Tonsillectomy in Children — Technique, Recovery and Diet

What is tonsillectomy?

Tonsillectomy is the surgical procedure through which the palatine tonsils are removed — formations of lymphoid tissue located on either side of the oropharynx. In children, the tonsils are frequently involved in recurrent throat infections and can contribute to upper airway obstruction, especially when hypertrophied.

The procedure is performed under general anesthesia and lasts between 20 and 45 minutes. It is one of the most commonly performed operations in pediatric ENT surgery. Dr. Vlad Postelnicu uses modern tonsillectomy techniques, including radiofrequency dissection and bipolar electrocautery, which significantly reduce intraoperative bleeding and postoperative pain.

When is tonsillectomy necessary?

The main indications for tonsillectomy in children are:

• Recurrent tonsillitis — according to Paradise criteria, tonsillectomy is indicated when the child presents 7 or more episodes of tonsillitis in one year, 5 episodes per year for 2 consecutive years, or 3 episodes per year for 3 consecutive years.
• Obstructive tonsillar hypertrophy — enlarged tonsils causing obstructive sleep apnea syndrome, swallowing difficulties, or growth disturbances.
• Peritonsillar abscess — a serious complication of acute tonsillitis requiring drainage and subsequent tonsillectomy to prevent recurrence.
• Suspicion of tonsillar tumor — extremely rare in children, but requires histopathological evaluation.
• Association with adenoidectomy — frequently, both procedures are performed in the same surgical session (adenotonsillectomy).

Preoperative preparation

The preliminary evaluation includes:

• Complete ENT examination — evaluation of the tonsils, oral cavity, and general ENT condition.
• Preoperative tests — complete blood count, coagulation tests, blood type and Rh factor.
• Anesthesia consultation — assessment of anesthetic risks and establishment of the anesthesia protocol.
• Discontinuation of anticoagulant medications — ibuprofen, aspirin, and other NSAIDs must be stopped 7–10 days before.

The child must be in a period of clinical remission (without active infection) at the time of the procedure. Complete fasting is mandatory for a minimum of 6 hours preoperatively.

How is the procedure performed?

Under general anesthesia with orotracheal intubation, the surgeon accesses the tonsils through the oral cavity using a special mouth retractor. The procedure consists of complete dissection of the tonsil from the tonsillar fossa.

Surgical techniques

• Bipolar electrocautery dissection — provides excellent hemostasis and reduces blood loss.
• Radiofrequency tonsillectomy (coblation) — a state-of-the-art technique that operates at low temperatures, minimizing damage to adjacent tissues and postoperative pain.
• Classic cold dissection tonsillectomy — used in special situations when complete excision with clear margins is necessary.

At the end of the procedure, hemostasis is carefully verified. The child is monitored in the recovery room until fully awake from anesthesia.

Recovery and dietary regimen

Recovery after tonsillectomy is more demanding than after adenoidectomy and requires special attention to diet:

First 3 days

• Moderate throat pain, sometimes radiating to the ears — managed with paracetamol.
• Diet is limited to cold liquids and soft foods: water, compote, yogurt, cold soup, purees.
• Hot, acidic, or spicy foods should be avoided.

Days 4–7

• Pain may have a secondary peak around days 5–6, corresponding to eschar separation.
• Soft foods are maintained: pasta, well-cooked rice, minced meat, pureed fruits.
• Adequate hydration is essential for rapid healing.

Days 8–14

• Gradual reintroduction of solid foods.
• Hard, crunchy foods (crackers, nuts, chips) and acidic juices should still be avoided.
• The child may resume light activities but should avoid intense physical exertion.

Important: Keeping the child hydrated is a priority. Frequent offering of cold liquids reduces pain and accelerates healing.

Risks and complications

• Postoperative bleeding — the most important risk; it may occur within the first 24 hours (primary bleeding) or between days 5–10 (secondary bleeding, during eschar separation). The incidence is approximately 3–5%.
• Dehydration — if the child refuses to drink due to pain. Requires careful monitoring.
• Referred ear pain — common, does not indicate an ear infection.
• Temporary voice change — resolves spontaneously within a few weeks.

Seek emergency medical attention if you notice active bleeding from the mouth or nose, persistent fever above 38.5°C, or complete refusal of food and liquids. Contact the ENT doctor also in case of foul-smelling nasal discharge or pain that does not respond to paracetamol.

Long-term results

Tonsillectomy provides excellent results:

• Dramatic reduction in tonsillitis episodes and missed school days.
• Improvement of nighttime breathing and disappearance of obstructive sleep apnea.
• Improvement of appetite and weight gain in children with significant obstruction.
• Improved quality of life reported by over 90% of families.

Tonsillectomy in children, when correctly indicated, is a procedure with demonstrated long-term benefits. Dr. Vlad Postelnicu recommends a detailed discussion of indications and therapeutic alternatives with each family, to make the most appropriate therapeutic decision. Each case is individually evaluated, taking into account the medical history, the child's age, and the impact of the condition on quality of life.