Tonsillectomy

Overview

Tonsillectomy (ton-sih-LEK-tuh-me) is surgery to remove the tonsils. The tonsils are two oval-shaped pads of tissue at the back of the throat. There's one tonsil on each side.

Tonsillectomy was once used to treat infection and inflammation of the tonsils. This is a condition called tonsillitis. Tonsillectomy still is used for this condition, but only when tonsillitis happens often or doesn't get better after other treatments. Today, tonsillectomy mostly is used to treat breathing problems that happen during sleep.

Tonsillectomy also may be used to treat breathing and other problems caused by enlarged tonsils and to treat rare diseases of the tonsils.

Recovery time for a tonsillectomy takes 10 to 14 days.

Why it's done

A tonsillectomy is used to treat:

• Repeating, chronic or severe tonsillitis.
• Breathing problems that happen during sleep.
• Other problems caused by enlarged tonsils.
• Bleeding of the tonsils.
• Rare diseases of the tonsils.

Tonsillitis

Tonsillitis is inflammation of the tonsils. The tonsils are the immune system's first line of defense against germs and viruses that enter the mouth. This work puts the tonsils at high risk of infection and swelling and irritation, called inflammation.

But the tonsil's immune work slows after puberty. This might explain why tonsilitis rarely happen in adults.

A doctor trained in conditions of the ear, nose and throat, called an ENT doctor, might suggest a tonsillectomy to treat recurring tonsillitis. This is tonsillitis that has come back:

• At least seven times in the past year.
• At least five times a year in the past two years.
• At least three times a year in the past three years.

An ENT doctor also might suggest the procedure if:

• A bacterial infection that causes tonsillitis doesn't get better with antibiotic treatment.
• An infection that causes pus to build up behind a tonsil doesn't improve with medicine or after being drained. The pus buildup is called a tonsillar abscess.

Complications of enlarged tonsils

Tonsils may get larger after repeat infections. Or they just may be large. A tonsillectomy can treat issues that enlarged tonsils cause, including:

• Trouble breathing.
• Breathing that stops during sleep, called obstructive sleep apnea.

Other diseases or conditions of the tonsils

A tonsillectomy also may treat other rare diseases or conditions of the tonsils, such as:

• Cancer in one or both tonsils.
• Bleeding from blood vessels near the surface of the tonsils.
• Severe bad breath, called halitosis, linked to small stones that form in the tonsils. The stones are called tonsil stones or tonsilloliths.

Risks

Tonsillectomy, like other surgeries, has some risks, including:

• Reaction to anesthesia. Medicines to make you sleep during surgery often cause minor, short-term problems. These include headache, nausea, vomiting or muscle soreness. Serious, long-term problems and death are rare.
• Swelling. Swelling of the tongue and soft roof of the mouth, called the soft palate, can cause breathing problems. This is most likely to happen during the first few hours after the procedure.
• Bleeding during surgery. Rarely, severe bleeding happens during surgery. This needs treatment and a longer hospital stay.
• Bleeding during healing. Bleeding can happen during the healing process. This is most likely if the scab from the wound comes loose and causes irritation.
• Infection. Rarely, surgery can lead to an infection that needs treatment.

How you prepare

The healthcare team tells you how to prepare for a tonsillectomy.

Information

Your healthcare team needs to know about:

• All medicines and dietary supplements that you take. Be sure to include those you get without a prescription.
• Personal or family history of bad reactions to anesthesia.
• Personal or family history of bleeding issues.
• Known allergies or other reactions to medicines, such as antibiotics.

Instructions

Your healthcare team may ask you to:

• Stop taking or change doses of some medicines several days before the surgery.
• Not eat anything after midnight before the surgery.
• Make sure you have a ride home.
• Plan for 10 to 14 days to recover. Adults may need more time than children do.

You or your child might need tests or bloodwork before surgery. You may need a sleep study, called a polysomnography, if your tonsillectomy is to treat obstructive sleep apnea, other airway blocks or some other conditions.

What you can expect

Most people who have a tonsillectomy can go home the day of the surgery. But the surgery might involve an overnight stay if there are complications, if a young child has the surgery or if there are other medical conditions.

Before the procedure

A member of your healthcare team may use a pre-surgery checklist of questions. This might include asking you to say your name and the reason for your surgery. The team uses the checklist to make sure of your safety.

During the procedure

A tonsillectomy uses medicine that puts you to sleep, called general anesthesia. You or your child won't be aware of the procedure or feel pain during the surgery.

The surgeon may cut out the tonsils with a knife called a scalpel. Or the surgeon may use a special surgical tool. The tool uses heat or sound waves to remove or destroy tissues and stop bleeding.

After the procedure

Common issues after a tonsillectomy can include:

• Mild to severe pain in the throat for 1 to 2 weeks.
• Pain in the ears, neck or jaw.
• Nausea and vomiting for a few days.
• Mild fever for a few days.
• Bad breath for up to two weeks.
• Swelling of the tongue or throat.
• Feeling of something stuck in the throat.
• Anxiety or disturbed sleep in children.

Steps to manage pain and help recovery include the following:

• Medicines. Take pain medicines as a member of your healthcare team tells you to.
• Fluids. Drink lots of fluids after surgery to keep from getting dehydrated. Water and ice pops are good choices.
• Food. Bland foods that are easy to swallow, such as applesauce or broth, are best right after surgery. You can add foods such as ice cream and pudding if they don't bother you. Add other foods that are easy to chew and swallow as soon as you can. Don't eat acidic, spicy, hard or crunchy foods that may cause pain or bleeding.
• Rest. Rest for several days after surgery. Don't run, bike ride or do other hard activities for two weeks after surgery.

You or your child should be able to return to work or school after being able to eat a regular diet, sleep through the night and not need pain medicine. Ask your healthcare team about what things you should not do.

When to contact your healthcare team or get emergency care

Watch for the following complications. These might need medical care right away:

• Bleeding. You may see small specks of dark blood from the nose or in the saliva. But if you see any bright red blood, go to an emergency room right away. You might need surgery to stop the bleeding.
• Fever. Contact your healthcare professional if you or your child has a fever of 102 F (38.9 C) or higher.
• Dehydration. Contact your healthcare professional if you see signs of dehydration. These include urinating less, being thirsty, feeling weak, having a headache, or being dizzy or lightheaded. Signs of dehydration in babies include urinating fewer than two or three times a day or crying with no tears.
• Breathing problems. Snoring or noisy breathing is common during the first week or so after surgery. But if you or your child has trouble breathing, get care right away.

Results

Tonsillectomies can reduce how often strep throat and other bacterial infections happen and how bad they are. Tonsillectomies also can improve breathing problems when other treatments have not helped.