Adult Tonsillectomy: What To Expect & How to Prepare

David Cuthbertson, MD

Adult Tonsillectomy

Didn’t a tonsillectomy sound kind of fun when you were a kid? How great would it be to eat ice cream for a week and not go to school! But now that you’re grown, you’re not sure what to expect or how significant an adult tonsillectomy really is.

What are the tonsils anyway, and how might removing them make a difference? If you’re considering a tonsillectomy, here’s what you need to know:

What’s the Purpose of Tonsils?

The tonsils are lymph nodes exposed to the environment. Our skin protects us from the external environment, but your nose and mouth are conduits through which bacteria and viruses get inside the body. To keep germs out, the body has a ring of lymphoid tissue called the Waldeyer’s Ring.

The adenoids, palatine tonsils, and lingual tonsils form this ring of immune system tissue to protect the body from viruses and bacteria. Essentially, it attempts to fight off infections before they make it fully inside.

There are two main reasons we remove tonsils:

1. Chronic tonsillitis: General guidelines suggest seven infections in one year, five infections per year for two years in a row, or three infections per year for three years qualifies a patient as “chronic.” Keep in mind, these are guidelines, not the rule for every patient or insurance company. Symptoms such as halitosis (bad breath), tonsil stones, chronic sore throat, and puss or abscesses on the tonsils point to a chronic issue and the possible need to remove the tonsils.

2. Obstructive Sleep Apnea: The other primary reason we remove tonsils is to treat obstructive sleep apnea. Indicated by excessive snoring and blockage of the throat during sleep, sleep apnea isn’t a condition we ignore. If a patient is experiencing obstructive sleep apnea, we may opt for an adult tonsillectomy or one of these alternative treatments.

Occasionally, we remove tonsils due to a concern of cancer, but that’s in a minority of cases.

Adult Tonsillectomy FAQs

If you and your doctor decide to proceed with a tonsillectomy, you’ll likely have several questions surrounding the procedure. We’ve answered our patients’ most frequent questions below so you know what to expect.

Before Your Tonsillectomy

Do insurance companies cover a tonsillectomy?

Yes. In fact, it’s so common most companies don’t even need to pre-authorize it. If we recommend an adult tonsillectomy, insurance companies usually comply. Sure, there are a few companies that push back, but these procedures are generally easily approved.

What’s the recommended pre-surgery diet?

The diet before surgery isn’t restrictive. But as with any surgery, don’t eat or drink after midnight on the day before.

How long do people take off work?

Recovery from an adult tonsillectomy is more involved than with children. Plan on taking two weeks off work to allow for a full recovery. This allows the tonsils to heal and helps avoid potential complications.

During The Operation

What do patients experience during the operation?

When patients arrive at the surgery center, they’ll get an IV before going back to the operating room. Once in the OR, we use a mask and an IV to administer anesthesia. When the patient is asleep, we operate through the mouth. We put a retractor in the mouth to hold it open, taking the tonsils out by removing them from the surrounding muscle.

We also double-check the adenoids to make sure they’re no longer there. Adenoids usually shrink and disappear entirely by the age of 12, so it’s rare that adults need these removed as well. However, if any tissue remains, we remove it.

When we’re done, we remove the retractor and wake the patient.

How long does a surgery typically take?

The surgery itself takes only about 20 minutes. Once we account for the time it takes a patient to go to sleep and wake up, plan on 40 minutes for the entire procedure.

Should a friend/family member accompany me?

Due to COVID precautions, we don’t allow visitors at this time for adults. While we typically prefer for our patients to have someone with them, we’re taking these extra measures to keep everyone as safe as possible. However, you still need to arrange for someone to drive you to and from the surgery center.

After Your Tonsillectomy

What is the post-op diet?

Patients often lose anywhere from 5 to 10 pounds after surgery because it’s painful to swallow. When you eat, opt for a soft diet: yogurt, mac and cheese, pudding, and scrambled eggs. Cold foods that melt and coat the throat are also great options — popsicles, shakes, smoothies, and slushies.

Hydration is the most important part of your recovery. It decreases the risk of bleeding and can decrease overall pain. Any fluid is good fluid — just avoid red liquids so you don’t confuse it with blood if vomiting occurs.

We also advise patients to avoid drinking through a straw, especially thick liquids like milkshakes. Theoretically, the suction could pull a scab from the throat and we want to avoid bleeding as much as possible.

Continue this soft diet with plenty of liquids for at least two weeks.

How active can patients be during recovery?

Keep activity to a minimum during your recovery. To decrease the risk of bleeding, avoid all strenuous activity, heavy lifting, or anything that raises your heart rate or blood pressure for at least two weeks. During the first week, you probably won’t feel like it, anyway.

What are signs of post-op complications?

Bleeding is the main complication that comes from this procedure and the reason we strongly recommend hydration and a soft diet. A week after surgery, the scabs begin to fall off the throat. If a scab comes off prematurely, there may be some bleeding. If it doesn’t stop on its own, we may have to go back to surgery to stop the bleeding.

Other side effects include potential constipation (from pain medication), dehydration, and fever caused by dehydration. As long as you drink plenty, you minimize your chance of these complications.

What pain relief is prescribed or recommended?

We recommend liquid pain medication around the clock. Patients should take the prescribed combination of hydrocodone and Tylenol every 4 hours for the first 2-3 days, even waking up so they don’t miss a dose. Staying ahead of the pain is much easier than trying to chase it after it starts. If patients need additional pain management, they can also take Ibuprofen between doses of prescription pain medication. With this combination, we can typically successfully manage pain.

Have any other questions? Give us a call and we’ll take steps to see if an adult tonsillectomy is the right treatment for you.

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