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,

You're definitely not alone! It’s totally normal to feel 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 will likely create a plan with your health care provider about how to prepare, including 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, read on for general information and what you might expect before, during, and after the procedure. 

What’s in a (procedure) name? A tonsillectomy is the surgical removal of the tonsils, which are pink 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 are 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 will not impact your ability to fight infections.

More to your question, Freaking out, while everyone’s experience may not be the same, the following are some general things you might expect before, during, and after surgery:

Pre-Operation: To prepare for either procedure, it’s a good idea to talk with your health care provider about your medical history. Be sure to inform the surgeon if you:

  • Have any kind of bleeding disorder.
  • Have sickle cell anemia.
  • Have any concerns about blood transfusions.
  • Are currently or may be pregnant.
  • Have used steroids in the past year.
  • Are taking any other medications, drugs, over-the-counter treatments, or herbal/nutritional supplements.

Additionally, as with any surgical procedure, the following are also highly recommended (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 (including coffee, tea, toothpaste, gum, mouthwash, or lozenges) eight to twelve hours prior to the procedure.
  • Be ready to notify the surgeon and anesthesiologist of any personal or family history of adverse reactions or other problems with anesthesia.

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

In the Operating Room: 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 procedure usually takes about 30 minutes to an hour to complete. Since you’ll be under anesthesia and won’t be awake, you won’t have to worry about pain during the procedure. And, because there are no external incisions, visible scaring either won’t be a concern either.

Post-Operation: 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, fever, vomiting, or ear pain. However, more serious side effects, such as bleeding or difficulty breathing, might warrant going back to the operating room immediately. Otherwise, as soon as the anesthesia has worn off and you’re fully awake, you’ll be given ice chips or clear liquids to make you comfortable. Generally, from pre- to post-op, the total time spent in the hospital averages about five to ten hours. 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.

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

  • Have over-the-counter pain killers on hand, like acetaminophen.
  • Keep ice and ice packs ready — you may have earaches or a sore jaw, throat, or mouth.
  • Stock your fridge and pantry with items like juices, clear soups, popsicles, and electrolyte sports drinks.
  • Re-introduce solid foods to your diet slowly, and start with soft, bland foods such as bread, rice, 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:

  • You can't keep clear liquids down and have severe gastrointestinal symptoms including nausea, vomiting, and diarrhea.
  • You experience difficulty breathing.
  • You have rashes on your body.
  • You have a fever higher than 100.5 F 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. 

For more details about pre- and post-op care, you can speak with your ENT specialist who can provide more information about your specific procedure and what to expect. In addition, you may consider having a close friend or family member nearby to help with those pre-op jitters, to arrange a ride to and from the hospital, and any post-op discomfort. Some hospitals even allow a comfort item (like a stuffed animal) to accompany a patient, so if this is something that might be soothing for you, it’s definitely worth asking!

Here's to an easy surgery and speedy recovery!

Alice!

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