Why is tonsillectomy carried out?

In the past, tonsillectomy was carried out almost as a matter of course. In the days before the widespread availability of antibiotics, tonsillitis could lead to a very severe illness and children would routinely have their tonsils removed to prevent this.

Nowadays we are much more conservative in our approach. Some people think that ENT surgeons have stopped performing tonsillectomy altogether. However if you or your child are experiencing repeated attacks of tonsillitis, with fever, severe sore thoat and difficulty eating or drinking it may well be that tonsillectomy could improve your or their quality of life significantly.

We generally say that if the attacks are occuring 5 times or more a year then tonsillectomy may be justified. However, in certain circumstances, such as if someone is losing a lot of time from their work or studies, their can be some flexibility with regard to this. Also if more than one admission to hospital has been necessary, we would normally consider a tonsillectomy.

The other main reason for tonsillectomy is if the tonsils are so large that they are causing an obstruction to breathing, leading to a condition called sleep apnoea. This is a severe form of snoring in which people may appear to hold their breath or stop breathing for a number of seconds. Although both children and adults can suffer from sleep apnoea, it is generally in children that large tonsils are to blame.

Are there any alternatives to surgery?

There is always a chance that people will grow out of tonsillitis, and it can be very difficult to predict if and when this may happen. It often comes down to a matter of judgement and experience, and we will be happy to discuss this with you. It is possible that if there is some doubt we will suggest a period of "watchful waiting" before making a final decision regarding surgery.

How is the surgery performed?

The operation is carried out under a general anaesthetic (you are fully asleep). The tonsils are removed through the mouth, with no external scars. Any bleeding is controlled with careful cautery and blood loss during the surgery is usually minimal.

Many people ask if they can keep their tonsils afterwards - unfortunately this is not allowed for reasons of patient safety and infection control.

What can I expect after the surgery?

If your operation is in the morning you will usually be discharged home the same day, providing that you are able to eat and drink, your pain is controlled and you don't have a raised temperature. If your operation is in the afternoon you will generally stay overnight.

You (or your child) should plan to take 2 weeks off work (or school). You should spend this time at home, taking things quietly.

There are a number of reasons for this. Firstly, tonsillectomy is unfortunately a painful procedure, and you are unlikely to feel much like working for two weeks. Secondly, there is a small risk of bleeding from where the tonsils were removed, and this can happen any time in the 2 weeks after surgery (please see below). If you are physically active during this time you may increase this risk. Thirdly, if you are around groups of people you are more likely to pick up an infection, and this can also increase the chance of bleeding.

You will be given some painkillers to take home, but unfortunately despite this you are likely to find the operation quite painful. Most people describe it as being like a bad attack of tonsillitis (although you may be consoled by knowing that this should at least be the last time you will feel like this!) You may find that the pain isn't too bad for the first day or two, but most people find that it then increases for a few days and is generally at its worst at about the seventh day after the operation. It should, however, start to get better after this. You may also experience some pain in one or both ears. This is called referred pain, when the brain can get confused about the source of a pain because of the way that the nervous system is arranged. It doesn't necessarily mean that you have a problem with your ears themselves.

If you look in a mirror (or in your child's throat) while the throat is healing you are likely to see what looks like a moist grey scab where the tonsils were removed. This is part of the natural healing process, and shouldn't be anything to worry about.

We don't routinely prescribe antibiotics to take home after tonsillectomy as their is no strong evidence that they are effective in reducing the chance of infection or bleeding if given in this way.

The most important thing is to keep eating and drinking. There have been various recomendations over the years as to what people should eat following tonsillectomy (from ice-cream to crisps!) but we generally suggest that you should try and eat as normal a diet as possible. We do however recommend that you avoid very hot drinks and spicy food - some people also find tomatoes or fruit juices uncomfortable.

What are the risks of the surgery?

All operations, however carefully and expertly they are carried out, have risks attached.

It is likely that you will experience some post-operative pain (please see above). If this is not adequately controlled you may need additional pain relief.

Almost all operations carry a risk of post-operative infection. If you feel unwell or feverish you should visit your GP as you may require antibiotics.

There is also a small risk of bleeding from where the tonsils were removed, and this can occur at any time during the first 2 weeks after the operation. If this does occur you should go directly to your nearest A&E department. It may then be necessary to admit you for observation, and you are likely be treated with antibiotics and possibly a drip. Rarely a second operation may be needed to stop the bleeding if it doesn't stop on its own.

Some patients experience some disturbance of their taste after the operation, but this is almost always temporary.

Very occasionally the tonsils can regrow follwoing surgery. This is particularly a risk if the tonsils are very scarred from a lot of previous infections, when it can be difficult to ensure that absolutely all of the tonsil tissue has been removed.

There is also a very small risk of tooth damage, particularly if you have any loose teeth, caps or crowns. If you do have any teeth which you feel may be at risk, please inform BOTH the anaesthetist AND the surgeon before your operation.