What's involved in surgery to get tonsils and adenoids out?

Dear Freaking out,

You're definitely not alone! It’s not unusual to have some anxiety or apprehension about going under the knife, especially if it's your first time. It might help to keep in mind that having your tonsils or adenoids removed is a fairly common procedure (more on that later). As your surgery date approaches, you’ll likely create a plan with your health care provider about how to prepare. This will most likely include going over the procedure in detail, how to prepare pre-surgery, and self-care during your recovery. Any member of your medical team (including the surgeon; anesthesiologist; ear, nose and throat (ENT) specialist; and primary care provider) can be a great resource to turn to for any additional questions. In the meantime, you can read on for general information and what you might expect before, during, and after the procedure. 

So, what exactly are these procedures? A tonsillectomy is the surgical removal of the tonsils, which are pink, oval-shaped masses of lymphoid tissue located on both sides at the back of the throat (not to be confused with the uvula). An adenoidectomy involves surgical removal of the adenoid. Unlike the tonsils, the adenoid is one mass of lymphoid tissue that can only be seen with special instruments because of its location at the back of the throat and near the passageway leading up to the nose. Why do some people have these tissues removed? Sometimes, the tonsils and adenoids can become infected and swollen, causing airway-blockage symptoms such as mouth-breathing, snoring, sleep apnea, and allergy symptoms. Usually, antibiotics can be used to treat these infections, but surgery may be recommended if they’re recurring or become severe. Also, while these tissues are the first line of defense against microorganisms, the good news is that they aren’t an essential part of your body’s immune system. As such, removal won’t impact your ability to fight infections!

More to your question, Freaking out, while everyone’s experience may not be the same, there are some common experiences before, during, and after surgery. To prepare for either procedure it’s a good idea to talk with your health care provider about your personal or family medical history. Be sure to inform the surgeon if you:

• Have any kind of bleeding disorder.
• Are currently or may be pregnant.
• Are taking any other medications, steroids, drugs, over-the-counter treatments, or nutritional supplements.
• Have any adverse reactions to anesthesia or antibiotics.

Additionally, as with any surgical procedure, these guidelines may be helpful when preparing for a surgery (but pay close attention to the instructions given to you by your health care provider):

• If you can, avoid taking aspirin or ibuprofen for at least ten days before the operation as it can affect blood clotting during and after surgery.
• Do your best to stay healthy — try to avoid sick friends or family and wash your hands often.
• Try to refrain from ingesting any food or drinking any liquids eight to twelve hours prior to the procedure.
• Arrange for someone to drive you to and from the hospital.

Health care providers will usually ask about these items in person or in writing before the procedure. After a general medical exam, laboratory tests (including blood and urine tests) may be completed prior to the procedure as well.

Once you’ve been taken to the operating room, anesthesia will be administered. After you’re fully asleep, the surgeon will make incisions at the site of the tissues in your throat and the blood vessels will be sealed off to stem bleeding after the tissue has been removed. The surgeon will likely be using either a scalpel to make the incisions or a specialized-surgical tool that uses heat or sound waves to remove tissues and stop bleeding. The procedure usually takes about 20 to 30 minutes to complete and, since you’ll be under anesthesia and won’t be awake, you won’t have to worry about pain during the procedure. Additionally, because there are no external incisions, visible scaring is unlikely.

Once the surgery is complete, you’ll be relocated to the recovery area of the hospital where you’ll be able to rest and be closely monitored. Some of the after-effects of surgery can be a little unpleasant and may include a sore throat, difficulty swallowing, mild fever, vomiting, or pain in your ears, neck, and jaw. However, more serious side effects, such as bleeding or difficulty breathing, might warrant going back to the operating room immediately. Otherwise, once the anesthesia has worn off and you’re fully awake, you’ll be given ice chips or clear liquids to make you more comfortable and, generally, you'll be allowed to go home day of the surgery. An overnight hospital stay is usually limited to very young patients or people with chronic medical conditions that may need additional monitoring and post-op support. Generally, once you've left the hospital, recovery time for these procedures takes around 10 to 14 days.

To prepare for a comfortable at-home recovery, you may consider some of these tips:

• Have over-the-counter pain relievers on hand, such as acetaminophen.
• Stock your fridge and pantry with items such as juices, clear soups, yogurt, smoothies and electrolyte sports drinks.
• Re-introduce solid foods to your diet slowly, and start with soft, bland foods such as scrambled eggs, mashed potatoes, pudding, and oatmeal.

You’ll also likely have you schedule a follow-up visit to determine how well you’re healing. However, if you notice any of the following symptoms during your recovery, it's recommended that you seek medical attention right away:

• Not being able to keep clear liquids down and have severe gastrointestinal symptoms including nausea, vomiting, and diarrhea.
• Experiencing difficulty breathing.
• Seeing bright red blood coming from your nose or in your saliva.
• Having a fever higher than 101° Fahrenheit or 38° Celsius or the fever is accompanied by bad breath. 

If you experience loud snoring or persistent voice changes (lasting more than a few weeks) after surgery, it’s also a good idea to visit with your health care provider to make sure there are no other issues. 

It's great that you're asking questions to help you prepare physically and emotionally for your procedure. In addition, you may consider having a close friend or family member nearby to help with those pre-op jitters and any post-op discomfort. Some hospitals even allow a comfort item (such as a stuffed animal) to accompany a patient, so if this might be soothing for you, it’s definitely worth asking!

Here's to an easy surgery and speedy recovery!