Tonsillectomy

What is a tonsillectomy?

A tonsillectomy is an operation to remove your tonsils, two round, fleshy lumps of tissue at the back of your throat. Tonsils are part of your immune system, but can sometimes become a source of infection or block your airway.

What conditions does a tonsillectomy treat?

A tonsillectomy is mainly used to treat two problems: frequent or long-lasting tonsil infections (tonsillitis), and breathing difficulties caused by swollen or enlarged tonsils, including snoring or sleep apnoea, where your breathing briefly stops during sleep.

It's more common in children, since children's tonsils are naturally bigger and tend to shrink as they get older, though adults sometimes need this operation too.

What are the benefits of a tonsillectomy?

A tonsillectomy can lead to better sleep quality, fewer infections, and an improved quality of life overall.

Removing your tonsils doesn't stop your body's general ability to fight infection day-to-day, although some research suggests people without tonsils may have a slightly higher long-term risk of certain respiratory, allergic or infectious conditions, so it's worth discussing any concerns with your doctor.

Are there different types of tonsillectomy?

Surgeons remove tonsils in several different ways. These include using heat (electrocautery), which also helps stop bleeding as it goes, a powered rotating shaver (microdebrider), or a technique using radiofrequency energy and plasma (Coblation).

Some also still use surgical scissors or a scalpel, with the wound closed using dissolvable stitches.

In children, tonsils are often removed at the same time as the adenoids (small glands behind the nose), which can add to the total time of the operation.

What happens before a tonsillectomy?

Before your operation, your doctor will check you're healthy enough for surgery, which may include blood tests. You'll be given instructions to follow, such as stopping certain medicines several days beforehand, or fasting from the night before, and you'll need to complete a pre-admission form.

If your child is having this operation, a nurse may call beforehand to check they're well enough to go ahead, for example that they don't have a fever or another infectious illness. You'll also be asked to sign a consent form on the day.

What happens during a tonsillectomy?

A tonsillectomy is performed under general anaesthetic, so you'll be asleep and feel no pain. It generally involves the following:

1. Your mouth is held open with a small instrument, which also gently holds your tongue out of the way
2. Your surgeon removes one or both tonsils, using heat, a shaver, radiofrequency energy, or surgical instruments, depending on their preferred method
3. Any bleeding is stopped and, if needed, the wound is closed with dissolvable stitches
4. If you're a child having your adenoids removed at the same time, this is usually done during the same operation.

Since the operation is performed through your mouth, there are no visible scars on the outside of your body. It usually takes around 20 to 30 minutes, though this can take longer if your adenoids are being removed too.

What does recovery from a tonsillectomy look like?

Tonsillectomy is usually done as a day case, so you can go home the same day, though occasionally an overnight stay is needed if there are any concerns after surgery. You'll be moved to a recovery area where staff check you're stable, and you'll need someone to take you home, since you won't be able to drive yourself.

In the first day or two, it's normal to have a sore throat, tiredness, a mild fever, bad breath, a hoarse voice, and a feeling of fullness in your throat from swelling.

Your sore throat often continues and may even feel worse around day 3 or 4. Some people also notice earache during this time, since nerves in your throat and ear are linked, even though there's nothing wrong with the ear itself.

Scabs form where your tonsils were and can cause a brief return of pain, or slightly blood-tinged mucus, as they loosen and shed, often around days 5 to 10. Most people are fully recovered within about 2 weeks, though recovery tends to take a little longer for adults than for children.

Drinking plenty of fluids is one of the most important things you can do for a smooth recovery. Stick to soft, cool foods for the first week, such as ice cream, yoghurt, mashed potato or scrambled eggs, and avoid crunchy, hard or spicy foods, which can irritate your throat.

It's best to take at least 10 days off work or school, both to support your recovery and to reduce your risk of picking up a cold or other infection while you heal.

What are the risks and complications of a tonsillectomy?

While serious problems are rare, all operations carry some risk. Possible complications include bleeding, either during the operation or in the days after, swelling of your tongue or the roof of your mouth, infection of the wound, a reaction to the anaesthetic, changes to your sense of taste, dehydration, or injury to your lip, tongue or teeth.

Bleeding is the most serious risk, and can occasionally mean a return to theatre to stop it. Around 2 in 100 children need to be readmitted to hospital because of bleeding after a tonsillectomy, though only about 1 in 100 need a second operation, and bleeding can happen any time in the two weeks after surgery, but is most common straight after the operation and around a week later.

Contact your medical team or go to your nearest emergency department straight away if you notice fresh bleeding from your mouth or nose, have severe pain that painkillers don't ease, or develop a high temperature that doesn't settle.