Tonsillectomy Post-operative Information
Food
Any foods can be consumed after the surgery although soft foods are obviously less painful to ingest. If one can follow a basic diet including foods with some substance (e.g. bread) then they tend to get better a bit faster. Acidic foods (Orange or pineapple juice, tomato sauce based pasta etc) will tend to sting but will not damage anything. If a child favours something, even if just chocolate milk, then just give it. This first week is just about getting in some calories and fluids, not balanced nutrition.
Pain
It is normal to experience significant pain in the first week following tonsil removal and it is not unusual to feel you are not making any progress until the second week after the surgery. Regular pain relief should be used over this time to maintain as normal a food intake as possible and try to get some sleep at night.
Children should have a dose of Panadol (paracetamol) appropriate for their weight regularly 4 times per day (30-45 mins before meals and bedtime). For the first 7 days a single dose of cortisone will also be prescribed (Redipred). The dose is usually higher the first 4 days then halved the second 3 days. This medication will help with pain, swelling, nausea and often perks patients up a little. Please take on waking in the morning (as will impair sleep if taken late). It will take 4-6 hrs to kick in well but lasts 24hrs. If the pain is not well controlled with the above then Oxycodone [Endone](liquid) can be used in addition to Paracetamol. Generally one can start by taking this first thing in the morning (when patients are most sore) and before bed but a midday dose can be added if really needed. Consult your surgeon if unsure. The dose will be on the bottle (approximately 0.1mg/kg body weight). At least twice a day is very normal for the first week. Oxycodone potently causes constipation and an artificial fibre supplement should be used in conjunction (e.g. Coloxyl drops, Benefibre or Movicol).
Adults are prescribed Paracetamol 4 times a day and a morning dose or cortisone (Prednisolone) the same as children. Celebrex is also often prescribed. This is an anti-inflammatory that does not affect clotting, unlike ibuprofen. This is taken 200mg twice daily. Adults are also usually given a slow release stronger morphine-like medication for the first week (Targin or Tapentadol SR). Oxycodone is also prescribed to be used as needed (for ‘breakthrough’ pain). Remember to take a regular laxative such as coloxyl and senna, metamucil or Agiofibre.
For most people, I recommend using an anaesthetic gargle such as Cepacaine. This is available over the counter and can be used every couple of hours. It is very helpful immediately before meals.
You are expected to start feeling better each day in the second week where pain relief can be used as required (often just regular paracetamol). You will not feel back to normal until 14-18 days post-operatively. Your throat will still feel tight and a little achy in the 3rd and 4th weeks with yawning.
Bleeding
As your surgeon has outlined bleeding is a significant risk in the two weeks following tonsil removal. This is most commonly between 5-14 days post-op and much more common in young adults than children, and quite uncommon in very young children. A white scab forms where the tonsils were removed and this starts to break off in the second week. This process can lead to bleeding in some. It is unfortunately just the nature of the location where the surgery occurred. Food can knock the scab off prematurely. Appropriate measures need to be taken by the hospital/surgeon and yourself if this potential risk occurs. Any bright blood that is noted following your surgery is not normal and should be discussed with a doctor, preferably your surgeon. This can be a few drops staining the saliva to a very large distressing bleed.
I personally do not like any ibuprofen (Nurofen) to be taken for 14 days following tonsillectomy (and for 12 days pre-op).
If you note some light bleeding that has settled then a doctor (your GP, surgeon or emergency staff) should look in your throat to check there are no clots or ongoing bleeding. If this is only for less than a minute then the patient can suck on some ice at the time, refrain from eating if within 4 hours of the bleed and contact your surgeon’s rooms the next day. If this keeps recurring you should go to emergency and have them make an assessment. If the bleeding is more than light then you need to go to an emergency department (not your local doctor) and your surgeon or the hospital ENT team may be contacted. You may need to call an ambulance if bleeding is severe or you are alone. Occasionally a return to the theatre will be necessary. Do not travel by air (at all) or on the road to anywhere more than 1.5-2 hours from a hospital offering ENT surgical services for an absolute minimum of 14 days following your surgery. The surgeon cannot help you if he cannot get to you and unavailable or inappropriately skilled back-up can be life-threatening. The risk of serious problems is very small if you simply stay where help is available for the full 14 days.
Activity
No exercise or activity more than walking (but not as exercise) should be undertaken for the 14 days post-op. Do not drink alcohol during this time. Both these activities increase your chance of bleeding. Smoking is allowed but should be limited as much as possible to allow better healing.
Antibiotics
These will be given for the first week following your surgery. The throat area always has a white covering following tonsil surgery for at least 2 weeks. This looks like pus but unless there is a fever or worsening pain (in the second week) infection is unlikely. Very bad breath is normal for 2 weeks following surgery. Infection post-tonsillectomy is rare.
Problems / Follow Up
If very minimal oral intake is possible because of pain and you are concerned about dehydration/ nausea or have other problems (i.e medication reaction) then you should contact your surgeons’ rooms within hours on 03 9347 0680. After hours your surgeon is available through the Private Hospital switchboard where you had your operation (explain you have recently had surgery). The nurse manager may speak to you first.
If your surgery was through the public hospital you can speak to the ENT registrar on-call for that hospital through their switchboard.
If very concerned at any time present to your local emergency department where they can make an assessment and organise further treatment as needed.
Dr Jumeau’s rooms will routinely contact you 2-3 weeks following surgery to make sure recovery is complete.
How to contact me
During business hours
Contact Raelene, my secretary. She will know where I am and how soon I’m available.
Phone: 03 9347 0680
Email: [email protected]
Email only if non-urgent. Emails after 5pm are not read until the next business day.
For public patients, please contact the Royal Victorian Eye and Ear Hospital (RVEEH) at (03) 9929 8666 and ask to speak to the Rhinology Fellow. They work with me directly and will likely have been involved in your case.
After hours/weekends
Please contact the Epworth on (03) 9483 3833
Do this regardless of which Epworth campus you had your surgery.
State you have had surgery with me, and your post-op instructions specify the Epworth will message Dr Jumeau if needed. They are familiar with this. If you have not heard back within an hour or two, call them again, as I endeavour to get back to everyone as promptly as I can. Don’t call Epworth Hawthorn as it is a Day Surgery and not open outside business hours.
For public patients, contact the Royal Victorian Eye and Ear Hospital and ask to speak to the ENT registrar on call (03) 9929 8666
Emergency
If you are bleeding profusely, have badly damaged your nose or have an emergency unrelated to your nose (Car accident, chest pain, etc.), attend your nearest emergency department or call an ambulance and notify me as soon as you can. I prefer to have you or a family member call me as soon as possible in these circumstances for me to help guide what you do and what gets done at Emergency to not damage your nose. Make sure somebody lets me know. Emergency staff will not always call. Have a phone on you so I can stay in contact as needed.
