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Tonsillectomy

(with or without Adenoidectomy) What are the tonsils? The tonsils are two pads of tissue located on either side of the back of the throat. Tonsils can become enlarged after recurrent tonsil infections or strep throat. They can also become a reservoir for bacteria.

Why does my child need a tonsillectomy? During a tonsillectomy, the tonsils are removed during surgery. Some children may need a tonsillectomy if they: • Have tonsil infections or strep throat often. • Have large tonsils that block their airway. Large tonsils can make it hard to breathe, and can even cause pauses in breathing (apnea).

Tonsils

Getting Ready for Surgery... 1. For 1 week before surgery make sure your child does not take ibuprofen or anti-inflammatory medications. Do not give: • Advil® or Motrin® (ibuprofen); Adenoids • Aspirin®, Aleve® (ASA); • Naprosyn®; • Gingko ; Tonsil • St. John’s Wort.

Base of skull Nose Nasal cavity

Tongue Lips

2. You may give acetaminophen (Tylenol® or Tempra®), over the counter cold medications or antibiotics as needed. Spine 3. Please tell your doctor if your child bruises easily, or if anyone in your family has had: • Problems with an anesthetic; • Bleeding tendencies.

Teeth Palate (roof of mouth) Trachea (Windpipe) Esophagus

4. After the surgery, we recommend that you stay: • Within 1 hour of CHEO for the first night. • Within 3 hours of a hospital that can deal with tonsillectomy patients for the 14 days after surgery. If you live outside of Ottawa, you’ll have to plan ahead. You may stay with friends or family. You may also book a room at Rotel (a reasonably priced hotel on the CHEO campus) by calling 613 733-1412.

What happens during surgery? Your child will have a general anesthetic (special sleep medicine) for the tonsillectomy. Most patients go home the same day. Some patients must stay in hospital overnight so we can watch them carefully. Adenoids are also often removed during the surgery (adenoidectomy). The surgery takes 30 – 45 minutes. Children usually stay at CHEO for 2 – 4 hours after surgery, unless they are staying overnight for observation.

Form # P5642E

September 2013

www.cheo.on.ca

Taking care of your child after surgery

It takes most children 10-14 days to recover after a tonsillectomy.

Breathing:

After surgery, there is some swelling, and it’s normal for children to snore and breathe through their mouths. They may also talk a little differently. You may also notice that your child has bad breath. This is OK-it’s caused by white scabs that form in the throat as the throat heals.

Pain: Most children have a fair bit of pain in the ear or throat after surgery.

It may get worse on the 5th day after surgery. They may also complain of neck stiffness. If neck stiffness lasts more than 2-3 days after surgery, contact your doctor. Many children have trouble eating, drinking and sleeping because of pain. Pain medication may be needed for as long as 7-10 days.

Fever:

A low grade fever is normal for a few days after surgery. Give acetaminophen (Tylenol®) as needed. Please call the surgeon’s office if the temperature is 39°C (102°F) by mouth, or higher.

Nausea and Vomiting:

Some children have nausea and vomiting after the general anesthetic. This should get better within a few hours. Please call the surgeon’s office if nausea and vomiting lasts for more that 12 - 24 hours.

Diet:

It is important to drink plenty of cool fluids. Some children do not want to drink because of pain. Begin with a clear liquid diet, progress to a soft diet, and then to a normal diet as your child feels like eating. Please call the surgeon’s office or go to the CHEO Emergency Department if you are worried that your child is not drinking enough or if there are signs of dehydration (peeing less than 2 – 3 times per day, crying without tears).

Preventing dehydration

Your child should drink close to: _________ each day, or _________ every waking hour, or _________ every 15 minutes (if she is resisting fluids).

Medication:

• Give Tylenol® every 4–6 hours. Do not give more than 5 doses in a 24 hour period. • Morphine or other pain medication may be prescribed. These medications can cause nausea, abdominal pain and constipation. You should never give more medication than prescribed. • You may give anti-nauseant medication, like dimenhydrinate (Gravol®). Stool softeners are often helpful. • Avoid NSAID drugs like Ketorolac (Toradol®).

Activity:

Children may return to school when they are eating and drinking normally, off of all pain medication and sleeping through the night. Your child can go back to light activities as soon as your child feels ready. Your child should wait for 2 weeks (14 days) before taking part in more vigorous activities like team sports. Your doctor will tell you about any other limits to activity.

Bleeding:

There should not be any bleeding from the mouth or nose after surgery, although some pink saliva is normal. Children are at risk for bleeding for up to 14 days after surgery. Please do not travel away from a major hospital for 2 weeks after surgery. If bleeding occurs, bring your child to the Emergency Department to be checked by the doctor on call. Call 911 if the bleeding is severe.

Emergencies after hours In an emergency: call Ontario Tele-Health (1-866-797-0000), go to an after hours clinic or to CHEO’s Emergency Department. Evenings: (5pm-8pm): CHEO Reception (613) 737-7600. Ask for the On-Call E.N.T. doctor.

Call between 8am-4pm MondayFriday for a follow up appointment in several weeks after surgery. Drs. MacCormick, Vaccani, Bromwich, Schramm: (for clinic or telephone follow up): (613) 737-7600 extension 2009 (Nurse, extension 2587) Drs. Girard, McLean, Scherer, Henry: (613) 562-9000 Dr. Antoniak 613-521-3223 Dr. Matyas 613-727-3132 Dr. Murphy 613-235-0469 Dr. Kherani 613-526-5737

www.cheo.on.ca

Dr. Dr. Dr. Dr.

Odell 613-737-8899 X 73287 Planet 613-746-2235 Kilty 613-729-2312 Macdonald 613-729-2834