Dear Alice,

This week I'm getting my tonsils and adenoids taken out. I've never had surgery before and I don't know what to expect. Can you explain please?!?

— Freaking out

Dear Freaking out,

It's natural for anyone facing a surgical procedure not to know what to expect and to feel the way you do. Asking about your upcoming operation is one way for you to learn more about what you can expect before, during, and after the procedure, hopefully helping you to feel more at ease and less freaked out. People need this information to prepare themselves and alleviate their anxiety. It is important that you speak with your surgeon, anesthesiologist, and primary care provider about what to expect before, during, and after surgery. Explaining their procedures is a vital part of preparation for surgery.

A tonsillectomy is the surgical removal of the tonsils, pink masses of lymphoid tissue located on both sides at the back of the throat. They are not to be confused with the more centrally positioned hanging flap of skin called the uvula. An adenoidectomy involves surgical removal of the adenoid, one mass (and not a pair as more commonly known) of lymphoid tissue found in the very upper rear part of the throat. It can only be seen with special instruments because it is situated between this part of the throat and the passageway leading up to the nose. The tonsils and the adenoid vary in size, with larger sizes of either being normal in some children. For these children, the tissue(s) may eventually decrease in size.

The tonsils and the adenoid act as part of the first line of the body's immune response, since they are present right near the opening of your mouth. They are made up of specialized cells that can keep microorganisms (e.g., bacteria, viruses) and particulate matter breathed in through the mouth and nose in check. These lymphoid tissues fight off infections because they are involved in antibody production. The tonsils and the adenoid are not essential parts of your body's defense against germs since similar tissues in other parts of the body work in the same way. So, your resistance will still be maintained without them.

Surgical removal of the tonsils and/or the adenoid is no longer considered the first line of treatment. Antibiotics have proven effective in managing an infection of the tonsils and/or adenoid. However, surgery is most often considered when:

  • Antibiotics cannot effectively treat recurring or chronic infections
  • These tissues are continually enlarged, causing frequent problems with normal breathing when awake and/or asleep

To prepare for the tonsillectomy and/or adenoidectomy, patients need to know their full medical history, so that they can provide this information to a health care provider when they're at the hospital. Laboratory tests, including blood tests and a urinalysis, are done prior to the procedure. In the operating room, the patient is administered anesthesia. Once asleep, the surgeon removes the tonsils and/or the adenoid through the patient's open mouth. To remove these tissues, incisions are made at their locations, and then the blood vessels are sealed off to stem bleeding. After the procedure is complete, the patient rests in the recovery area of the hospital, where s/he is monitored closely.

Following the surgery, some of the aftereffects can include a sore throat, difficulty swallowing, fever, vomiting, and/or ear pain. If the patient is bleeding or continues to have difficulty breathing, s/he will be sent back to the operating room right away. Once the effects of the anesthesia have worn off, the patient may be given ice chips or clear liquids. The total time spent in the hospital averages about 5 - 10 hours. An overnight hospital stay is usually limited to very young patients or people with chronic medical conditions.

As with any surgical procedure, the following is highly recommended for patients:

  • Avoid taking aspirin or products with aspirin for at least two weeks before the operation (because they affect blood clotting)
  • Refrain from eating any food or drinking any liquids (including toothpaste, gum, mouthwash, or lozenges) after 12 midnight before the surgery
  • Notify the surgeon and anesthesiologist of past personal and family history of any reactions or other problems with anesthesia (these providers will ask you these questions in person, in writing, and/or both)

In addition, inform the surgeon if you:

  • Have a bleeding disorder of some kind
  • Are taking any other medications, drugs, over-the-counter treatments, or nutritional supplements
  • Have sickle cell anemia
  • Are concerned about blood transfusion
  • Are pregnant
  • Have used steroids in the past year

For specific details about pre- and post-operative care, you can speak with your ENT specialist. S/he can provide more information about the procedure and what to expect.


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