Surgery & Aftercare Information

After removal of the adenoids, a period of approximately 2-5 days is required for the return of appetite, relief of sore throat, and general recovery. Since there is also a wide individual variation in the time required for complete recuperation, no hard and fast rules can be laid down. The following remarks should be used only as a guide.

Diet

Usually, a liquid or soft food diet for the first 24-48 hours followed by return to normal diet is acceptable. Some patients may not eat solid food for several days. This is okay as long as they drink plenty of fluids.

During the first 24 hours at home, fluids should be offered every hour when the patient is awake. Adequate fluid intake is very important.

If the throat is very sore, do not expect the patient to drink a large glass of fluid all at once. It is better to give small amounts frequently and in a small glass.

Usually, the fluids most easily taken are water, milk, ginger ale, and coke (which may be diluted in half with water). Ice cream, Jell-O, custard, soft boiled eggs, and cooked cereals can often be taken early.

Orange juice, grapefruit juice, and tomato juice usually causes stinging, but some patients like them well enough that they can drink them anyway. They will not hurt the site of surgery!

Care of the Throat

Other than the frequent administering of liquids, usually no special care is required after adenoidectomy. Chloraseptic spray may be used to help with throat discomfort. Tylenol or Motrin, in appropriate dosage for child’s age and weight, may be given for any pain.

Bowels

If the patient has not had a bowel movement by the end of the second day at home, a mild laxative such as milk of magnesia or mineral oil may be given. IF THE PATIENT HAS ABDOMINAL PAIN, DO NOT GIVE ANY LAXATIVE BEFORE CONSULTING YOUR DOCTOR.

Activities

Patient may resume normal activities as soon as he/she feels like it after the first 24 hours.  Foul odor or an unpleasant odor from the mouth or nose is common for 1-2 weeks after adenoidectomy. This does not require special treatment and will go away on its own.

Symptoms

As in any other operative procedure, certain minor events occasionally follow removal of adenoids. Those occurring most frequently are listed:

1. Difficulty breathing through the nose: not unusual for the first few days and will usually resolve with no treatment.
2. Pain in the ears: can occur spasmodically and usually clears up quickly. The child may wake up at night, briefly complain of his ears and soon go back to sleep; or, the swallowing of food and liquids may cause momentary discomfort in the ears. This causes no permanent discomfort in the ears. This is of no permanent significance and should disappear within a few days.
3. Vomiting: If this occurs on the first day after the patient has returned home, nothing should be given by mouth for an hour or so. After this time, small amounts of fluid should be given until larger amounts can be tolerated. IF VOMITING PERSISTS, CALL OUR OFFICE OR GO TO THE EMERGENCY ROOM.
4. Night Terrors
   ; Occasionally, a child will have some difficulty sleeping because of nightmare or night terrors. These can usually be controlled by reassurance at bedtime. If this does not resolve in two or three days, call the nurse at our office.
5. Fever: Most children will have a slight elevation of temperature at some time during the day for several days after returning home. If recovery is otherwise normal, a rectal temp of 99.9 to 100.8 is not uncommon during the first three to four days. If an elevation persists, get in touch with our office.
6. Bleeding from nose or throat: This event occurs in about 1% of all patients, and it is well to remember it is rarely of serious nature.

There are certain points which if observed, will make the handling of a bleeding patient much simpler for all concerned and is far less frightening for the child.

Maintain a calm and reassuring manner and your child will usually respond with similar behavior. Sit the patient up in bed and forward over a basin which is placed in the patient’s lap. If the bleeding either lasts longer than ten minutes or measures more than 2 tablespoons, go to the emergency room. With any bleeding, please let us know.

We will call on the day after surgery to check on the patient. We appreciate your call to our office with any questions that you may have. 

After removal of the tonsils and the adenoids, a period of approximately ten days is required for the return of appetite, relief of sore throat, and general recovery.  Since there is also a wide individual variation on the time required for complete recuperation, no hard and fast rules can be laid down.  The following remarks should be used only as a guide.

Diet

Usually a liquid or soft food diet for the first 48 hours followed by the gradual addition of other solid foods is more acceptable. Patient should not eat hard foods like chips or tacos for two weeks. Some patients may not eat solid for several days. This is okay as long as they drink plenty of fluids.

During the first 24 hours at home, fluids should be offered every hour when the patient is awake. Adequate fluid intake is very important.

If the throat is very sore, do not expect the patient to drink a large glass of fluid all at once. It is better to give small amounts frequently and in a small glass.

Usually, the fluids most easily taken are water, milk, ginger-ale, and Coca-Cola (which may be diluted in half with water). Ice cream, Jell-O, custard, soft boiled eggs, and cooked cereals can often be taken early.

Orange juice, grapefruit juice, and tomato juice usually causes stinging, but some patients like them well enough that they can drink them anyway. They will not hurt the site of surgery!

Care of the Throat

Other than the frequent administering of liquids, usually no special care is required after a tonsillectomy. Chloraseptic spray may be used to help with throat discomfort.

Bowels

If the patient has not had a bowel movement by the end of the second day at home, a mild laxative such as milk of magnesia or mineral oil may be given. IF THE PATIENT HAS ABDOMINAL PAIN, DO NOT GIVE ANY LAXATIVE BEFORE CONSULTING YOUR DOCTOR.

Activities

For the first 24 to 48 hours, the patient should remain in the bed or on a couch, but is allowed up for bathroom privileges. After this time, a child is usually anxious to be up and around and they may be with discretion.

They should, however, remain indoors and reasonably quiet for four days after returning home. At the end of the time, they may be allowed outdoors for a short time for quiet play, if the weather is warm and sunny.

It is well to insist upon a rest period in the middle of the morning and after the mid-day meal for a week or longer depending on how well recovery is taking place.

Full normal activity may be resumed at the end of ten to fourteen days but return to school should not occur before four days and may take a week or more. In instances where convalescence is slow, two full weeks may be allowed for recovery.

Swimming or other forms of exertion is not safe for two weeks from the date of operation.

Symptoms

As in any other operative procedure, certain minor events occasionally follow removal of tonsils and adenoids. Those occurring most frequently are listed:

1. Difficulty breathing: patients who have had upper airway surgery and seem to have a problem breathing should call us.
2. Pain in the ears: in the absence of other signs, this is almost always due to referred pain from the site of surgery. It is often more severe on the fifth, sixth, or seventh day than on earlier days. It tends to occur spasmodically and clear up quickly. The child may wake up at night, briefly complaining of his ears, and soon go back to sleep; or, the swallowing of food and liquids may cause momentary discomfort in the ears. This is of no permanent significance and should disappear within a few days.
3. Vomiting: if this occurs on the first day after the patient has returned home, nothing should be given my mouth for an hour or so. After this time, small amounts of fluid should be given until larger amounts can be tolerated. IF VOMITING PERSISTS, CALL US OR GO TO THE EMERGENCY ROOM.
4. Night Terrors
   ; occasionally a child will have some difficulty sleeping because of nightmares or night terrors. These can usually be controlled by reassurance at bedtime. If this does not resolve in two or three days, call the nurse at our office.
5. Fever: Most children will have a slight elevation of temperature at sometime during the day for several days after returning home. If recovery is otherwise normal, a rectal temp of 99.9 to 100.8 is usually of no significance during the first three to four days. If an elevation persists, get in touch with our office.
6. Bleeding from nose or throat: this event occurs in 1-3 percent of patients, and it is well to remember it is not usually of a serious nature.

There are certain points, which, if observed, will make the handling of a bleeding patient much simpler for all concerned and is far less frightening for the child.

Maintain a calm and reassuring manner and your child will usually respond with similar behavior. Sit the patient up in bed and forward over a basin which is placed in the patient’s lap. If the bleeding either lasts longer than ten minutes or measures more than 2 tablespoons, go to the emergency room. With any bleeding, let us know.

We will call on the day after surgery to check on the patient and we will call to check on the patient two weeks after surgery. We appreciate your calling the office with any questions that you may have.

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What to Expect

• Your child’s throat will be very sore for 7-14 days.
  • Your child’s pain may be worse the first few days after surgery, improve and then worsen around post-operative day #5 – 7.
  • Children will often complain of an earache after a tonsillectomy.
• Your child will probably run a low grade fever the first day or two (less than 101).
  • Children’s acetaminophen (Tylenol) and Children’s ibuprofen (Motrin/Advil) will help control this. Check the package for the dose and frequency.
  • The fever will be worse if your child does not have enough fluid intake and becomes dehydrated.
  • It is very important to keep your child well hydrated and to push fluids frequently at least every 30-60 minutes.
• Snoring and nasal congestion is common 5-7 days after surgery until the swelling goes away.
• A small amount of bleeding may occur from the mouth.
  • Between the 7^th and 10^th day after surgery, the surgery site goes through the final phase of healing.
  • At this time, your child may spit up a small amount of bloody mucous.
  • Your child may have a small amount of bleeding. If there is more than 1 teaspoon of bright red blood, or the bleeding won’t stop, IMMEDIATELY go to the nearest emergency room and call the ENT office.
• Your child will have bad breath as the throat and adenoid sites heal. The odor comes from a white tissue that forms over the tonsil surgery site- this is not an infection.  They may brush their teeth after surgery, but this will not make the bad breath go away.  The odor will clear in 7-14 days as the throat heals.
• Nausea and/or vomiting are common after surgery. If nausea occurs, treat with a clear liquid diet, and advance as tolerated.
• Your child’s voice may be high pitched after surgery especially in children over 3 years of age. It is temporary and should return to normal as the throat heals.
• Night terrors- occasionally a child will have some difficulty sleeping because of nightmares or night terrors. These can usually be controlled by reassurance at bedtime.  If this does not resolve in 2-3 days, call the nurse at our office.

Diet

• Keeping up with fluid intake is very important.
  • Liquids, i.e. popsicles, milkshakes, Gatorade, are the most important things for your child to have after surgery.
  • Your child will not want to swallow and may easily become dehydrated.
  • Some signs of dehydration include:
    • Decreased urine output,
    • No tears and/or dry mouth.
  • It is very important to keep your child well hydrated and to push fluids frequently at least every 30-60 minutes.
  • Your child should be urinating at least every 8 hours.
  • Offer cool or room temperature fluids at least every 30-60 minutes
  • Avoid acidic drinks, such as orange juice, as they may burn.
  • Frequent, small feedings of soft foods will be easy to swallow. Avoid foods with hard edges such as potato chips and pizza crusts.
  • Weight loss is common the first week.

Medication

• Alternate Children’s acetaminophen (Tylenol) and Children’s ibuprofen (Motrin/Advil) every 3 hours. Check the package for the dose.  Do this around the clock for 10 days.
• If you are given a prescription of Oxycodone, you may use it every 4-6 hours for breakthrough
• You will also be given a prescription for oral steroids to be taken by mouth once a day for the first 3 days after surgery. This medication will help to reduce pain and swelling after surgery.
• For young children, usually less than 5 years of age, prescription pain medication may not be prescribed. Please alternate Children’s acetaminophen (Tylenol) and Children’s ibuprofen (Motrin/Advil) every 3 hours for pain relief.  Check the package for dose.

Activity

• Your child may not have as much energy as usual and may tire easily.
  • Avoid rough play, contact sports and any strenuous activity for 2 full weeks after surgery.
  • Mild activity is fine as tolerated.
  • It is important for them to be in a home environment for at least 1 – 2 weeks so they can rest and sleep as needed, and so that any problems can be taken care of quickly.
  • Children usually are able to return to school in 5 to 10 days after surgery.

YOU WILL RECEIVE A POST-OP FOLLOW UP CALL FROM THE ENT NURSE THE NEXT BUSINESS DAY AFTER SURGERY.  THERE IS NO RETURN APPOINTMENT NEEDED FOR TONSILLECTOMY/ADENOIDECTOMY.

When to Call Your Doctor

• Your child may have a small amount of bleeding. If there is more than 1 teaspoon of bright red blood, or the bleeding won’t stop, IMMEDIATELY go to the nearest emergency room and call the ENT office.
• Temperature above 101 degrees for 24 hours
• Excessive nausea, vomiting, if your child has not urinated for longer than 8 hours or any concerns regarding dehydration.

Your skin lesion has been treated with the Cryopen Cryosurgical System.  Some stinging starts during treatment and may continue through thawing, but settles within a few minutes.  There may be some discomfort a few hours later as reactive swelling occurs.  If you are not allergic, acetaminophen may be used.

Redness and some swelling can be expected.  Within 24 hours, a water or blood blister may form, especially where the skin is thin and sensitive.  A small blister or open sore should be covered with an adhesive dressing.  A scaly crust will form on the area treated and usually peals off over 2 – 3 weeks removing the treated skin lesion.  Redness surrounding the area may last 2-4 weeks.

If you have cause for any concern, please contact us at (256) 329-1114.

Remember that you may require a second treatment in 6-8 weeks.

1. If you have packing in your ear, you should change the cotton ball twice a day, but leave the packing in the ear. If the packing begins to come out, gently push it back in to the canal.
2. A small amount of bloody oozing from the ear or the incision behind the ear (if you have one) is normal.
3. If you have an incision behind your ear, after 24 hours, you should wash it twice a day with peroxide or soap and water and coat it with antibiotic ointment.
4. The ear that was operated on will feel stopped up for several weeks after surgery.
5. Please resume all of your normal medications at home. Pain medication will sometimes cause nausea.  If you find you are too nauseated to eat or drink normally, take your medicine with meals, cut the tablets to half the dose, or switch to plain Tylenol. If you are still nauseated, then call our office and speak with the nurse.
6. An intravenous line was placed in your arm for your operation and for intravenous fluids after surgery.  You may later notice a small tender knot in your hand or arm vein. This is a small blood clot caused by the catheter, medicines, and fluids. This clot is not dangerous to you and the clot and tenderness will disappear with heat and patience.
7. You will find that you fatigue easily.  This is normal following an operation.  Please remain active. You will regain your pre-op stamina after 2-3 weeks.
8. Dr. McLeod’s nurse will usually call you at home the day after you have been discharged to be certain that you are recovering satisfactorily.  If she does not reach you by 4:00 p.m., we would appreciate your calling our office with a brief report.
9. If you have any problems or questions, we can be reached by calling our office at (256) 329-1114. Please be certain to keep your follow-up appointment.

1. Patient should rest on the day of surgery.
2. Normal activities should resume the day after surgery.
3. There may be a small amount of bleeding from the ears for 1-2 days after surgery. – Do not be concerned about this.
4. Ear tubes do not cause pain after the initial discomfort of surgery.
5. Use the drops given after surgery, 3 drops in each ear 3 times a day for 3 days unless they burn the ears.  If they burn, discontinue use.
6. ALWAYS keep water out of ears as long as the tubes are in place.
7. If the patient has problems with drainage from the ears, and the child is otherwise okay, it is generally not necessary to go to the Emergency Room.  Call us for an appointment the morning of the next business day to see us for cleaning and medication.
8. Most tubes generally last 12-18 months.  There is a chance that some tubes may stay in too long and need to be removed or they may fall out early and need to be replaced.
9. We need to perform a hearing test about 4 weeks after the tubes are placed.

We fit earplugs of all shapes and sizes, including ones that float! For more information about special earplugs, please contact us.

1. Keep wound clean and dry for the first 48 hours after surgery unless covered with skin glue – if so, you can shower normally.  After the first 48 hours, if there is no glue on the wound, then wash the wound carefully with soap and water or peroxide twice a day and coat with an antibiotic ointment.
2. Your wound will become firm 2-3 weeks after surgery and will feel like a lump or knot. This is normal wound healing and contraction process.  The wound will soften 8-12 weeks after surgery.
3. If your wound becomes too painful, bleeds or swells excessively, call our office.
4. Do not sunburn the scar for at least 6 months or the scar may remain pink indefinitely.
5. Please resume all of your normal medications at home.  Pain medication will sometimes cause nausea.  If you find you are too nauseated to eat or drink normally, take your medicine with meals, cut the tablets to half the dose, or switch to plain Tylenol.  If you are still nauseated, then call our office and speak with the nurse.

1. You should rest with your head elevated after your surgery – through the day of your surgery and the day after!
2. On the second day after surgery, you may be able to resume some activities such as desk work or light grocery shopping.
3. Avoid bending, stopping, or lifting anything over 5 -10 lbs for at least three days after surgery.
4. Expect bloody oozing for the first 24 – 48 hours after your surgery. There will also be increased mucous production while packing or splints are in place.
5. You should use Nasal Saline about every 1-2 hours while you are awake for two weeks after surgery.
6. Following surgery, if your nose is stuffy, you may use Afrin for the first two days ONLY!
7. Please resume all of your normal medications at home. Pain medication will sometimes cause nausea. If you find you are too nauseated to eat or drink properly, take your medicine with meals, cut the tablet to half the dose, or switch to simple Tylenol. If you are still nauseated, please call our office and speak with the nurse.
8. An intravenous line was placed in your arm for your operation and for intravenous fluids after surgery. You may later notice a small tender knot in your hand or arm vein. This is a small blood clot caused by the catheter, medicines, and fluids. This clot is not dangerous to you and the clot and tenderness will disappear with heat and patience.
9. Dr. McLeod’s nurse will usually call you at home the day after you have been discharged to be certain that you are recovering satisfactorily. If she does not reach you by 4:00 p.m., we would appreciate you calling our office with a brief report.
10. If you have any problems or questions, we can be reached by calling our office at (256) 329-1114. Please be certain to keep your follow-up appointment.