Otolaryngology 36.6 (2011): 531-542.

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