onsillectomy is surgery to remove the tonsils. These two fleshy oval-shaped pads are located on either side of the back of the throat. Tonsillectomy is needed when the tonsils become infected frequently (tonsillitis) or an infection doesn’t get better with other treatment. In some cases, tonsillectomy is done because enlarged tonsils block normal breathing. This can lead to problems such as sleep apnea. Less often, tonsillectomy is done to treat cancer or a tonsil that won’t stop bleeding. Tonsillectomy is one of the more common surgeries in children, but it’s done less often in adults.
Tonsillectomy is generally done for one of these reasons:
- To prevent recurrent (chronic) tonsil infections
- To treat breathing or swallowing problems or other issues caused by enlarged tonsils
- In rare cases, to remove cancer or suspected cancer of the tonsil
- To treat a bleeding tonsil, which is also rare
Most people choose to have a tonsillectomy after deciding symptoms are bad enough that the pain and potential risks of surgery are worth it. To help weigh the potential benefits and risks of surgery, your doctor will consider a number of factors such as your age, any other health problems you have and any medications you take on a regular basis.
Tonsils play a minor role in fighting infections, but they can cause more harm than good when they get infected themselves. A tonsillectomy may be needed to treat a serious infection, or if you have infections that keep recurring.
Most cases of tonsillitis are caused by viruses, including the virus that causes mononucleosis (Epstein-Barr virus). In other cases, tonsillitis is caused by a bacterial infection. When tonsillitis is due to the specific type of bacteria known as group A streptococcus, the illness is also referred to as strep throat.
Serious tonsil infections can cause a number of problems in children and adults, including:
- Trouble eating and swallowing
- An abscess — pocket of infection — in the back of the throat (peritonsillar abscess)
- Chronic bad breath
- Other health problems, including rheumatic fever and glomerulonephritis — a type of kidney disease.
As well as being painful and inconvenient, for many people tonsillitis also means doctor visits and missed school days or workdays.
Tonsillectomy generally helps cure infections in both adults and children. But, in most cases, younger people appear to benefit more from tonsillectomy than do adults.
Usually, a tonsillectomy is considered when other treatments aren’t effective. Like any surgery, doctors want to try other treatments first — and make sure surgery is needed and likely to help.
For tonsillitis, your child’s doctor may recommend tonsillectomy if your child has:
- A tonsil infection or throat abscess that doesn’t get better with other treatment
- Seven or more serious throat infections in one year
- Five or more serious throat infections every year over a two-year period
- Three or more serious throat infections every year over a three-year period
For enlarged tonsils, your child’s doctor may recommend a tonsillectomy if your child has enlarged tonsils that:
- Block normal breathing, which can lead to sleep apnea and other problems
- Make swallowing difficult
Tonsillectomy is a major surgery and like other surgeries, it has certain risks. Risks during and immediately following the procedure include:
- Reactions to anesthesia. Medication to make you sleep during surgery (general anesthesia) can sometimes cause mild or serious reactions.
- Tongue soreness or swelling. The tool used to keep your mouth open during a tonsillectomy may make your tongue numb or sore right after the procedure. This is temporary.
- Bleeding during surgery. In rare cases, severe bleeding occurs during surgery and requires additional treatment and a longer hospital stay.
Risks during recovery include:
- Bleeding during healing. After a tonsillectomy, about one in five adults have bleeding that won’t stop. Bleeding occurs less often in children, but can still occur. It usually occurs a week or so after surgery, but may happen sooner or up to two weeks later. This type of bleeding is believed to occur when the scab comes off the tonsil area. It can be caused by eating hard-edged food, such as chips, or by strenuous activity. This requires a trip to the emergency room to check the extent of the bleeding.
- Complications with anesthesia if you need surgery to stop bleeding. Follow-up surgery with anesthesia to stop the bleeding can be dangerous because you probably will have food in your stomach. This could place you at risk of inhaling (aspirating) food or liquids.
- Infection. Rarely, surgery can lead to an infection that requires further treatment.
- Delayed recovery. Some people take longer to heal than do others after a tonsillectomy. Although children usually recover in less than two weeks, it can take a month or longer for some adults. It’s difficult to predict exactly how long it will take for you or your child to recover.
- Pain. Both children and adults have throat pain after the procedure. However, adults may have more pain than do children, and in adults, pain generally lasts longer. In some cases, adults have throat pain bad enough to make swallowing difficult for several weeks.
Tonsillectomy is usually done on an outpatient basis. That means you, or your child, will be able to go home the day of the surgery.
During the surgery
- You, or your child, will be asleep (under general anesthesia) and won’t feel any pain.
- Using an instrument to hold the mouth open, the doctor will use a special scalpel or burning tool to cut the tonsils from the back of the throat.
- Depending on the reason for tonsillectomy, the adenoids also may be removed during surgery. Adenoids are similar to tonsils, but higher up in the throat under the nasal passage. Surgery to remove the adenoids is called adenoidectomy. Surgery, recovery and risks are similar to a tonsillectomy.
Recovery may be more painful — and take longer — in adults and teens than in children. Several things can help with recovery after tonsillectomy:
- Take medications as directed. If your doctor prescribed antibiotics, make sure you take the entire course exactly as prescribed.
- Avoid catching anything contagious. You’re more susceptible to infection than usual after surgery. Avoid crowds and exposure to anyone who might be ill.
- Stay hydrated. Be sure to drink plenty of water or drink a hydration beverage, such as Gatorade, even though it may be painful to swallow. Dehydration is a common problem after tonsillectomy. It can increase throat pain making it even harder to drink or eat. Sucking on ice cubes or frozen fruit pops, eating ice cream or sherbet, and drinking cold liquids can help ease throat pain. It can also be helpful to use a cool-mist humidifier to moisten the air.
- Eat cool, soft and bland foods at first. Examples include ice cream, applesauce, jello, pudding and cold soups. You can eat solid foods when you’re ready, but avoid foods that are crispy, brittle or have hard edges, such as chips or pizza — these may cause bleeding. Also avoid acidic or sour foods such as orange juice, which will sting your throat. Gum chewing may be beneficial in helping with pain and healing.
- Limit strenuous activity for two weeks after surgery. Ask your doctor what’s OK and what’s not. Avoid running, contact sports and jarring activities such as tumbling or roughhousing. Less strenuous activities such as walking are OK.
- Don’t take pain medications that can increase bleeding. You can take acetaminophen (Tylenol, others), but ibuprofen (Advil, Motrin, others), naproxen (Aleve, Naprosyn, others) or aspirin may increase your risk of bleeding. Children and teens should never take aspirin, as it puts them at risk of Reye’s syndrome, a rare but serious condition.
After surgery, you or your child may need to see the doctor if:
- The surgery area starts to bleed. Any bleeding requires a trip to the emergency room to be evaluated. Sometimes the bleeding will require a return to the operating room. Swallowing blood can give you an upset stomach, so try to avoid it as much as possible.
- You or your child has a fever of 102 F (38.9 C) or higher.
- You or your child has trouble swallowing liquids or has signs or symptoms of dehydration. These can include reduced urination, thirst, dry mouth, fatigue, weakness, headache, dizziness and lightheadedness. Children are likely to be less active than usual and may have few or no tears when crying.