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Vincent’s S.C.A.N.S 
Ear, Nose and Throat (ENT), Head and Neck Surgery
Specialist Clinic
TONSILLECTOMY refers to the surgical removal of the tonsils. ADENOIDECTOMY refers to the surgical removal of the adenoids. Both the surgeries can be done concurrently (called ADENOTONSILLECTOMY) or independently. 6 hours of fasting (i.e strictly NO food or drinks) before the surgery is needed. The surgery will be done under general anaesthesia (GA) (i.e patient is fully ‘asleep’ and unaware). What will I experience or expect following the procedure?   After   your   surgery,   your   anaesthetist   and   the   nurses   continue   to   monitor   your   condition   carefully   as   you gently   return   to   full   consciousness.   You   may   be   given   some   oxygen   through   the   oxygen   mask   to breathe. Intravenous drips will be given  to replenish the fluids that you might require. 1. You   are   likely   to   feel   drowsy,   tired   and   sleepy   at   this   stage.   Some   may   feel   that   the   throat   is   sore   - this   is   most   likely   due   to   the   insertion   of   the   breathing   tube   during   surgery.   During   this   time   it   is important   that   you   relax   as   much   as   you   can,   breathe   deeply,   do   not   be   afraid   to   cough,   and   do   not hesitate   to   ask   the   nursing   staff   for   any   pain   relief,   and   about   any   queries   you   may   have.   You   are likely to have hazy memories of this time and some patients experience vivid dreams. 2. Due   to   the   effects   of   the   general   anesthesia   and   the   drugs   used   during   the   surgery,   you   may   feel nauseated   and   may   vomit   following   the   procedure.   This   is   normal   and   will   resolve   shortly.   Do   not be alarmed if there is blood stain in your vomitus or sputum. 3. After   the   operation,   as   soon   as   you   are   alert   and   conscious   (this   usually   takes   2-4   hours   after coming   out   from   the   operating   room),   you   are   allowed   to   eat   and   drink.   However,   you   experience some discomfort due to the pain in the throat. 4. Diet: It is very important to be watchful of your diet in the first few days following the surgery. You are encouraged to drink clear cold fluids such as water and take cold food such as ice-cream or jelly. Avoid: hot steaming food/drinks as this can increase the risk of bleeding after the surgery. Favour: cold food/drinks as this lessens the risk of bleeding after the surgery and more soothing on the healing throat. Avoid: citrus juices and carbonated beverages (colas) because they may cause increased pain and throat irritation. Juices that are sour can irritate the raw area where the tonsils used to be, After a few days start trying foods that are easy to swallow. Favour: Soft noodles, porridge(cold), jelly/puddings, yogurt, and ice cream. Avoid: steamy, hot, or spicy foods or hard, crunchy foods. Your appetite is expected to return to normal soon after. 5. Drink plenty of fluids. This will prevent you from dehydration. 6. It is expected that you will still experience some sore throat or blood-tinged saliva (but NOT active fresh bleeding).  Your uvula may swell up for 3 or 4 days after surgery. You may feel there there is something constantly in the back of your throat that needs to be swallowed. Don't be alarmed - this is normal ! It will resolve over the next few days. 7. If   pain   is   persistent,   please   take   your   pain   medication   (eg.   paracetamol   ‘Panadol’,   diclofenac ‘Voltaren’,    celecoxib    ‘Celebrex’,    etoricoxib    ‘Arcoxia’)    as    prescribed    by    your    surgeon.    You    can rinse/gargle   gently   with   the   gargle   medication   (eg.   Difflam,   chlorhexidine,   hydrogen   peroxide)   to   cleanse   the   back   of   the   throat   after   eating   and to help remove any bad taste. Once the pain has resolved, you can stop the painkillers at any time. 8. Avoid products that contain aspirin because they interfere with blood clotting. This can cause bleeding from the operated site. 9. You   may   notice   that   voice   has   changed   slightly. This   is   due   to   the   larger   airspace   in   you throat   now.   This   is   not   a   cause   for   concern.   On   a   positive   note,   you   should   be   able   to breathe better now. 10. You   may   experience   pain   in   one   or   both   your   ears.   This   is   common   during   the   first week.   This   is   due   to   'referred   pain’.   Referred   pain   is   where   injury   in   one   area   causes pain    in    another    due    to    the    similar    nerve    supply.       This    does    not    mean    you    have problems   with   your   ears.   If   it   is   persistent   despite   the   painkillers,   you   are   encouraged   to return for a review. 11. You may also have a low-grade fever (less than 37.5 Celcius) for a few days. Please monitor your temperature. 12. It is normal to see yellowish/whitish slough at the back of the throat where the tonsils were (see picture).  This is due to normal process of healing over the operated site. This does not necessarily mean there is an infection. 13. Bad breath may result from scabs where the tonsils were removed. Do not worry as these scabs are expected to fall off in about a week’s time, after which your breath odor will return to normal. Do not gargle, as this will hurt and may cause bleeding. Rinse your mouth with any antiseptic mouthwash.   When can I leave hospital ? Once you have started taking orally and your general condition permitting, you can usually go home the morning after the surgery. It is important to eat and drink normally even though it may be sore. You will be given details of when your next appointment in the ENT clinic where your progress will be reviewed. You   may   return   to   work   in   about   1-2   weeks.   Depending   on   how   soon   your   resume   your   normal   diet   and   the   level   of   pain/discomfort,   most   adults need about 1 week to recuperate. Children may take longer. You will be given medical leave chit for this period. You   are   encouraged   to   stay   away   from   smoky   atmospheres   and   people   with   colds,   coughs   or   any   other   infection.   A   throat   infection   during   this period can lead to bleeding and should this happen you will need to go straight to the nearest accident and emergency department. When should I call the doctor? Bleeding Persistent pain Not able to resume eating/drinking High fever The   most   common   significant   risk   is   bleeding   (2-4%   of   cases).   While   blood-stained   saliva   is   expected,   profuse   fresh   bleeding   warrants   medical attention   !   If   you   have   more   than   2   teaspoons   of   bright   red   blood,   please   return   to   the   ENT   clinic   or   the   nearest   accident   and   emergency department for a prompt review. Depending   on   the   amount   of   bleeding,   you   may   need   to   be   returned   to   operating   theatre   to   have   the   bleeding   point   stopped.   Bleeding   also   may happen between 5 to 10 days after the operation and is nearly always due to infection. If   you   still   experience   great   pain   despite   the   oral   painkillers,   to   the   extent   of   affecting   your   oral   intake,   re-admission   into   the   ward   may   be necessary for stronger injection-based systemic painkiller. If you have a persistent fever (38°C or 100°F) for more than 48 hours and or you develop chills, it may be a sign of infection. Infection increases the risk of bleeding from the operated site. With that, we wish you  A SPEEDY RECOVERY In your surgery !
Surgical Care   Tonsil & adenoid surgery EDUCATION Medications you may be prescribed on discharge from the ward:  •	Painkillers (eg. paracetamol ‘Panadol’, diclofenac ‘Voltaren’, celecoxib ‘Celebrex’, etoricoxib ‘Arcoxia’)  •	Gargle solution (eg. Difflam, chlorhexidine, hydrogen peroxide)  •	Antibiotics (eg.Augmentin, Zinnat) •	Xylocaine/Lignocaine viscous
Adenoid & Tonsil Surgical Care (English language)
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This patient education is provided in good faith to help patients and their families learn more about their medical conditions, the options available to them and the possible consequences of their decisions. This information is not intended to be used for diagnosis, or treatment of any specific individual. Please consult with your ENT doctor regarding your particular circumstances.
Right: A close-up view of the oral cavity and oropharynx (upper throat) Left: Throat examination revealing large tonsils (red lines). Compare the narrowed airway with the above picture (without enlarged tonsils) © Vincent Tan ENT uvula
Adenoid & Tonsil Surgical Care (Bahasa Malaysia)
Copyright Vincent Specialist Solutions Sdn Bhd 2016. All rights reserved
Last update:  10/1/13 
Adenoid &  Tonsil Surgical Care (Chinese language)
PATIENT’S HEAD END PATIENT’S HEAD END A Tonsillectomy in progress while the patient is under general anaesthesia PATIENT’S MOUTH PATIENT’S  MOUTH © Vincent Tan ENT
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Day 2 after tonsillectomy: Some amount of whitish-yellowish slough (red arrows) over the tonsillar fossa is expected. The uvula may be slightly swollen (red *). * Day 5 after tonsillectomy: The slough (white arrows) over the tonsillar fossa has reduced. The uvula is also less swollen now (white *). * Before tonsillectomy: Look at the enlarged tonsils !  (red lines) Day 11 after tonsillectomy: The slough over the tonsillar fossa has fully resolved. The operation site is almost fully healed now. © Vincent Tan ENT
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D R. V INCENT T AN Consultant Ear, Nose and Throat, Head and Neck Surgeon, MD (UKM), MS ORL-HNS (UKM), DOHNS RCS Edinburgh (UK), MRCS Edinburgh (UK), Postgrad. Allergy (UK), A.M. (Mal), Fellowship in Rhinology (Singapore) Fellowship in Head and Neck Oncology & Surgery (Amsterdam)
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