The tonsils are a pair of lymph glands at the back of the mouth on either side of the uvula (the band of tissue that hangs down in the middle of the back of your mouth). They are part of a ring of glands at the back of the nose and throat (including the adenoids) that act as a filter to germs that enter in the air when you breathe in.
Tonsillectomy is usually performed if you get recurrent and persistent infections of the tonsils, requiring repeated courses of antibiotics and time off work or school. If you have had more than one quinsy (an abscess in the back of the throat with severe tonsillitis), that too may be a reason to perform it.
It may also be carried out if the tonsils are very large and are causing problems with eating and breathing at night. This may cause snoring and, in the worst cases, difficulty catching your breath while asleep (obstructive sleep apnoea). If this is the case, it may also be necessary to remove the adenoids in children (please see our Adenoidectomy leaflet).
In all these cases, the tonsils are not performing a useful function and are actually causing more harm than good. Removing them has no effect on the ability of you or your throat to fight infection.
If the episodes of tonsillitis are not too frequent (less than an episode every other month for two years), a period of ‘wait and see’ in children is a perfectly reasonable option, to see if the infections settle. There is less evidence, however, that adults are likely to improve with time. If the tonsils look large but are not causing any problems, a tonsillectomy is not usually needed. The only reason for a tonsillectomy definitely being required is where obstructive sleep apnoea is likely or, very rarely, where the tonsil needs to be removed urgently to allow microscopic examination by a pathologist if a tumour of the tonsil is a possibility.
Before the operation
You will need to book two weeks off work or school, and it is wise to expect not to be able to do very much other than relax during this whole period — arrange help at home as required. If you, or anyone in your family, has bleeding problems, or if you are taking medicines that thin the blood such as aspirin or warfarin, it is vital to tell us before we consider surgery. Your operation will have to be postponed if you develop a cold, chest infection or tonsillitis in the month prior to surgery.
The operation
Tonsillectomy is performed through the mouth with you or your child asleep (general anaesthetic). The operation takes about half an hour, and on average you or your child will be in hospital for four hours after waking, to allow us to observe you until you are able to go home. It can be carried out via a traditional extracapsular technique or, particularly in children, via an intracapsular technique using a coblation wand.
Tonsillectomy is safe, but there are a few small risks, as in all operations under a general anaesthetic. The risks we specifically warn about are:
- Pain. Some degree of discomfort after tonsillectomy is inevitable, but you or your child will be given a regime of painkillers to use after the operation. The newer techniques of tonsillectomy have also meant that pain levels afterwards have become much reduced, especially in children.
- Damage to the teeth and lips (please warn us and the anaesthetist if there are any loose teeth or crowns).
- Bleeding. This is very rare, but can occur afterwards — either during the first four hours (in which case you will still be in hospital, and usually need to return to theatre to stop it) or at home up to 10 days after surgery. The latter usually occurs if you get a throat infection. Research has shown that on average 10% of adults will need to be readmitted to hospital after discharge because of bleeding, but at this later stage only 2% will need a further operation to stop it, as it usually resolves spontaneously.
After the operation
Some pain after tonsillectomy is inevitable, but you will be given strong painkillers to take home with you. These should be taken regularly up to the maximum prescribed dose, with the times interspersed if more than one is prescribed — do not wait for the pain to build before you take them. Do not take aspirin or other aspirin-like drugs, as these may cause bleeding.
The pain may not be too bad at first, but can build to its worst point at the 4th to 5th day after the operation, and then starts to improve towards the 7th to 10th day. You may also feel pain in your ears — this is not due to a problem in your ears as a result of the operation, but due to the shared nerve supply between the ears and the throat, causing the phenomenon of referred pain (in the same way that back pain is sometimes felt down the back of the leg in sciatica).
The tonsil sockets will have a white covering on them as they heal, which is normal and not in itself indicative of any problem.
Drink plenty of fluids and eat your normal diet in a ‘little and often’ fashion. Avoid spicy foods, however. Ice cream and soft foods are more comfortable, but crunchier food will help keep the back of your throat cleaner. Chewing sugar-free gum keeps the mouth moist and the jaw muscles active, and may help recovery.
Avoid crowds and unnecessary contact with people — the less risk of catching an infection, the better. Definitely avoid anyone with coughs or colds. If you start to feel feverish or unwell, or your breath starts to smell, you may be developing an infection, and it is wise to get antibiotics from us or your GP as soon as possible.
If you have any bleeding, you need to be examined and may need to come back into hospital. Please call our office on 01622 232880 during office hours, or your GP / emergency doctor. If the bleeding is significant, however, go straight to Accident & Emergency (ideally The William Harvey Hospital in Ashford, where there are ENT doctors on site) as soon as possible.