15605 Tonsillectomy

Overview

A tonsillectomy (say: ton-sil-ECK-toe-mee) is an operation to take out the tonsils. The tonsils are two small pads of soft tissue at the back of your throat, one on each side. They are part of the body's defence system and help fight germs. Sometimes, though, the tonsils cause more trouble than they help. They can get infected again and again, or they can be so big that they block breathing and swallowing. When that happens, a doctor may suggest removing them. The operation is done under a general anaesthetic, which means you or your child will be asleep and feel nothing during the surgery.

Yes. Tonsillectomy is one of the most common operations performed on children worldwide, and many adults have it too. Doctors are careful about recommending it, so it is done far less often today than in the past.

It is most often done in children between about 3 and 15 years old, because tonsils tend to be largest and infections are more frequent in that age group. Adults can also need a tonsillectomy, usually because of repeated severe throat infections. Recovery can be a little slower for adults than for children, but most people recover fully.

Symptoms

Common symptoms

• Sore throats that keep coming back, often with fever and swollen neck glands
• A sore throat that lasts several days and makes swallowing painful
• White or yellow patches on the tonsils, or tonsils that look red and swollen
• Bad breath or a bad taste in the mouth during infections
• Loud snoring, restless sleep or pauses in breathing during sleep (from large tonsils)
• A voice that sounds blocked or 'hot potato'-like during infections
• Frequent time off school or work because of throat infections

Symptoms in children

• Trouble eating or drinking during a sore throat, leading to poor appetite
• Mouth breathing or drooling, especially in younger children
• Pauses in breathing during sleep, or gasping and snoring loudly
• Being unusually sleepy or irritable during the day because of poor sleep
• Frequent ear infections alongside throat infections

Symptoms in older adults

• Repeated throat infections that seem to take longer to clear than they used to
• A chronic cough or a constant feeling of something stuck in the throat
• Snoring or breathing problems during sleep that were not there before
• More tiredness than usual after a throat infection

Causes

Main causes

• Repeated tonsillitis: infections of the tonsils, usually caused by common viruses or bacteria, that keep coming back
• Large tonsils that narrow the airway, causing snoring or pauses in breathing during sleep (sleep apnoea)
• Repeated collections of pus around the tonsils (sometimes called a quinsy)
• Long-standing inflammation that makes the tonsils stay swollen and sore

Risk factors

• Being a child or teenager, when tonsils are largest and infections spread easily
• Close contact with others at school, nursery or in crowded settings
• Exposure to cigarette smoke, which irritates the throat and increases infections
• A weakened immune system or certain long-term health conditions
• A history of frequent throat infections in the family

When to see a doctor

See a doctor urgently if:

• You or your child cannot swallow fluids or keep them down
• Breathing is noisy, difficult or unusually fast
• There are signs of dehydration, or your child is much sleepier than usual
• A sore throat is severe and getting worse on one side, or the mouth is hard to open
• There is bleeding from the mouth after tonsil surgery

Book a routine appointment if:

• Sore throats keep coming back and are affecting school, work or sleep
• You or your child snores loudly or seems to pause breathing during sleep
• Throat infections are frequent enough that you want to talk about options, including surgery
• You have questions about what a tonsillectomy involves or how long recovery takes

Diagnosis

A doctor usually starts by asking about the pattern of symptoms: how many sore throats there have been in the past year or two, how long each one lasted, and whether sleep or breathing has been affected. They will look into the mouth and throat with a light and feel the neck for swollen glands. A diagnosis of 'frequent tonsillitis' is based mainly on this history, not on a single test. If sleep problems are a concern, they may ask about snoring, breathing pauses and daytime tiredness.

Tests that may be done

• A throat examination with a light and a small tongue depressor
• A throat swab, to check whether a bacterial infection is present
• Blood tests in some cases, to look for other causes of repeated infections
• A sleep study in some children with suspected sleep apnoea
• A referral to an ear, nose and throat (ENT) specialist if surgery is being considered

What to expect at your appointment

The appointment is usually quick and painless. Your doctor may count how many throat infections you or your child have had over a set period, because national guidance uses those numbers to decide whether surgery is likely to help. If you are referred to a specialist, they will explain the operation, its risks and benefits, and answer your questions before you decide.

Treatment

Treatment depends on how often and how badly the tonsils are causing problems. Many people manage well with rest, fluids and pain relief during infections. If infections are frequent or the tonsils block breathing, a specialist may recommend removing them. There is no single 'right' answer for everyone, so the decision is made together with your healthcare team.

Self-care at home

• Rest your voice and get plenty of sleep while your throat is sore
• Drink regularly in small sips, even when it hurts, to stay hydrated
• Eat soft, cool foods such as yoghurt, soup or mashed food if swallowing is painful
• Gargle with warm salt water if your doctor or pharmacist suggests it
• Keep the air in your home from getting too dry, and avoid cigarette smoke
• Wash hands often and avoid sharing cups, bottles or cutlery during infections
• After surgery, follow the recovery instructions given by your hospital team

Medical treatments

For throat infections, doctors sometimes prescribe antibiotics if a bacterial infection is likely, but many sore throats are caused by viruses and do not need them. Pain relief bought from a pharmacy, or prescribed by your doctor, can ease discomfort; ask your pharmacist which option is suitable for you or your child, and always follow the label. Steroid medicines are occasionally used for short periods in certain cases. If surgery is chosen, the tonsils are removed under general anaesthetic, usually with a technique that seals the tissue as it cuts. Your surgical team will explain which method they plan to use.

When is surgery considered?

Guidance used in the UK and many other countries suggests considering a tonsillectomy when sore throats caused by tonsillitis happen very often, for example around seven or more times in one year, five or more times a year for two years, or three or more times a year for three years. Surgery may also be offered when large tonsils cause breathing pauses during sleep, when there have been repeated pus collections around the tonsils, or when infections are severe enough to need hospital care. Your specialist will weigh these points against the risks of surgery for your individual situation.

Living with this condition

If you are waiting for surgery, life carries on much as usual, with treatment for infections as they come. After a tonsillectomy, plan for roughly two weeks of taking it easy. The throat will be sore, and white or yellowish scabs will form where the tonsils were and slowly fall away. Some earache, a husky voice and bad breath are common during this time. Children usually need about two weeks off school, and adults often need the same off work. Keep up with pain relief as advised so that drinking and eating stay comfortable.

Lifestyle tips

• Stay away from smoky places, including cigarette smoke at home
• Keep up handwashing and avoid sharing drinks or utensils during infections
• During recovery, avoid vigorous exercise, swimming and dusty or smoky environments for about two weeks
• Plan quiet activities and plenty of rest for the first week after surgery
• Keep a simple diary of throat infections if surgery is being considered — it helps your doctor see the pattern

Diet and exercise

During a sore throat, choose soft, moist foods and plenty of fluids. After surgery, start with liquids and soft foods, and avoid crunchy, sharp, spicy or very acidic foods for the first couple of weeks, as these can hurt the healing area. Cool foods such as ice lollies or yoghurt can be soothing. Avoid fizzy drinks. Gentle walking is fine after surgery, but wait until you are eating and drinking normally and feel well before returning to sport or heavy activity — usually around two weeks.

Mental health and emotional wellbeing

Repeated illness can be tiring and frustrating, for children and adults alike. Children may feel anxious about the operation or about missing school, and parents often feel worried too. Adults sometimes feel low during recovery, especially if they are used to being busy. These feelings usually ease as recovery progresses. If you or your child feel very anxious or low, and it is affecting daily life, speak to your doctor. If you ever have thoughts of harming yourself, contact your local crisis support service or emergency services straight away.

Prevention

You cannot always prevent the problems that lead to a tonsillectomy, because some people are simply more prone to throat infections. But you can lower the number of infections by washing hands well, avoiding sharing cups and cutlery, keeping away from cigarette smoke, and treating throat infections early. If surgery is needed, there is nothing you did wrong to cause it.

Vaccines

Make sure you and your child are up to date with routine vaccinations, including the flu vaccine if it is offered to you. Vaccines do not prevent all throat infections, but they reduce some of the illnesses that can lead to them. Ask your doctor or pharmacist which vaccines are recommended for your age and health.

Screening programmes

There is no screening programme for tonsil problems. If you are worried about repeated sore throats or your child's breathing during sleep, book an appointment with your doctor to talk it through.

Complications

If left untreated

• Continuing cycles of sore throats, missed school or work, and time spent recovering
• Poor sleep and daytime tiredness from large tonsils or sleep apnoea
• A collection of pus around the tonsils, which is painful and needs urgent treatment
• Rarely, more serious spread of infection in the neck
• In children, slow weight gain or growth problems if eating is regularly painful

Long-term outlook

The outlook is good. Most people who have a tonsillectomy recover fully within about two weeks and notice far fewer sore throats afterwards, along with better sleep and more energy. Like any operation, there are risks — mainly bleeding after surgery, infection, or temporary problems with drinking enough — but these are uncommon and your surgical team will explain how they are managed. Many people never need surgery at all and manage well with simple care. Either way, with the right support, the vast majority of people do very well.

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