What are the tonsils and adenoids, and what are their functions?
The tonsils and adenoids are collections of lymphoid tissue that are found at the back of the mouth and nose respectively. They have an immunologic function and help the body fight infections.
Why do they sometimes need to be removed surgically?
If they repeatedly become infected they can cause more harm than good, resulting in recurrent pain & fever, poor appetite and repeated absence from school or work. Low grade infections can also linger on in them between episodes. Repeated infections can make the management of other medical conditions (e.g. asthma, epilepsy etc) difficult. Enlargement of the tonsils and adenoids can cause obstruction of the upper airways leading to nasal obstruction/discharge, snoring and delayed speech development. Rarely, tumours can develop in these tissues.
Will removal of them render the immune system vulnerable?
No, as there are numerous smaller groups of lymphoid tissue in the same area that will continue to function.
How are they removed?
Tonsils and adenoids are removed through the mouth using electrocautery. This causes a small burn at the raw edge of the tissue which helps seal the blood vessels closed and prevent bleeding.
Does it hurt?
Yes, for 1-2 weeks following surgery the throat can be very sore. This is caused by stiffness of the throat muscles. You will be given strong pain medication to help with the pain. Never use any Aspirin containing medication as this can result in bleeding. Associated ear pain is very common and is caused by nerve stimulation.
How does the tonsil bed heal following surgery?
A yellow scab forms over the raw areas – this does not indicate infection. The scabs usually fall off after 7-10 days. A slight rise in temperature is also common during this time.
What else makes it feel better?
Chewing gum can be helpful; it helps to exercise the muscles of the jaw that are often sore after the surgery and contributing to the throat pain. An ice pack on the neck may help. Gargling with salt water can help to keep down the growth of bacteria on the scabs in the back of the throat. But most importantly, taking in plenty of fluids and regularly using the pain medication for the first few days will make it easier to recover.
What should I expect during the recovery phase?
Nausea/vomiting: There are several factors that can each contribute to nausea and vomiting. Some patients are sensitive to the anaesthesia medicines and this can last for 24 hours after surgery. Sometimes swallowed blood may cause vomiting. Some patients get sick from the pain medicine or from the antibiotics.
Yellow-cream patches in the back of the throat: These patches are simply scabs that are bathed in saliva, and so are soft and swollen and whitish-yellow. They are not a sign of infection but rather part of the healing process.
Bad breath: Most patients will have foul smelling breath after this surgery. The scabs in the back of the throat serve as home base for bacteria living in the mouth and throat. They are full of nutrients that the bacteria live off of. The antibiotics prescription that we usually give after surgery helps to reduce the number of organisms living in the scabs. Also, throat gargles or salt water gargles can help with this.
Fever: Most patients will have a low-grade temperature (up to 38°C) after this surgery. Anything higher should be reported.
What should I eat?
The patient that eats well, does well! They experience less pain and make a quicker recovery. Eat a normal diet as far as possible. Avoid acidic foods like tomatoes, oranges and pineapples and also spicy foods or chocolate. Encourage “chewy” foods like biltong, meat, bread, toast, apples, biscuits and chips. Drink plenty of fluids. Do not eat only “soft” foods – ice cream and jelly are the rewards for eating the rest of the meal!
Recovery can last up to 2 weeks, although some heal quicker than others. When you or your child feels well enough to return to daily activities, then it is fine. Return to school or work should be delayed for 10 days following surgery. Physical activity after 2 weeks is permitted.
What problems should I report to the doctor’s office?
Report any bleeding immediately. Bleeding, if it occurs, usually happens between days 7 to 10 after surgery when the wet scabs in the back of the throat are sloughing off. 98% of the time this is a brief bleed that is not significant. However, in one in 1,000 patients, this bleeding can precede more severe bleeding and is a warning sign.
Report a temperature of more than 39°C.
Report neck pain associated with a stiff neck or fixed head position.Please expect a period of tiredness and irritability after surgery. Whatever the effort made, having an operation is a very stressful experience and rest, good food, lots of fluids to drink and plenty of sleep will speed you towards recovery!