Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Tonsillectomy (with or without adenoidectomy) in children: Postoperative care and complications

Anna H Messner, MD
Section Editor
Glenn C Isaacson, MD, FAAP
Deputy Editor
Carrie Armsby, MD, MPH


Tonsillectomy (with or without adenoidectomy) is one of the most common surgical procedures performed in children. General postoperative care and potential complications in children who have undergone tonsillectomy (with or without adenoidectomy) are reviewed in this topic.

The indications, contraindications, preoperative, and intraoperative care for tonsillectomy and/or adenoidectomy; postoperative care and complications of adenoidectomy alone; and adenotonsillectomy in children with obstructive sleep apnea are discussed separately:

(See "Tonsillectomy and/or adenoidectomy in children: Indications and contraindications".)

(See "Tonsillectomy and/or adenoidectomy in children: Preoperative evaluation and care".)

(See "Anesthesia for tonsillectomy with or without adenoidectomy in children".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 03, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 144:S1.
  2. Roland PS, Rosenfeld RM, Brooks LJ, et al. Clinical practice guideline: Polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 145:S1.
  3. Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2012; 130:e714.
  4. Isaacson G. Tonsillectomy care for the pediatrician. Pediatrics 2012; 130:324.
  5. Le T, Drolet J, Parayno E, et al. Follow-up phone calls after pediatric ambulatory surgery for tonsillectomy: what can we learn from families? J Perianesth Nurs 2007; 22:256.
  6. Fortier MA, MacLaren JE, Martin SR, et al. Pediatric pain after ambulatory surgery: where's the medication? Pediatrics 2009; 124:e588.
  7. Huth MM, Broome ME. A snapshot of children's postoperative tonsillectomy outcomes at home. J Spec Pediatr Nurs 2007; 12:186.
  8. Schmidt R, Herzog A, Cook S, et al. Complications of tonsillectomy: a comparison of techniques. Arch Otolaryngol Head Neck Surg 2007; 133:925.
  9. Stewart DW, Ragg PG, Sheppard S, Chalkiadis GA. The severity and duration of postoperative pain and analgesia requirements in children after tonsillectomy, orchidopexy, or inguinal hernia repair. Paediatr Anaesth 2012; 22:136.
  10. Kain ZN, Mayes LC, Caldwell-Andrews AA, et al. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics 2006; 118:651.
  11. Nafiu OO, Shanks A, Abdo S, et al. Association of high body mass index in children with early post-tonsillectomy pain. Int J Pediatr Otorhinolaryngol 2013; 77:256.
  12. Sadhasivam S, Chidambaran V, Ngamprasertwong P, et al. Race and unequal burden of perioperative pain and opioid related adverse effects in children. Pediatrics 2012; 129:832.
  13. Moir MS, Bair E, Shinnick P, Messner A. Acetaminophen versus acetaminophen with codeine after pediatric tonsillectomy. Laryngoscope 2000; 110:1824.
  14. Kokki H. Nonsteroidal anti-inflammatory drugs for postoperative pain: a focus on children. Paediatr Drugs 2003; 5:103.
  15. Ingram DG, Friedman NR. Toward Adenotonsillectomy in Children: A Review for the General Pediatrician. JAMA Pediatr 2015; 169:1155.
  16. Liu C, Ulualp SO. Outcomes of an Alternating Ibuprofen and Acetaminophen Regimen for Pain Relief After Tonsillectomy in Children. Ann Otol Rhinol Laryngol 2015; 124:777.
  17. St Charles CS, Matt BH, Hamilton MM, Katz BP. A comparison of ibuprofen versus acetaminophen with codeine in the young tonsillectomy patient. Otolaryngol Head Neck Surg 1997; 117:76.
  18. Kelly LE, Sommer DD, Ramakrishna J, et al. Morphine or Ibuprofen for post-tonsillectomy analgesia: a randomized trial. Pediatrics 2015; 135:307.
  19. Yaman H, Belada A, Yilmaz S. The effect of ibuprofen on postoperative hemorrhage following tonsillectomy in children. Eur Arch Otorhinolaryngol 2011; 268:615.
  20. Jeyakumar A, Brickman TM, Williamson ME, et al. Nonsteroidal anti-inflammatory drugs and postoperative bleeding following adenotonsillectomy in pediatric patients. Arch Otolaryngol Head Neck Surg 2008; 134:24.
  21. Lewis SR, Nicholson A, Cardwell ME, et al. Nonsteroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy. Cochrane Database Syst Rev 2013; :CD003591.
  22. Krishna S, Hughes LF, Lin SY. Postoperative hemorrhage with nonsteroidal anti-inflammatory drug use after tonsillectomy: a meta-analysis. Arch Otolaryngol Head Neck Surg 2003; 129:1086.
  23. Sutters KA, Miaskowski C, Holdridge-Zeuner D, et al. A randomized clinical trial of the efficacy of scheduled dosing of acetaminophen and hydrocodone for the management of postoperative pain in children after tonsillectomy. Clin J Pain 2010; 26:95.
  24. Sutters KA, Holdridge-Zeuner D, Waite S, et al. A descriptive feasibility study to evaluate scheduled oral analgesic dosing at home for the management of postoperative pain in preschool children following tonsillectomy. Pain Med 2012; 13:472.
  25. Ciszkowski C, Madadi P, Phillips MS, et al. Codeine, ultrarapid-metabolism genotype, and postoperative death. N Engl J Med 2009; 361:827.
  26. Kelly LE, Rieder M, van den Anker J, et al. More codeine fatalities after tonsillectomy in North American children. Pediatrics 2012; 129:e1343.
  27. FDA Drug Safety Communication: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women. Available at: https://www.fda.gov/Drugs/DrugSafety/ucm549679.htm (Accessed on April 21, 2017).
  28. Fedorowicz Z, van Zuuren EJ, Nasser M, et al. Oral rinses, mouthwashes and sprays for improving recovery following tonsillectomy. Cochrane Database Syst Rev 2013; :CD007806.
  29. Jahanshahi J, Pazira S, Farahani F, et al. Effect of topical sucralfate vs clindamycin on posttonsillectomy pain in children aged 6 to 12 years: a triple-blind randomized clinical trial. JAMA Otolaryngol Head Neck Surg 2014; 140:698.
  30. Tsao GJ, Messner AH, Seybold J, et al. Intraoperative acupuncture for posttonsillectomy pain: a randomized, double-blind, placebo-controlled trial. Laryngoscope 2015; 125:1972.
  31. Gilbey P, Bretler S, Avraham Y, et al. Acupuncture for posttonsillectomy pain in children: a randomized, controlled study. Paediatr Anaesth 2015; 25:603.
  32. Johnson LB, Elluru RG, Myer CM 3rd. Complications of adenotonsillectomy. Laryngoscope 2002; 112:35.
  33. Bolton CM, Myles PS, Nolan T, Sterne JA. Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis. Br J Anaesth 2006; 97:593.
  34. Tonsillectomy for Obstructive Sleep-Disordered Breathing or Recurrent Throat Infection in Children, Comparative Effectiveness Review Number 183, Agency for Healthcare Research and Quality. Available at: https://www.effectivehealthcare.ahrq.gov/ehc/products/620/2424/tonsillectomy-report-170113.pdf (Accessed on January 18, 2017).
  35. Macassey E, Dawes P, Taylor B, Gray A. The effect of a postoperative course of oral prednisone on postoperative morbidity following childhood tonsillectomy. Otolaryngol Head Neck Surg 2012; 147:551.
  36. Tabaee A, Lin JW, Dupiton V, Jones JE. The role of oral fluid intake following adeno-tonsillectomy. Int J Pediatr Otorhinolaryngol 2006; 70:1159.
  37. Messner AH, Barbita JA. Oral fluid intake following tonsillectomy. Int J Pediatr Otorhinolaryngol 1997; 39:19.
  38. Rohlfing ML, Wistermayer PR, Bungo TM, et al. Investigation of Postoperative Oral Fluid Intake as a Predictor of Postoperative Emergency Department Visits After Pediatric Tonsillectomy. JAMA Otolaryngol Head Neck Surg 2016; 142:357.
  39. Hall MD, Brodsky L. The effect of post-operative diet on recovery in the first twelve hours after tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol 1995; 31:215.
  40. Brodsky L, Radomski K, Gendler J. The effect of post-operative instructions on recovery after tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol 1993; 25:133.
  41. Papakostas K, Moraitis D, Lancaster J, McCormick MS. Depressive symptoms in children after tonsillectomy. Int J Pediatr Otorhinolaryngol 2003; 67:127.
  42. Dhiwakar M, Clement WA, Supriya M, McKerrow W. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev 2012; 12:CD005607.
  43. Milder EA, Rizzi MD, Morales KH, et al. Impact of a new practice guideline on antibiotic use with pediatric tonsillectomy. JAMA Otolaryngol Head Neck Surg 2015; 141:410.
  44. Paradise JL, Bluestone CD, Colborn DK, et al. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics 2002; 110:7.
  45. Colclasure JB, Graham SS. Complications of outpatient tonsillectomy and adenoidectomy: a review of 3,340 cases. Ear Nose Throat J 1990; 69:155.
  46. Granell J, Gete P, Villafruela M, et al. Safety of outpatient tonsillectomy in children: a review of 6 years in a tertiary hospital experience. Otolaryngol Head Neck Surg 2004; 131:383.
  47. Liu JH, Anderson KE, Willging JP, et al. Posttonsillectomy hemorrhage: what is it and what should be recorded? Arch Otolaryngol Head Neck Surg 2001; 127:1271.
  48. De Luca Canto G, Pachêco-Pereira C, Aydinoz S, et al. Adenotonsillectomy Complications: A Meta-analysis. Pediatrics 2015; 136:702.
  49. Amoils M, Chang KW, Saynina O, et al. Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings. JAMA Otolaryngol Head Neck Surg 2016; 142:344.
  50. Edmonson MB, Eickhoff JC, Zhang C. A population-based study of acute care revisits following tonsillectomy. J Pediatr 2015; 166:607.
  51. Shay S, Shapiro NL, Bhattacharyya N. Revisit rates and diagnoses following pediatric tonsillectomy in a large multistate population. Laryngoscope 2015; 125:457.
  52. Curtis JL, Harvey DB, Willie S, et al. Causes and costs for ED visits after pediatric adenotonsillectomy. Otolaryngol Head Neck Surg 2015; 152:691.
  53. Mathew R, Asimacopoulos E, Walker D, et al. Analysis of clinical negligence claims following tonsillectomy in England 1995 to 2010. Ann Otol Rhinol Laryngol 2012; 121:337.
  54. Tom LW, DeDio RM, Cohen DE, et al. Is outpatient tonsillectomy appropriate for young children? Laryngoscope 1992; 102:277.
  55. Cohen D, Dor M. Morbidity and mortality of post-tonsillectomy bleeding: analysis of cases. J Laryngol Otol 2008; 122:88.
  56. Orestes MI, Lander L, Verghese S, Shah RK. Incidence of laryngospasm and bronchospasm in pediatric adenotonsillectomy. Laryngoscope 2012; 122:425.
  57. Peng A, Dodson KM, Thacker LR, et al. Use of laryngeal mask airway in pediatric adenotonsillectomy. Arch Otolaryngol Head Neck Surg 2011; 137:42.
  58. Rosen GM, Muckle RP, Mahowald MW, et al. Postoperative respiratory compromise in children with obstructive sleep apnea syndrome: can it be anticipated? Pediatrics 1994; 93:784.
  59. Liang C, Ruiz AG, Jensen EL, Friedman NR. Indications, clinical course, and postoperative outcomes of urgent adenotonsillectomy in children. JAMA Otolaryngol Head Neck Surg 2015; 141:236.
  60. Nafiu OO, Green GE, Walton S, et al. Obesity and risk of peri-operative complications in children presenting for adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2009; 73:89.
  61. Leong AC, Davis JP. Morbidity after adenotonsillectomy for paediatric obstructive sleep apnoea syndrome: waking up to a pragmatic approach. J Laryngol Otol 2007; 121:809.
  62. Lavin JM, Shah RK. Postoperative complications in obese children undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2015; 79:1732.
  63. Hill CA, Litvak A, Canapari C, et al. A pilot study to identify pre- and peri-operative risk factors for airway complications following adenotonsillectomy for treatment of severe pediatric OSA. Int J Pediatr Otorhinolaryngol 2011; 75:1385.
  64. Keamy DG, Chhabra KR, Hartnick CJ. Predictors of complications following adenotonsillectomy in children with severe obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2015; 79:1838.
  65. Subramanyam R, Varughese A, Willging JP, Sadhasivam S. Future of pediatric tonsillectomy and perioperative outcomes. Int J Pediatr Otorhinolaryngol 2013; 77:194.
  66. Lowe D, van der Meulen J, Cromwell D, et al. Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 2007; 117:717.
  67. Sarny S, Ossimitz G, Habermann W, Stammberger H. Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope 2011; 121:2553.
  68. Windfuhr JP, Schloendorff G, Baburi D, Kremer B. Serious post-tonsillectomy hemorrhage with and without lethal outcome in children and adolescents. Int J Pediatr Otorhinolaryngol 2008; 72:1029.
  69. Lescanne E, Chiron B, Constant I, et al. Pediatric tonsillectomy: clinical practice guidelines. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:264.
  70. Windfuhr JP, Schloendorff G, Sesterhenn AM, et al. A devastating outcome after adenoidectomy and tonsillectomy: ideas for improved prevention and management. Otolaryngol Head Neck Surg 2009; 140:191.
  71. Hessén Söderman AC, Ericsson E, Hemlin C, et al. Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope 2011; 121:2322.
  72. Perkins JN, Liang C, Gao D, et al. Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope 2012; 122:2311.
  73. Spencer DJ, Jones JE. Complications of adenotonsillectomy in patients younger than 3 years. Arch Otolaryngol Head Neck Surg 2012; 138:335.
  74. Murray AD, Gibbs SR, Billings KR, Biavati MJ. Respiratory difficulty following bismuth subgallate aspiration. Arch Otolaryngol Head Neck Surg 2000; 126:79.
  75. Werle AH, Nicklaus PJ, Kirse DJ, Bruegger DE. A retrospective study of tonsillectomy in the under 2-year-old child: indications, perioperative management, and complications. Int J Pediatr Otorhinolaryngol 2003; 67:453.
  76. Hydri AS, Malik SM. Reduced mouth opening following tonsillectomy in children: myth or reality. J Coll Physicians Surg Pak 2010; 20:781.
  77. Goldman JL, Baugh RF, Davies L, et al. Mortality and major morbidity after tonsillectomy: etiologic factors and strategies for prevention. Laryngoscope 2013; 123:2544.