Tonsillectomy and adenotonsillectomy

A tonsillectomy is an operation to remove your tonsils. An adenotonsillectomy is an operation to remove both your adenoids and your tonsils. These operations may be performed in children or adults.

Key points

  1. A tonsillectomy or adenotonsillectomy may be needed if you or your child have snoring, obstructed breathing or pauses between breathing at night.
  2. They may also be recommended for frequent and severe bouts of tonsillitis or long-lasting tonsillitis.
  3. They are both short operations performed under general anaesthetic.
  4. After the operation, you will need to stay in hospital for about 6 hours for observation. Once you are able to eat and drink, you can leave the hospital. An overnight stay is often not necessary.
  5. It takes 10 to 14 days to recover from the operation.

What are tonsils and adenoids and why are they removed?

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Tonsils and adenoids are lumps of tissue (similar to the glands in your neck).

The tonsils sit on either side of the back of your throat (pharynx). Adenoids sit where the back of your nose meets your throat. You can't see them through your mouth without the use of special instruments.

Tonsils and adenoids are usually larger in children but tend to shrink to adult proportions by the age of 8 to 12 years.

They are part of your body’s system that fights infection (immune system) and are only important during the first few years of life. They are not essential, and removing them will not cause harm to your immune system.

How do I know if tonsils and adenoids are causing problems?

If tonsils and/or adenoids get too big they can:

  • cause narrowing of your airway during sleep, which makes breathing difficult
  • cause blockage of your nose, resulting in mouth breathing and a nasal-sounding voice
  • cause snoring, which can be a sign of obstructive sleep apnoea
  • contribute to repeated throat infections or tonsillitis
  • cause difficulty eating
  • cause continuing nasal discharge
  • cause an infection of your sinuses (sinusitis)
  • change the growth of the upper jaw and cause changes in the position of the teeth.

Even if they are not too big, infected adenoids can contribute to glue ear and/or repeated ear infections in children.

When is a tonsillectomy or an adenotonsillectomy performed?

Obstructed breathing

Your doctor may recommend an operation if you or your child have swollen or enlarged tonsils that block the airways and cause snoring, difficulty breathing or short pauses in breathing (sleep apnoea). 

Frequent and severe bouts of tonsillitis

Your doctor may recommend an operation if you or your child have ongoing or repeated infections of the tonsils (tonsillitis). As a general guide, this is:

  • 7 or more infections in 1 year (and each infection is severe enough to affect normal life, such as needing time off work or school)
  • 5 infections each year over 2 consecutive years, or
  • 3 to 4 infections each year over 3 or more years.

Long-lasting tonsillitis

Your doctor may recommend an operation when there is so much damage to your tonsils that they remain infected and do not respond well to antibiotic treatment. This may cause a sore throat much of the time, often with bad breath and sometimes yellow, cheesy, bad-smelling and bad-tasting material in the small cracks of your tonsils.

Other reasons

  • If you have an abscess behind your tonsils (quinsy) that does not respond to drainage.
  • If you have diabetes, heart valve problems or immunodeficiency, tonsillectomy may be considered early because of concerns that the tonsil infection may spread to other parts of your body.
  • If a biopsy is needed to evaluate a suspected tumour of the tonsil. 

How effective is the operation?

For sleep-disordered breathing

Studies show that an adenotonsillectomy will cure or improve symptoms of sleep-disordered breathing in 80 to 97% of cases. The operation is more successful if there are no other conditions that may be contributing to sleep-disordered breathing (such as obesity). On rare occasions, the adenoids may grow again.

For repeated acute tonsillitis

After removal of the tonsils, tonsillitis should never happen again. Throat infections due to colds and the flu will still happen.

What does the operation involve?

During the surgery

  • A tonsillectomy or adenotonsillectomy usually takes less than an hour.
  • It is performed under a general anaesthetic.
  • During the surgery, your tonsils are removed through your mouth. Usually, there are no cuts on your neck or stitches in your throat.

How long do you need to be in hospital after the operation?

  • After the operation, you will need to stay in hospital for about 6 hours for observation.
  • Once you are able to eat and drink, you can leave the hospital on the same day.
  • An overnight stay is often not necessary.  

Recovery from tonsillectomy or adenotonsillectomy

While healing takes place, your throat will be very sore for 10 to 14 days. Your throat will look white in colour and may develop scabs while it heals. This is normal.

Some patients have an earache after the operation. This is because the tonsils share some of the same nerves. This is normal and should go away in about 2 to 3 days. 

You may have some bloodstained saliva, discharge from your nose or bleeding. Sucking ice can help this, but if there is a larger amount of fresh blood (more than 1 to 2 teaspoonfuls), or if the bleeding continues for more than 10 minutes, phone 111 within New Zealand and ask for emergency medical help).

Medication

Pain relief is important after the operation. Your doctor or nurse can advise you about what pain relief to use. Giving pain-relieving medication (such as paracetamol) regularly is important for as long it is needed.

Don't give children any aspirin or aspirin-containing medicines (such as Aspro, AsproClear or Codis). If you are unsure, check the label and see if it mentions the words aspirin or salicylic acids. Aspirin may increase the risk of bleeding during or after the operation and may increase the risk of a serious and rare disease named Reye syndrome.

Discuss the use of any other medicines or remedies with your doctor during this period.

Eating and drinking

Eat and drink as normally as possible. It may feel more comfortable having softer foods at first.

Avoid hot liquids, acidic or highly spiced foods for several days.

Cool fluids and ice blocks are a good option. Fluids are especially important to help recovery, to prevent dehydration and to prevent the build-up of debris and blood clots at the operation site.

Taking pain relief 30 minutes before eating can help. However, follow your doctor's advice about pain relief.

Rest

You might feel tired. Try to rest on the day you go home and the following day. This will help you to recover from the general anaesthetic.

  • Children should rest for 5 to 7 days after their operation. They should avoid sports and swimming for 14 days. They can usually return to school and normal activity after 14 days.

What are the risks of having a tonsillectomy? 

There are risks associated with any surgery. Your doctor will discuss the risks of having a tonsillectomy with you. Possible problems from this surgery include:

Bleeding

Bleeding from the area where the tonsils have been removed is the most frequent complication – it happens in 2–5% of children.

  • Dehydration and too much activity after the operation increase the chances of bleeding.
  • Usually, the bleeding is mild – only a small number of children have to return to hospital to stop the bleeding or to have a blood transfusion.
  • Bleeding is more common 7 to 14 days after the operation, but it can happen up to 21 days afterwards.
  • It is best to avoid going away in the 3 weeks following the operation in case of bleeding. You should not travel overseas or to a remote area during this time.
  • If bleeding does happen, give your child some ice to suck on and cold water to drink and rest their head on a high pillow.
  • If there is a large amount of blood (more than 1 to 2 teaspoonfuls), or if the bleeding continues for more than 10 minutes, dial 111 within New Zealand and ask for urgent medical help.

Infection

Infection following an adenotonsillectomy is not common. Increasing pain or fever can be a sign of infection.

When should I seek help?

When should I dial 111?

Dial 111 within New Zealand and ask for urgent medical help (use the appropriate emergency number in other countries) if:

  • bleeding does not stop after 10 minutes of rest, elevation and sucking on ice
  • there is a large amount of blood (more than 1 to 2 teaspoonfuls).

When should I go to hospital?

Return to the hospital where the operation took place, or the nearest hospital emergency department if you or your child:

  • is vomiting and cannot take any fluids
  • is experiencing pain that is not controlled by the pain relief that was prescribed
  • has a fever greater than 38.5°C for longer than 4 hours. 

What to think about when deciding whether to have a tonsillectomy

When trying to decide whether you or your child should have a tonsillectomy, you might want to think about and discuss the following issues with your healthcare provider: 

  • How often the sore throats occur and whether they affect your ability to eat, drink and sleep.  
  • How much time is missed from school or work because of throat infections.
  • How much stress and inconvenience the illness has on the family.
  • The benefits and risks of the surgery.

What are the alternative treatments for tonsillitis?

You may choose not to have your tonsils removed surgically and treat episodes of tonsillitis with antibiotics and pain relief.

People who frequently get tonsillitis may be prescribed prophylactic or preventative antibiotics to try to prevent further infection. These antibiotics are usually prescribed at a low dose, to be taken daily or twice daily on an ongoing basis. However, over time, this may cause bacteria to become resistant to antibiotics, leaving the antibiotic less effective against severe infections. 

Learn more

Tonsillectomy and adenotonsillectomy KidsHealth, NZ, 2017

Credits: Editorial team. Last reviewed: 25 Feb 2016