Prof. Dr. Gediz Murat Serin – Teşvikiye ENT Group / Patient Information Document
What is Tonsillectomy in Brief?
Tonsillectomy is the surgical complete removal of the tonsils. It is considered in the following situations:
- Frequently recurring infections and chronic tonsillitis (bad breath, tonsil stones (tonsilloliths), feeling of something stuck in the throat)
- Snoring/sleep apnea and difficulty swallowing due to tonsillar hypertrophy
- Peritonsillar abscess (abscess formation following tonsillitis)
- Suspicion of cancer such as unilateral irregular growth
Note: Complete removal is not mandatory in every case of tonsillar enlargement and bad odor; in suitable cases, vaporization (tonsillotomy/reduction) to reduce size may be preferred.
Post-Operative Bleeding: What’s Normal, What’s Emergency?
“Bleeding risk is inherent in the nature of the surgery. A significant portion of bleeding seen after tonsillectomy is related to factors that develop outside the physician’s control, such as individual vascular structure, natural separation of the healing scab, infection, dehydration, or certain medications used. The surgeon’s meticulous technique and appropriate operating room conditions reduce this risk but cannot completely eliminate it. Therefore, it is very important to comply with recommended medication, fluid intake, and nutrition instructions, and to contact the healthcare team without delay when you notice warning signs.”
Post-tonsillectomy bleeding is of two types:
- Primary bleeding (first 24 hours):
Occurs due to failure of blood vessel ends to close or early loss of clot. Requires emergency evaluation. - Secondary bleeding (Usually days 5–10):
Mild oozing due to falling of healing scab. However, bright red, continuous bleeding after scab falling is an emergency.
Situations that can be considered normal during home monitoring:
- Small red specks in saliva
- Small amount of dark clot (especially when scab is falling)
Situations requiring emergency consultation:
- Bright red, continuous blood from mouth-nose
- Vomiting clots, inability to take fluids
- Fever above 38.5 °C
- Significant weakness/paleness, shortness of breath
If there is rapidly flowing bleeding in children: Place in lateral position and preferably go to the emergency room and meanwhile notify your doctor or call 112.
Golden Rules of Home Recovery
- Plenty of fluids: In small sips, at frequent intervals from the first days.
- Nutrition: Cold/lukewarm, soft foods (yogurt, pudding, puree, ice cream, lukewarm soup).
- Pain control: Paracetamol (acetaminophen) is preferred.
- Cold application: To the neck at short intervals.
- Avoiding irritants: Hot, spicy, acidic, hard foods; cigarette smoke; hot shower/bath not recommended in the first days.
- Medication warning: NSAIDs such as aspirin/ibuprofen increase bleeding risk. Do not use unless specifically recommended by your physician.
Day-by-Day Recovery Guide
- Day 0–1: Mouth and throat pain prominent; cold/lukewarm fluids, paracetamol, brief neck cooling.
- Day 2–4: Pain may radiate to ears (referred pain); frequent sips of water, soft foods; bad breath is normal.
- Day 5–10: Scab falling period; streaky blood/specks in saliva may occur. Bright red bleeding is an emergency.
- Day 10–14: Pain and sensitivity decrease; food variety can be increased.
- Return to work/school: Usually within 1–2 weeks when pain and eating are tolerated.
When is Partial Reduction (Tonsillotomy)?
Vaporization/reduction (partial reduction) instead of complete removal;
- For those with large tonsils and related sleep apnea/snoring complaints,
- Tonsil stones (bad breath)
- Advantages; less pain, faster recovery. Your physician determines the indication according to the patient.
Frequently Asked Questions (FAQ)
1) Is the surgery performed under general anesthesia?
Yes, tonsillectomy is performed under general anesthesia; procedure duration varies according to the case.
2) Why do my ears hurt after surgery?
Throat nerves share common pain pathways with the ear; this is referred pain and is normal.
3) Is bad breath normal?
In the first 7–10 days, odor and bad taste due to the scab is normal; plenty of fluids and lukewarm foods help.
4) When can I exercise?
Stay away from heavy exertion for at least 2 weeks until bleeding risk decreases. Avoid high heat/sauna-hammam.
5) Are antibiotics mandatory?
Not mandatory for every patient; physician decides based on clinical findings.
6) Should I use gargle?
In the first days, very gentle mouth rinsing with lukewarm water may be sufficient. Avoid alcohol-containing gargles; if your physician recommended it, follow their prescription.
At Home “Do’s / Don’ts” Mini List
Do:
- Drink water in frequent sips
- Lukewarm/cold soft foods
- Pain control with paracetamol
- Brief neck cooling
- Rest, regular sleep
Avoid:
- Hot, spicy, hard/acidic foods
- Hot bath/sauna, heavy exercise
- Exposure to cigarettes and smoke
- NSAIDs such as aspirin/ibuprofen
- Adding/removing medication on your own
Red Flags: When to Notify Immediately?
- Bright red, continuous bleeding
- Vomiting clots, dizziness, significant paleness
- Fever above 38.5 °C
- Inability to take fluids, darkening of urine color
- Shortness of breath
In case of rapidly flowing bleeding in children, lateral position and going to the emergency room or calling 112 is essential.
Summary
Tonsillectomy, when properly indicated, improves quality of life. Plenty of fluids, soft-lukewarm nutrition, paracetamol-based pain management, and being alert to bleeding signs are the keys to recovery. Partial reduction may offer the advantage of faster recovery in selected cases. In all cases, the plan is individualized.
