A tonsillectomy is a surgical procedure to remove the tonsils, which are lymph tissue that sits at the back of the throat. A person may undergo tonsillectomy to treat chronic or recurrent tonsil infections or issues related to enlarged or abnormal tonsils.

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This article describes what a tonsillectomy is, including the long-term and short-term risks and benefits.

We also offer advice on how to prepare for the procedure and outline the procedure itself and the recovery process and outlook.

A tonsillectomy is a surgical procedure that involves removing the tonsils. There are three types of tonsil:

  • Palatine tonsils: These are at the top of the throat
  • Adenoids — tonsilla pharyngealis: These sit in the nasal cavity
  • Lingual tonsils — tonsilla lingualis: This type is in the throat below the palatine tonsils

A tonsillectomy typically involves removing the palatine tonsils.

Uses

A doctor may recommend tonsillectomy to treat the following:

Read more about neck and throat surgeries here.

A 2018 study involving more than a million participants investigated the long-term effects of undergoing a tonsillectomy, adenoidectomy, or both as a child.

The researchers associated these surgeries with a significantly increased risk of infectious, allergic, and respiratory diseases later in life.

In contrast, a 2020 study involving over 3,000 people who had undergone a tonsillectomy due to recurrent tonsillitis showed a significant decrease in the number and severity of tonsillitis cases.

The study concluded that the impact of tonsillectomy on general health needs further evaluation.

Read more about the tonsils and adenoids here.

Criteria

Surgeons may consider a tonsillectomy in people with recurrent throat infections if they have had:

  • at least seven documented episodes in the past year
  • at least five documented episodes per year for 2 years
  • at least three documented episodes per year for 3 years

They will also consider if a person has one or more of the following to define qualifying throat infections:

  • temperature above 38.3°C
  • adenopathy — swollen lymph nodes
  • tonsillar exudate — fluid from tonsils in response to infection
  • positive test for strep throat or group A beta-hemolytic streptococcus

Additional considerations are:

  • history of peritonsillar abscess
  • periodic fever, aphthous stomatitis, pharyngitis, and adenitis
  • antibiotic allergies
  • sleep apnea or sleep-disordered breathing

If people do not meet these criteria, doctors may suggest the risks of the procedures outweigh the benefits, but they will consider the options available for a person.

As with any surgery, tonsillectomy also carries some more immediate risks. Examples include:

It is also quite common to experience dehydration from not eating and drinking enough following the procedure. A person may also have bleeding during or immediately following the surgery or 2 weeks after.

Doctors will discuss all the possible risks and complications a person may encounter and offer advice on managing the symptoms and their condition.

However, a person should seek medical attention immediately if they cough or throw up bright red blood or blood clots. This may be a sign that the scabbing area has started to bleed, requiring doctors to perform another procedure to stop the bleeding.

A person undergoing a tonsillectomy should be able to go home on the same day as the procedure.

However, children under 3 years old and children or adults with severe sleep apnea will usually stay overnight.

There are also certain steps for a person to prepare for the surgery, such as:

  • notifying their doctor of any medications or supplements — doctors may recommend stopping these in the week or two weeks before the surgery
  • fasting for 6 hours before the general anesthetic, depending on the center performing the surgery and the age of the person
  • avoiding smoking before the surgery, as smoking increases the risk of post-surgical complications, such as:
    • impaired heart and lung functions
    • infections
    • delayed wound healing
  • making arrangements for someone to drive home after the procedure

Shortly before the tonsillectomy takes place, a person will receive a general anesthetic. This will ensure that they are asleep for the duration of the procedure and cannot feel any pain or discomfort.

The procedure usually takes around 20–30 minutes. The surgeon will typically perform one of two types of tonsillectomy: traditional (extracapsular) or intracapsular.

Traditional tonsillectomy

Traditional tonsillectomy involves the complete removal of both tonsils. Surgeons perform this type of tonsillectomy with cold dissection. This is where they cut away the tonsil with metal instruments such as a knife, scissor, or snare. They then control blood loss with ties or stitches.

Intracapsular tonsillectomy

Intracapsular tonsillectomy involves removing all the affected tonsil tissue but leaving a small layer to protect the throat muscles. Rarely the remaining tissue may regrow or become infected, requiring further surgery.

However, this type of tonsillectomy has an association with the following benefits:

  • less pain
  • less bleeding
  • less difficulty eating and drinking following the procedure
  • faster recovery

At present, only 20% of doctors in the United States perform the intracapsular procedure. Given the aforementioned benefits, the researchers predict a shift toward this type of tonsillectomy in the future.

There are a few different methods for removing the tonsils, which include:

  • Ultrasonic scalpel: This uses ultrasonic energy to cut the tonsils and seals blood vessels to stop bleeding simultaneously.
  • Cauterization: The electrocautery technique burns the tonsillar tissue, which helps in reducing blood loss.
  • Coblation: An electrically powered handpiece that ‘burns’ tissues using low temperatures.

The above methods have various benefits and risks, which a doctor will discuss in greater detail with the person. The techniques that aim to remove the tonsils and stop bleeding tend to reduce postoperative risk.

Shortly after the procedure, the person will wake up in a recovery room. Here, healthcare professionals will monitor the person’s vital signs, including their blood pressure and heart rate. Once the person is stable, their medical team will send them home with a detailed care plan.

A person will need to arrange for a friend or family member to collect them from the hospital and take care of them at home for the rest of the day.

A doctor will prescribe pain medication to help ease any pain and discomfort following the surgery. The following may also help to ease pain and aid recovery:

  • drinking plenty of fluids
  • eating a bland diet consisting of foods that are easy to swallow, such as mashed bananas or applesauce
  • if a doctor permits, taking pain relievers before a meal to help ease pain or discomfort from eating
  • resting as much as possible
  • avoiding people who are ill to reduce the risk of infection

What to expect

Following the procedure, it is quite common for a person to experience:

  • sore throat up to a week after the surgery
  • scabbing over where the tonsils were
  • earache, which may last several days
  • bad breath
  • stuffy or bunged-up nose

A tonsillectomy is a common procedure that doctors use to treat chronic or recurrent tonsillitis or issues involving enlarged or abnormal tonsils.

There are different criteria a person will need to meet in order to be a suitable candidate for tonsil removal. If a person meets these criteria, the benefits of the procedure will likely outweigh any risks that any type of tonsillectomy may carry.