Tonsillectomy adults

Overview

A tonsillectomy is a surgery to remove the tonsils. The tonsils are two small pads of tissue at the back of the throat that help fight infections. This surgery is usually done when the tonsils cause repeated problems, such as frequent infections or breathing difficulties.

Yes, tonsillectomy is a common surgery, though it is performed more often in children than in adults. However, many adults also have this procedure for recurrent infections or other issues.

Adults of any age may have a tonsillectomy, but it is most often done for those who have had repeated severe tonsillitis, throat infections, or problems like sleep apnoea caused by enlarged tonsils.

Symptoms

Common symptoms

• Frequent sore throats or tonsillitis (inflammation of the tonsils) that keep coming back
• Difficulty swallowing or a feeling that something is stuck in the throat
• Loud snoring or pauses in breathing during sleep (sleep apnoea)
• Bad breath or a persistent cough caused by tonsil problems

Symptoms in children

• This article is about adults. For children, symptoms that may lead to tonsillectomy include very frequent throat infections, poor weight gain due to eating difficulties, or severe sleep apnoea.

Symptoms in older adults

• Older adults may have fewer tonsil infections, but if they do, they might experience more severe pain, higher fever, or longer healing times. Enlarged tonsils can also worsen snoring or sleep apnoea.

Causes

Main causes

• The tonsils become repeatedly infected (tonsillitis) caused by viruses or bacteria, leading to a cycle of illness.
• The tonsils grow large enough to block the airway, causing sleep apnoea or difficulty breathing.
• A collection of pus behind the tonsil (peritonsillar abscess) that keeps coming back.

Risk factors

• Having frequent close contact with others, like in schools or crowded places, which spreads infections
• A weakened immune system
• Being a smoker or exposed to secondhand smoke, which irritates the throat
• Having allergies or acid reflux that can make throat problems worse

When to see a doctor

See a doctor urgently if:

• You have a very sore throat with a high fever and cannot swallow or breathe normally
• You have a severe swelling in one side of your throat that makes it hard to open your mouth
• You have bleeding from your throat that seems heavy

Book a routine appointment if:

• You have had several episodes of tonsillitis (for example, 5 or more in a year) that keep you from work or daily activities
• You snore loudly or have pauses in breathing during sleep
• You or your doctor have noticed a lump or unusual spot on your tonsil that does not go away

Diagnosis

Your doctor will ask about your symptoms and examine your throat. They may use a light and a tongue depressor to look at your tonsils. Sometimes they will take a swab to test for bacteria.

Tests that may be done

• A throat swab to check for group A streptococcus (strep throat) or other bacteria
• A blood test to look for signs of infection or other health issues
• A sleep study if sleep apnoea is suspected

What to expect at your appointment

If your doctor thinks you might need a tonsillectomy, they will refer you to an ear, nose, and throat (ENT) specialist. The specialist will review your history and decide if surgery is the best option. They will explain the risks and benefits and help you prepare.

Treatment

For mild or infrequent tonsil problems, treatment focuses on managing symptoms. For more severe or repeated issues, surgery to remove the tonsils (tonsillectomy) may be recommended.

Self-care at home

• Drink plenty of warm liquids like tea or broth to soothe the throat
• Gargle with warm salt water (half a teaspoon of salt in a glass of water) a few times a day
• Get plenty of rest and avoid smoking or secondhand smoke
• Use a humidifier to keep the air moist and reduce throat irritation

Medical treatments

Your doctor may suggest over-the-counter pain relievers such as paracetamol or ibuprofen to help with pain and fever. For bacterial infections, they may prescribe antibiotics. Always follow your doctor's advice and never take more than the recommended dose.

When is surgery considered?

Surgery is usually considered when you have had many episodes of tonsillitis (for example, 7 or more in one year, 5 each year for two years, or 3 each year for three years), or if you have a peritonsillar abscess that keeps coming back, or if enlarged tonsils cause sleep apnoea or trouble swallowing.

Living with this condition

After a tonsillectomy, you will need to take it easy for at least a week. You may have a sore throat that can make it hard to eat and drink. It is important to drink plenty of fluids to stay hydrated. You may need to take time off work or avoid strenuous activity for up to two weeks.

Lifestyle tips

• Avoid smoking and alcohol for at least 2 weeks after surgery as they can slow healing and increase bleeding risk.
• Stay away from people who are ill to reduce your chance of infection.
• Use a soft diet (like smoothies, yoghurt, mashed potatoes) until the throat heals.

Diet and exercise

Stick to cool, soft foods and drinks for the first few days. Avoid crunchy, spicy, or acidic foods that can irritate the throat. Gentle walking is fine, but avoid heavy lifting or exercise for at least two weeks.

Mental health and emotional wellbeing

Recovering from surgery can be frustrating and tiring. The pain may make you feel anxious or low. It is important to reach out to friends or family for support. If you feel very down, talk to your doctor.

Prevention

You cannot always prevent the need for tonsillectomy, but you can reduce the chance of frequent infections by practicing good hand washing, avoiding close contact with sick people, and not smoking.

Vaccines

Getting vaccinated against the flu and other respiratory infections may help lower your risk of throat infections that could lead to tonsillitis.

Screening programmes

There is no routine screening for tonsil problems. You should see a doctor if you have repeated sore throats or other symptoms that bother you.

Complications

If left untreated

• Repeated severe tonsillitis can lead to a peritonsillar abscess (a collection of pus near the tonsil) that requires drainage.
• Enlarged tonsils can cause sleep apnoea, which increases the risk of high blood pressure, heart problems, and daytime fatigue.
• Chronic throat infections can sometimes lead to kidney inflammation or rheumatic fever (rare).

Long-term outlook

For most adults, tonsillectomy greatly improves quality of life by reducing the number of throat infections and helping them breathe and sleep better. Recovery can be uncomfortable but is temporary, and complications are rare. With proper care, most people heal well and feel much better afterwards.

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