What are the white patches in the back of my throat after a tonsillectomy?

White Patches After Tonsillectomy

The white patches you're seeing in the back of your throat after tonsillectomy are normal healing tissue called fibrinous exudate or slough—this is an expected part of the healing process and typically appears within the first few days after surgery, persisting for 7-10 days before gradually resolving.

What These White Patches Are

• Normal wound healing response: After tonsil removal, the surgical sites develop a white or grayish-white coating of fibrin (a protein involved in clotting and healing) as the tissue begins to repair itself 1
• Not an infection: These white patches are not pus or signs of infection in the vast majority of cases—they represent the normal scab formation that occurs on mucosal surfaces 2
• Expected appearance: The tonsillar fossae (where your tonsils used to be) will look white, yellow-white, or gray during the healing phase 1

Timeline of Healing

• Days 1-3 post-surgery: White patches begin to form over the surgical sites 2
• Days 3-7: The white coating is most prominent during this period 1
• Days 7-14: The white patches gradually slough off as pink, healthy tissue regenerates underneath 2
• Complete healing: Usually occurs within 2-3 weeks, though this varies by individual 1

When White Patches Are Normal vs. Concerning

Normal findings (no action needed):

• White/gray patches confined to the tonsillar fossae (surgical sites) 2
• Mild to moderate throat pain that is manageable with prescribed pain medication 1
• Ability to swallow liquids and soft foods 1
• No fever or low-grade fever (<101°F/38.3°C) 2

Warning signs requiring immediate medical attention:

• Bleeding: Any bright red blood from the mouth or nose, or blood-tinged saliva beyond minimal streaking 1
• High fever: Temperature ≥101°F (38.3°C) that persists or worsens 2
• Severe pain: Pain that is not controlled with prescribed medications or is worsening after day 3-4 1
• Dehydration signs: Inability to swallow liquids, decreased urination, extreme thirst, dizziness 2
• Foul odor with systemic symptoms: While some bad breath is normal during healing, a severely foul odor combined with fever or severe pain may indicate infection 2

Important Care Instructions

• Pain management: Follow your prescribed pain medication regimen closely, as adequate pain control is essential for maintaining hydration and nutrition 1
• Hydration: Drink plenty of cool fluids to keep the throat moist and prevent dehydration—this is critical for healing 2
• Diet: Soft, cool foods are best; avoid hot, spicy, acidic, or rough-textured foods that can irritate the healing tissue 1
• Activity: Rest is important, but gentle activity is acceptable; avoid strenuous exercise for 2 weeks 2

Common Pitfalls to Avoid

• Do not pick or scrape at the white patches—this can cause bleeding and delay healing 2
• Do not assume infection based solely on the appearance of white patches without other symptoms 2
• Do not stop pain medication prematurely—adequate pain control helps maintain hydration, which is crucial for preventing complications 1
• Do not ignore bleeding—even small amounts of fresh blood warrant immediate contact with your surgeon, as postoperative hemorrhage can be life-threatening 2, 3