What do the tonsils do?
The tonsils (palatine tonsils) are lymphatic tissue on either side at the back of the throat and are part of the immune system. Together with the adenoids behind the nose and the lymphatic tissue at the base of the tongue, they play a role in the first line of defence against germs entering through the mouth and nose.
When the tonsils become inflamed often, or grow large enough to narrow the airway, they can become more of a source of problems than a protection. Research has shown that removing the tonsils has no significant negative effect on the immune system.
What is tonsillitis?
Tonsillitis is common in children; most cases are caused by viruses, and in children about 15–30% are caused by group A streptococcus bacteria. It causes fever, sore throat, difficulty swallowing, tiredness and swollen glands in the neck; the tonsils may look swollen and red, with white spots or a coating on them.
- Acute tonsillitis: an infection that usually clears within a week, with medicine if needed.
- Chronic tonsillitis: a sore throat and swollen tonsils lasting 3 months or longer, accompanied by bad breath, poor appetite and persistently swollen neck glands.
- Recurrent tonsillitis: at least 7 episodes of tonsillitis in one year, at least 5 in each of the last two years, or at least 3 in each of the last three years.
Infections caused by group A beta-haemolytic streptococcus can rarely lead to problems such as an abscess around the tonsil, scarlet fever, rheumatic fever or kidney inflammation.
When is tonsil surgery needed?
Tonsil surgery (tonsillectomy) is recommended when medical treatment is not enough, or when the tonsils markedly affect health and quality of life.
- Tonsillitis recurring as often as described above
- Chronic tonsillitis
- An abscess around the tonsil (especially if recurrent)
- Loud snoring, sleeping with the mouth open and pauses in breathing during sleep (sleep apnoea)
- Tonsils large enough to make swallowing or speaking difficult
- Problems with tooth and facial development caused by enlarged tonsils and adenoids
- Enlargement of one tonsil only, or marked asymmetry (assessment for a tumour)
In children whose enlarged tonsils affect sleep and growth, sleep quality, appetite and growth usually improve after surgery.
Examination and diagnosis
The assessment is based on a full ear, nose and throat examination: the size of the tonsils, the adenoids, the eardrums and the neck glands are checked. Sometimes fluid in the middle ear is also found in a child with no symptoms at all. If needed, blood tests and a throat swab culture are carried out. If pauses in breathing during sleep are suspected, a sleep assessment may be recommended.
If the adenoids are also enlarged, adenoid removal can be carried out under the same anaesthetic, and if there is long-standing fluid in the middle ear, grommets can be inserted at the same time.
How is the operation performed?
Tonsil surgery is performed under general anaesthesia and takes about 30 minutes. The tonsils are removed through the mouth; there is no cut in the skin.
- Blood tests are done before surgery, and an anaesthetist assesses the child or adult patient.
- Some painkillers and supplements that can increase bleeding are stopped before surgery; you are given the list in advance.
- The anaesthesia team will tell you separately how long to fast and what time to arrive at the hospital.
- After surgery, vital signs are monitored in the recovery area; parents can usually join their child at this stage.
Most patients go home the same day; if needed, they stay in hospital for one night.
Recovery
Children recover from tonsil surgery faster and with less pain than adults; return to school or work is usually after 10 days.
| Period | What to expect |
|---|---|
| Days 1–2 | Sore throat (much milder in children than in adults), mild fever, tiredness, bad breath and a feeling of fullness in the throat. |
| Days 3–5 | The areas where the tonsils were removed are covered with a white layer; this is part of normal healing. |
| Days 5–10 | The pain eases; in adults, scabs and pain may continue during this period. |
| Day 10 | Return to school or work. |
Eating and drinking: drinking plenty of fluids is the most important part of recovery. For about ten days, soft and cold foods (water, milk, yoghurt, pudding, ice cream, mashed potato and apple purée, broth) are preferred; hard, crunchy and spicy foods are avoided.
What are the risks?
Tonsil surgery is a common and generally safe operation; even so, it has risks.
- Bleeding: the most important risk; it can occur in the first days after surgery or when the scabs come away
- Infection
- Temporary swelling of the tongue and soft palate
- Risks related to anaesthesia
Contact your doctor straight away if there is bleeding, difficulty breathing, severe pain not relieved by painkillers, vomiting, inability to drink enough fluids, or a fever of 38 °C or higher that does not come down despite medicine.
How does the process work with Prof. Dr. Öner Çelik?
- Consultation: the tonsils, adenoids and ears are assessed together at the clinic in Suadiye.
- Decision: whether surgery is needed is discussed after considering together how often infections occur, the effect on sleep and growth, and the response to medical treatment.
- Surgery: performed at Maltepe University Hospital; most patients go home the same day.
- Check-ups: healing is followed up at the clinic.
Details are on the your treatment in Istanbul page.
Frequently asked
When is a tonsillectomy needed?
It is performed for frequently recurring or chronic tonsillitis, snoring, sleep apnoea or tonsils large enough to make swallowing difficult. It takes about 30 minutes under general anaesthesia and children usually go home the same day; they usually return to school after 10 days.
More detail: Tonsillectomy.
When do children return to school after surgery?
It depends on the operation: most children recover within 2–3 days after adenoidectomy, while after a tonsillectomy they usually return to school after 10 days. Children recover faster and with less pain than adults.
More detail: Paediatric ENT.
At what age can a tonsillectomy be done?
There is no fixed age limit for tonsillectomy; the decision is based not on age but on how often infections occur, sleep and breathing problems and the effect on the child’s growth. In very young children, anaesthesia and aftercare are planned with extra care.
Does removing the tonsils weaken immunity?
No. Research has shown that tonsillectomy does not harm the immune system. The throat can still get infections after the tonsils are removed, but this is not caused by their removal.
References
- Mitchell RB et al. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngol Head Neck Surg. 2019;160(1_suppl):S1-S42.
- Wong Chung JERE et al. Tonsillotomy versus tonsillectomy in adults suffering from tonsil-related afflictions: a systematic review. Acta Otolaryngol, 2018. pubmed.ncbi.nlm.nih.gov
This content is for information only and does not replace medical advice. Every medical procedure requires an individual assessment and may carry risks. Results vary from person to person.
