I wrote this years ago, when I had they surgery and for some reason never posted it. Hope this will be helpful to someone going forward…

They say that getting a tonsillectomy is worse as an adult than as a child. That’s like saying dinosaurs were bigger than today’s lizards. Everything I’ve heard from people who had the procedure as a child comes down to ‘it hurt some, I ate ice cream or snowballs for a few days, then it was over’. As an adult, it was quite a different story. 

But let me start at the beginning. If you just want the 8 key important points, go ahead and jump to the bottom.

I went to my ENT primarily because I was experiencing some ongoing really bad breath. Or maybe I should say my wife and others around me were experiencing it; I was just told it was happening. I was also still getting sick more than I should have been, and thought maybe there was a postnasal issue. We felt we had ruled out stomach issues so we went north to the ‘ears, nose, throat’ area. 

I used to get a lot of sinus infections, which have reduced since sinus surgery. My ENT checked for infections, noted swollen tonsils, and in an effort to rule out infection (and avoid surgery) put me on a course of antibiotics for several weeks. I believe it was cypro, a very powerful antibiotic which wore me out. Interestingly the bad breath went away while on the antibiotic but came back as soon as the course of treatment was complete.

He explained that this was most likely because of bacteria trapped in the tonsils. Ongoing infection of the tonsils (tonsillitis) can lead to a variety of other issues such as breathing problems, abscess, and more. He then suggested that I could do a tonsillectomy, that it was often very painful for adults, and though it doesn’t happen often sometimes the tonsils actually grow back. Considering that the alternative was people around me flinching when I tried to have a conversation, I didn’t see much alternative. Surgery it was.


A Quick Aside – What Are Tonsils?

tonsils in open mouth and sagittal view

Tonsils are tissues that are actually part of the immune system. The tonsils we usually think of are the ‘palatine tonsils’ – small masses of tissue on either side of the back of the throat. There are others as well, but this is (mostly) what gets removed. Usually tonsils are only removed in the case of regular ongoing illness. I had strep quite a bit as a child so I’m surprised I never had it done, but tonsils aren’t something you want to just remove without good cause; keep every part of your immune system you can!

Unfortunately, since the tonsils are basically filled with pockets that can trap anything coming down the throat, they can be perfect little spots for infections to grow. They then become inflamed and harbor those infections, providing a strong fortress from which to return even after antibiotics. They can also form tonsil stones from the debris which are hard stinky bundles of whatever nasty stuff has been sitting there.


The Surgery

They knock you out for this; general anesthetic. In general it is an outpatient procedure, and it was for me. The doctor will remove the tonsils with either a blade or a special tool that uses heat or sound to destroy tissue. Mine used heat; basically everything was destroyed and cauterized at the same time.

Here’s the really surprising thing to me – when we talk about the tonsils we talk about the little nubs on either side of the back of the throat. Unfortunately he said there is actually tonsil tissue all through the throat. That means the surface area being removed rose by a factor at least 10! Later when I got to see, instead of looking in my mouth to see the two small pieces of flesh gone, most of the back surface of my throat had been burned off! (pictures to come) Believe me that this has an impact on recovery and how you feel. 

When I woke up I came to consciousness slowly; it really took a while to feel ok again. In fact, I felt confused and out of it for weeks, though that may have been lack of sleep. We got home and I had my first of many Rita’s gelatos, which really do help quite a bit. 


The Recovery

Tough to see but you can tell it is a slow healing. That white stuff comes off and it is awful.

Pain, ice, pain, gelato, sleep, pain, ice. That’s basically how recovery goes. Eating is painful at various times, hot foods are not very pleasant, and even on several milligrams of dilaudid it always hurts a lot. Breathing became painful as well. I made the mistake of having surgery in January, a very dry time of year with the cold. We kept two humidifiers running in the room with me at all times just to provide some moisture, and even weeks later I had to aim the humidifier at my head in bed.

I thought I would be sleeping a lot, but what I ended up with was a long series of painful naps. You really can’t stay asleep for very long, but between lack of sleep and pain medicine you’re too confused to keep track of much. That’s why it really is important to have help; someone who can at least prepare some things for you, set alarms for medicine, and the like. Ideally you should have someone there all the time. My parents happened to be living with Jo and I when this surgery was done, so I always had either Jo or one of them to help.

Another important note is that the pain will get a little better over the first couple of days, then get dramatically worse as the scabs start to fall off. Around day 7-10 will really be the peak of the pain. Don’t underestimate this. I am blessed to be able to work from home so I worked starting somewhere in that second week, but even once I got back in the office I kept a portable humidifier at my desk.

Otherwise recovery was just a lengthy process of waiting out the pain. I should mention here that different people have different experiences, and it probably has as much to do with how much tissue has to be removed as anything else, but the bulk of material (both from doctors and online searches) indicate that this is just very, very painful.

So with all of that said, here are…

The top 8 things I learned having a tonsillectomy as an adult

  1. Don’t do it in the winter
    I made the mistake of having this surgery in January. The cold, dry air of winter isn’t my friend at the best of times and this made it much, much worse. I had two humidifiers running and probably could have used a 3rd. If you have the option, schedule this when it will be warm and humid.
  2. Sleep is your worst enemy.
    Most surgeries, you wake up in a stupor and spend the next few weeks dozing. You’re in and out of a daze while you heal, there’s some pain and you have to stay on top of meds, but sleep is your best friend. Not here. No, sleep instead pits you against your own body, and raises pain to new heights.First is the process of falling asleep. You must sleep sitting up or you choke on your own burnt and inflamed tissues. Once the land of sleep is reached, it lasts about 15 minutes to an hour. The longer the worse, because while you are sleeping your throat is drying out. Eventually you’ll arise feeling like someone dumped crushed glass down your throat while you were sleeping. That’s with pain meds. The only way out? Cold fluids and slushies.
  3. Fluids aren’t just a good thing, they are your life.
    The idea of swallowing anything feels like some medieval version of torture. However, maintaining hydration is one of the best things you can do for yourself. An ice cold water swallowed properly helps numb the throat but possibly more importantly keeps it moist. Dry throat = a world of pain your meds can’t touch.Interestingly, warm (NOT hot) tea with honey also helped quite a bit. I expected the warmth to cause pain but it did not, and the honey acts as a demulcent to coat the throat and protect it for a while at least.
  4. Ice cream – NO. Gelatos YES.
    They always talk about ice cream and tonsillectomies together. I’ve heard some folks these days, however, being told “no milk products”, and I learned why. First, everything in your throat hurts. Second, for a good while nothing works right either. I spent many nights trying to fall asleep but choking on my own saliva. Dairy products increase production of mucus which means more choking. We did a lot of Ritas Italian Ice. I found that for some reason straight frozen ice (or ‘snowballs’ or whatever) wasn’t good either, but a gelato, which does admittedly have some milk to it, was the perfect blend. The custard acts as a buffer to the over-cold italian ice and really helped me a great deal. Keeping the throat cold with gelatos, cold drinks, and anything else you can come up with really helps a lot.
  5. It gets better before it gets worse. That’s not a typo.
    The first day hurts. The second day maybe hurts more. Then it starts to get better and you think “I don’t need two weeks to recover from this.” Then the pain actually gets going again, much worse than it started off, and continues while the scabs come off (which by the way you will choke on at least occasionally). About 7-10 days in you reach the peak of pain and then it slowly subsides. Be prepared.
  6. Stay ahead of your pain meds and ask for options
    First and foremost – whatever medicine you have make sure you are on a schedule. Don’t get complacent. It is worth getting up in the night to take a dose of pain medicine if it will avoid the fireball of pain that comes from missing that dose.Different surgeons offer different pain medications. Most will specifically prescribe a liquid as pills can be very difficult to take. I was given liquid acetaminophen with codeine. My wife thankfully asked for something stronger and I also went home with hydromorphone, otherwise known as Dilaudid. Ask questions though. There are other liquids such as morphine, and I’ve even heard of people being given lidocaine liquid for when it gets really bad. Cough drops help, and I wish I had gotten a benzocaine spray much earlier in the process. I didn’t get one until late in the second week and it helped me sleep much more easily.
  7. Have something to do…
    You will be in pain, on pain meds, and not sleeping much. There were times I couldn’t read or even watch TV because my eyes crossed. Thankfully my wife had gotten me a nice Star Wars audio book through the Kindle. When I couldn’t sleep and couldn’t focus on anything else, that audio book came out.Otherwise, be prepared. Pick out movies, TV shows, books.
  8. …But don’t think you’ll be doing a lot
    On the other hand, I thought I would be doing push ups, jogging, working on my novel, and so much more. This was a delusion. There is simply too much pain, too many drugs, and too little sleep, not to mention real serious risks with physical activity. 

So there it is. It’s not a fun process but most folks, myself included, are still glad to have it done. The breath issue is gone and I’m not getting sick as often. That’s a success in my book. 

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