A tonsillectomy is usually done for repeated throat infections or for breathing problems during sleep caused by large tonsils. The operation is short, but for most people the recovery is an uncomfortable fortnight. Knowing what to expect makes those two weeks calmer and helps you recognise warning signs early. What follows applies to children and adults alike; your surgeon will give you the instructions for your own situation or your child’s.
You need to be able to eat and drink before you go home. The guideline recommends that children under three, and children with severe sleep apnoea, spend the night after surgery in hospital under observation.
How the pain usually runs
Expect moderate to severe throat pain after a tonsillectomy. It often gets worse over the first five to seven days before slowly easing, and it can be on one or both sides. In children the throat can stay sore for up to two weeks. Pain that increases in the first days does not mean healing is going badly; for most people this is the expected course.
Ear pain is common too, often starting after a couple of days. The throat and ears share nerves, so the pain is felt in the ear; it does not usually mean an ear infection.
A white coating forms where the tonsils were. This is normal healing, not pus, and does not need antibiotics. A temperature of 38°C or slightly above is also common in the first day or two and, if it settles quickly, does not need antibiotics. The guideline likewise recommends against routine antibiotics for children having the operation.
Pain relief, as prescribed and on time
Painkillers work better taken at regular intervals than after the pain has built up. Use the medicines recommended for you or your child at the times and doses given, and never exceed the daily dose. Do not take another medicine that also contains paracetamol, as it is easy to take too much without noticing. In the first days, taking a painkiller about half an hour before meals makes eating easier. Writing the doses and times down helps you not to miss one, especially at night. After a week you can usually start reducing the painkillers, and most people stop at around two weeks.
For children, the guideline recommends ibuprofen, paracetamol or both for pain. Codeine, or any medicine containing codeine, must not be given to children under twelve. Aspirin is not given to children unless a doctor has prescribed it.
The guideline also stresses talking about pain before the operation, and expecting, reassessing and adequately treating it afterwards. If your pain is not controlled by your painkillers, say so without waiting.
Eating and drinking
Drinking plenty is one of the most important parts of recovery. Someone who does not drink enough can easily become dehydrated, and some children need hospital treatment for this. Give your child a drink with every meal and offer water often through the day. If they are passing much less urine than usual, have a dry mouth or are unusually listless, they may not be drinking enough.
Eating normal food helps the throat heal. Soft, lukewarm food may be easier for the first days, but return to your usual meals as soon as you can. Very acidic or spicy food can sting a healing throat.
If you find it hard to swallow liquids, or your child refuses to drink, let the practice know the same day.
The bleeding window
The guideline distinguishes bleeding within the first 24 hours after surgery (primary bleeding) from bleeding later than 24 hours (secondary bleeding). In practice, bleeding can happen at any time in the two weeks after the operation, which is why those two weeks call for care.
Slightly blood-stained saliva on the first day is normal. Beyond that, take any bleeding from the throat seriously; even a small bleed that stops by itself means the throat needs to be examined. Spitting out bright red blood or clots, difficulty breathing, or vomiting that is bright red, black or brown is an emergency: call 112 or go to the nearest emergency department straight away.
Infection in the throat can also develop in those two weeks. To lower the risk, keep away from crowds, from people with coughs or colds, and from smoky or dusty places. If you smoke, you are advised not to before or after surgery, as smoke irritates the healing throat.
When to get help
Some problems are not emergencies but should be reported the same day: difficulty swallowing liquids or not drinking enough, pain that painkillers do not control, a temperature of 38°C or more that does not come down despite paracetamol, or a bad smell from the throat together with a fever. These can be signs of infection or dehydration. In that case, call the practice.
Bright red blood or clots from the mouth, difficulty breathing, or vomiting blood cannot wait. Do not try to get advice by phone first: call 112 or go straight to the nearest emergency department.
Back to school or work
Adults are usually advised to take two full weeks off work to let the throat heal. Children usually need two weeks off school and social activities. Tiredness in the first days is normal; let your child rest quietly at home. Keeping away from crowds during these two weeks also lowers the chance of picking up an infection, which is one reason school and work are planned around this period.
By the end of two weeks most people feel clearly better, and the two weeks of watching for bleeding are behind them. Ask your surgeon at your check-up when you can return to strenuous sport or heavy physical work.
If the operation was done for sleep apnoea or other breathing problems in sleep, snoring and pauses in breathing can persist or come back afterwards. If you notice this, mention it at your check-up, as further assessment or treatment may be needed.