Pre-operative and Post-operative instructions for
Tonsils & Adenoids
Pre-operative and Post-operative instructions
for Tubes.
Videos Detailing Tonsillectomy & Adenoidectomy and Placement of Ear Tubes.
What are
Tonsils and Adenoids?
Tonsils and adenoids are collections of lymphoid tissue found in the
throat. The tonsils are located on each side of the throat in the soft palate.
The adenoids are located behind the nose and above the soft palate and generally
cannot be seen without the aid of special mirrors to examine these areas. Both
tonsils and adenoids function to filter bacteria and viruses entering through the nose or
throat.
What are
tonsillitis and pharyngitis?
Tonsillitis is an infection of the tonsils. Pharyngitis is an infection of
the back of the throat (known as the pharynx). These two infections may often occur
at the same time. Symptoms of tonsillitis of pharyngitis are fever (usually greater
than 101º F or 38º C), chills, sore throat and pain on swallowing.
Why Remove Tonsils and Adenoids
There are two basic reasons that otolaryngologists
recommend tonsil and adenoid surgery (T&A). These are infection and obstruction. The infectious indications should include
chronicity or recurrence as support of these subcategories. The infections may include the
ears, nose, nasopharynx, adenoids, sinuses, pharynx, tonsils, peritonsillar tissues and/or
the cervical lymph nodes. Obstructions may involve the nasal or oral airways as well as
swallowing difficulties.
What
are the symptoms associated with enlarged tonsils and adenoids?
Children with enlarged adenoids may complain of
difficulty breathing through the nose or be chronic "mouth breathers".
Noisy breathing with "snoring" quality may be present in awake or
sleeping children. Pauses in breathing while sleeping are also seen with enlarged
tonsils and adenoids and this is called apnea. Sleep apnea may be a serious medical
condition.
Age of Patient
Ninety percent of all T&A's are performed on
children under 15 years old. Tonsillectomy alone is rarely done in children less than
three years old. Adenoids are less frequently removed in adults.
Benefits of Tonsil and Adenoid Surgery
Decrease the frequency and severity of ear, nose, or
throat illnesses.
Reduce obstruction in breathing which may improve sleep, growth, and attention span while reducing problems with bed-wetting.
Improve hearing if ear infections were problematic.
Removal of tonsils and adenoids is not associated with increased infections due to the relative inactivity of infected tonsillar and adenoid tissue, as well as the presence of vast amounts of similar tissue left in the body after the procedure, such as lymph nodes.
What
are the risks of Tonsil and Adenoid Surgery?
Tonsillectomy is performed under a general
anesthetic, and there always is small risk of complications from the anesthesia. The
major complication associated with the tonsillectomy/adenoidectomy itself is bleeding at
the site where the tonsils/adenoids were removed. This can occur right after the operation
or up to seven to ten days afterwards when the eschar covering the operative site falls
off. Approximately 1-2% of patients who undergo tonsillectomy/adenoidectomy will
have bleeding severe enough to require a trip to the emergency room. About on-half
of these people will need to go back to the operating room to control the bleeding, and
the other half will stop bleeding on their own. Other rare risks of tonsillectomy/adenoidectomy
include infection, delayed healing or abnormal scarring. Dehydration may occur if
fluid intake is not maintained at an adequate level.
Follow instructions from anesthesia/day surgery
personnel regarding eating or drinking prior to surgery and time to come to day surgery
for your procedure.
You will likely need to remain without food or drink after midnight before the day of your procedure and arrive 1-2 hours earlier than the scheduled time of the procedure.
Avoid use of over the counter medications.
Do not take the following medications for three
weeks prior to surgery
-
ADVIL and all ibuprofen-type medications including
Aleve, Relafen, Flexeril, and Motrin.
-
AFRIN and all over the counter nose sprays.
-
ASPIRIN and all aspirin containing drugs such as
Goody's, BC's and Alka-Seltzer.
WHAT YOU CAN EXPECT:
-
Sore throat for 1 to 14 days, with increasing discomfort for the first 5 days.
-
Elevated temperature for up to 4 days.
-
Earache, especially with swallowing.
-
Possible mild constipation.
-
Some blood tinged mucus.
HELPFUL HINTS:
To help avoid nausea do not take pain medication on
an empty stomach (with the exception of Tylenol).
Use an ice collar for discomfort or small amount of
bleeding. Use regular chewing gum 1/2 hour before meals to stretch throat muscles and make
swallowing easier.
Adequate fluid intake will prevent temperature
elevation.
May use a mild laxative after the first day, if
necessary.
The sooner the throat is used, the sooner the
earache will be relieved. Use the throat for talking, swallowing and chewing. It reduces
soreness.
Return to work or school after seven days if no
difficulties arise. No play on playground or Physical Education for 14 days.
On the fourth day, you may begin eating crusty
foods such as crackers, potato chips, pizza, etc. to "rough" the back of the
throat and promote healing.
More than likely you will have a foul odor to your
breath 3-5 days past surgery. You can gargle with mouthwash or take 1-2 teaspoons of fruit
flavored yogurt in your mouth and let it dissolve.
Do not take aspirin or any medication with aspirin.
Patients on blood thinners (Coumadin, Aspirin, Plavix, etc.) should discuss this with the doctor.
REPORT AND/OR SEE A DOCTOR FOR:
High fever, although
mild fever is not uncommon in the first 4 days after surgery.
Bright red bleeding. The greatest danger period is
day 4 through 9 when the white crust comes off. If slight bleeding occurs, put on an ice
collar and put the patient to bed. Seek medical treatment if bleeding continues. The
patient will be checked by his or her doctor in 1-4 weeks. If you have any question,
please call Mann ENT Clinic at (919)859-4744 or go
directly to the emergency room.
INDICATIONS
Myringotomy and tube placement is a common procedure performed in
children. The reasons for ventilation tube insertion include: 1) fluid is present in the
middle ear cleft for greater than 8-12 weeks despite adequate medical therapy causing a
significant hearing impairment, 2) recurrent ear infections are debilitating secondary to
severity or frequency, 3) severe retraction makes the ear likely to develop adhesions,
cholesteatoma, or other chronic ear problems such as vertigo, tinnitus, and/or speech and
language delays, 4)eustachian tube dysfunction with intermittent ear complaints.
Follow instructions from anesthesia/ day surgery personnel
regarding eating or drinking prior to surgery, and time to come to day surgery for your
procedure.
Avoid use of over the counter medications.
Do not take the following medications for three weeks prior to
surgery:
- ADVIL and all ibuprofen type drugs including Aleve, Relafen,
Flexeril, and Motrin.
- AFRIN and all over the counter nose sprays.
- ASPIRIN and all aspirin containing drugs such as Goody's, BC's,
Alka-Seltzer, and Excedrin.
Operation
Surgery for myringotomy and tube insertion is usually performed
under general anesthesia with a mask ventilation technique. There is normally no need for
an IV (intravenous line) and the whole procedure is less than 20-30 minutes in length. Any
fluid is aspirated, and appropriate cultures are performed when necessary. Eardrops are
commonly prescribed in the post operative period.
WHAT
YOU CAN EXPECT
- Mild pain in the ear and neck.
- Drainage from the ear for 48 hours.
HELPFUL
HINTS
- Avoid getting water in the ear. Be very careful while bathing. You
can coat a cotton ball completely around with Vaseline and place in your ear in order to
make a good seal while bathing. No Swimming!! After you return to the office for your
post-operative check-up we will discuss ear plug options with you if you plan to go
swimming.
- Place two drops of Floxin Otic Solution in the ear
canals two times a day for three days, then only use as needed (i.e. ear discomfort,
child pulling at ear or placing finger in ears.)
- If you have been prescribed an antibiotic (not everyone requires
this), please take it according to the directions on the bottle and complete the amount
given to you, even if you feel better before the medication is finished.
- Tylenol may be used for pain.
- You may resume normal activity level one day after surgery
excluding getting ears wet.
- A follow-up appointment will be made for two weeks following
surgery. After that visit, an appointment for two to ten weeks later for a hearing
and pressure test may be necessary.
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