What to Expect After a Tonsillectomy

Bad breath after a tonsillectomy, a surgery to remove your tonsils, is a common symptom you or your child may experience during recovery. A swollen uvula or tongue, nausea, and pain are also common.

A tonsillectomy procedure may done if you or your child experiences frequent infections, or because of large tonsils that contribute to snoring or sleep apnea.

This article discusses what to expect after having your tonsils removed. It will help you to know if you need to see your healthcare provider for your symptoms or can manage them at home with ice chips, cool liquids, and soft foods.

Bad Breath After Your Tonsils Are Out

Bad breath (also called halitosis) is common after a tonsillectomy. This symptom usually goes away as your throat heals. It's caused by:

• Cauterization or burning of the site where your tonsils were
• Swelling of your tongue, which can cause food particles to become trapped
• Scabs over your surgical site

Your bad breath may last up to two weeks. Keep in mind that tonsil stones (clumps of debris trapped in pockets of the tonsils) and chronically inflamed tonsils also cause bad breath, so it's likely that you'll have an overall improvement once you've healed from your surgery.

You can try gargling with a salt solution (1/2 teaspoon of table salt in 8 ounces of water) or chewing gum to deal with both the pain and bad breath. Don't use over-the-counter mouthwashes, though, because they are likely to dry your throat out.

Nausea

Nausea and vomiting can happen as a side effect of medications given during the procedure, such as anesthetic and pain medication. Up to 50% of children who undergo a tonsillectomy will experience nausea and/or vomiting without medications to help reduce this common side effect. 

Vomiting is especially concerning after a tonsillectomy because it is associated with additional problems like dehydration and electrolyte disturbances. It is also possible to aspirate (breathe in) stomach contents when you vomit after surgery. People who experience this side effect may have a longer hospital stay or be readmitted later on.

Bleeding

Bleeding is common after tonsillectomy. Bleeding that occurs within 24 hours of surgery is called primary bleeding. If bleeding occurs after the first 24 hours, it's called secondary bleeding.

Primary bleeding occurs in .1% to 5.8% of tonsillectomies, while secondary bleeding occurs in .2% to 7.5% of cases.

Bleeding may be described as minor or excessive. Hemorrhage, the most serious type of bleeding, is life-threatening and requires emergency medical care. In severe cases, bleeding can be fatal.

If you have bleeding, you may feel the need to swallow frequently. When you do, you may feel a trickle of blood in the back of your throat. If you experience frequent swallowing or can feel blood in your throat, call your healthcare provider immediately.

Your healthcare provider may advise you to keep an eye on minor bleeding at home. Excessive bleeding requires readmission to the hospital for additional care such as surgery or cauterization and a blood transfusion.

Swollen Tongue

Having a swollen tongue is typical in the first few days after surgery. Your tongue was exposed to manipulation during your tonsillectomy, such as suctioning and repositioning. This can cause it to feel sore and swollen. A thick white film on the tongue is also common after surgery.

Inflammation can also spread from the area where your tonsils were to other parts of the throat.

Your healthcare provider will likely prescribe pain medication. To make your tongue feel better, try:

• Drinking cold or cool, clear liquids, like water and apple juice
• Eating ice chips to reduce tongue swelling and ease the pain
• Using a cold pack on the outside of your throat

Ice cream and popsicles are top pain relief choices for children as they heal, according to studies of various comfort-food remedies. That said, it's important to follow instructions from your healthcare provider after your tonsils are removed.

Swollen Uvula

Your uvula is the flap of tissue that hangs in the back of your throat. It helps you swallow and speak. It will likely be sore and look red. After you have your tonsils taken out, swelling of your uvula happens for the same reasons your tongue hurts: It got bumped during the surgery, or inflammation spread to it.

Drinking cool fluids and eating ice chips can help. When you are ready to eat, start with easy-to-swallow, soft, cold foods like yogurt, pudding, and scrambled eggs.

Call your healthcare provider if you start:

• Drooling
• Gagging
• Having difficulty talking
• Having difficulty breathing

These might be signs that the swelling is blocking your airway.

White Scabs

After surgery, you may see white scabs or a yellow film on the site where your tonsils were. Don't worry as the scabs usually go away within five to 10 days.

However, call your healthcare provider if you notice bright red streaks of blood coming from where your tonsils were or if there's a green tint. These symptoms could be signs of bleeding or an infection.

Other Symptoms

It may take up to two weeks to recover from a tonsillectomy. Some of the other symptoms you can expect during recovery include:

• Pain, especially when swallowing
• Fatigue, including longer periods of sleep and sleep during the day
• Ear pain
• Low-grade fever
• Nightmares
• Behavior changes (in children)

For most children, the pain usually resolves in about eight days. Adults tend to experience pain for longer than children do, with some still reporting moderate pain on the 14th day after surgery.

It's also important to watch for signs of infection. A low-grade fever is normal during the first few days after surgery. Contact your provider for a fever over 101 degrees F in children and adults.

Risk of Complications

Certain activities and habits after tonsillectomy may increase your risk for complications. Some of these include:

• Smoking: Adults who smoke after a tonsillectomy have an increased risk of bleeding. Smoking may also contribute to longer healing times. 
• Not drinking enough fluids: Dehydration can make your throat dry out, increasing the risk of bleeding.
• Taking NSAIDs: NSAIDs may also increase the risk of bleeding.
  

Eating soft or cold foods can reduce pain. You may also be advised to follow a restricted diet and limit physical activity to help reduce the risk of complications after surgery.

Recent research, however, suggests that these restrictions may not affect your recovery. Still, it is always best to discuss diet and exercise following tonsillectomy with your healthcare provider and follow their recommendations.

Follow Up

Plan on taking a week or two to recover fully. Your healthcare provider will want to check you within a couple of weeks to make sure you are healing. Keeping this appointment and following any post-surgery instructions are essential.

Summary

After a tonsillectomy, you may experience pain, swollen tongue and uvula, white scabs where your tonsils were, and bad breath.

These are all normal changes that will go away as your throat heals. Call your healthcare provider if you think you're bleeding in the back of the throat or if you have a fever over 101 degrees F.