Tonsillectomy Recovery Guide

What should I expect?

Recovery usually takes 10 to 14 days, and sometimes longer. Recovery varies from person to person. Many children need up to 2 weeks before they are back to normal, and adults tend to have more throat pain. All of these are normal:

• A very sore throat and pain with swallowing. Pain may get worse over the first few days before it improves.
• Ear pain. It comes from the throat, because the nerves to the throat and ear cross paths.
• White patches in the back of the throat. They are part of normal healing, not an infection.
• Bad breath for the first week or two.
• Nausea or a low appetite for the first few days.
• A fever up to 101°F in the first couple of days.
• Temporary tongue soreness, numbness or a change in taste, from the instrument that holds the mouth open during surgery.
• A mild, temporary change in voice.

If the adenoids were removed too, snoring and a stuffy nose can continue until the swelling goes down, up to 2 weeks.

Bleeding is most likely around 5 to 8 days after surgery, when the scabs come off, and it can happen up to about 2 weeks later. It often starts in the evening or overnight, so keep a phone nearby and know the way to the nearest ER. Call us for any bleeding.

1. 1Uvula
2. 2Tonsil
3. 3White or yellow healing layer: normal healing, not an infection

White patches are normal. While the throat heals, white or yellow patches cover the places where the tonsils were. They are not an infection and come off on their own.

How should I manage pain?

Stay ahead of the pain

• Give pain medicine on a schedule, around the clock, including overnight, for the first several days. Waiting until the pain is bad makes it harder to bring under control.
• Use both acetaminophen (Tylenol) and ibuprofen (Advil, Motrin). Each helps, and they work better as a pair than either one alone.
• Alternate them rather than giving them at the same time, so a dose is due every few hours: for example, acetaminophen, then ibuprofen 3 hours later, then acetaminophen 3 hours after that. Keep to each medicine’s timing and daily limit below.
• As the pain eases, space the doses out, then stop.

Adults

*Some acetaminophen packages list a lower limit of 3,000 mg a day. If you are not sure which limit applies to you, ask us.

Children (liquid medicine, dosed by weight)

Dose by your child’s weight, not age: about 10 to 15 mg of acetaminophen and 5 to 10 mg of ibuprofen per kilogram (2.2 pounds) of body weight per dose. Give acetaminophen every 4 to 6 hours (no more than 5 doses in 24 hours) and ibuprofen every 6 to 8 hours (no more than 4 doses in 24 hours). The table shows doses of children’s liquid medicine for common weights; measure with the syringe or cup that comes with the medicine.

• Check the strength on the box. These amounts are only for the strengths shown. Infants’ ibuprofen drops are stronger, so do not use these amounts with them.

Medicine safety

• Ibuprofen is typically fine after a tonsillectomy: it eases pain without increasing bleeding. In some cases your surgeon may ask you to avoid it; we will tell you if so.
• Do not take aspirin or products containing aspirin for 2 weeks after surgery.
• Some prescription pain medicines also contain acetaminophen. Count it toward the daily limit, and do not add Tylenol on top of it without checking with us.
• Never give codeine or tramadol to anyone under 18 after tonsil or adenoid surgery. They can dangerously slow a child’s breathing, and the FDA warns against this use.
• If your surgeon prescribed a stronger pain medicine, use it only for severe pain that the schedule above does not control, and stop it as soon as you can.
• Check with us first if you have kidney disease, a stomach ulcer or take a blood thinner (before ibuprofen), or have liver disease (before acetaminophen).

What else helps?

These help alongside pain medicine, not in place of it:

• Cold foods and drinks. Ice pops and ice cream ease pain, especially in the first hours after surgery.
• Sipping often. Staying well hydrated keeps the throat more comfortable.
• Distraction. For children, a favorite show, game or book can help between doses.

What can I eat and drink?

• Drinking is the most important thing you can do. We recommend at least 30 to 40 ounces of water a day; adults should aim for about 60 ounces (7 to 8 cups) of fluid a day unless told to limit fluids. Using a straw is fine. In the first few days, fluids matter more than food.
• Follow your surgeon’s diet instructions for 2 weeks. That may mean soft foods only, or your usual foods with a few to avoid. Your surgeon will tell you which.
• Either way, avoid sharp, crunchy, acidic or very spicy foods for 2 weeks, such as chips, crackers, toast and citrus. Even if you feel healed, a scratch to the healing throat can cause bleeding.
• Easy choices while it is sore: ice pops, smoothies, applesauce, broth and lukewarm soups, yogurt, pudding and mashed potatoes.

When can I get back to normal?

This is what we usually recommend. Your surgeon may adjust it for you.

• After anesthesia: for 24 hours, do not drive, drink alcohol, use machinery or sign important papers. After general anesthesia, we recommend having an adult stay with you (or your child) the first night.
• For the first 48 hours, spend most of the time in bed or seated in a chair.
• No heavy lifting, strenuous exercise or anything tiring for 2 weeks. Children should not do any hard playing or get worn out for 2 weeks. No hard playing means no running games, trampolines, bikes, sports or rough play; quiet play, board games, screens and short walks are fine.
• Most children are ready for school within 1 to 2 weeks, and some need longer; your surgeon will tell you when. Skip recess and P.E. until 2 weeks after surgery.
• For 2 weeks after surgery, stay within about an hour’s drive of our office or a hospital emergency room, and do not fly.

What these limits mean: heavy lifting means anything over about 10 pounds (a gallon of milk weighs about 8), such as a full laundry basket, a case of water or a suitcase. Strenuous activity means anything that makes you breathe hard, strain or sweat: running, weight training, yard work, hard cycling or sports. Once the first 48 hours of rest are over, walking, light housework, desk work and showering are fine. When the limit ends, start at about half your usual effort and build up over a week; if any bleeding starts, stop and call us.

When should I call?