Tonsillectomy

A tonsillectomy is a surgical procedure in which a surgeon removes the tonsils — the two small, oval-shaped glands at the back of the throat that are part of the body's immune system.

The tonsils help fight infection, but they can become a problem when they are repeatedly infected or grow so large that they block normal breathing or swallowing. During the operation, the surgeon detaches each tonsil from the surrounding throat tissue and removes it completely. Once the tonsils are gone, the rest of the immune system continues to protect the body, so their absence does not leave a person without defences.

Doctors recommend a tonsillectomy when tonsil problems are frequent, severe, or seriously affect a person's quality of life. The most common reasons fall into two broad groups: recurring infection and physical obstruction (blockage caused by enlarged tonsils).

• Recurrent tonsillitis (repeated throat infections) — typically defined as several episodes per year over more than one year
• Tonsillitis that does not respond to antibiotic treatment
• A peritonsillar abscess (a pocket of pus beside the tonsil) that keeps coming back
• Obstructive sleep apnoea (breathing pauses during sleep) caused by enlarged tonsils
• Severe snoring or disrupted sleep linked to large tonsils
• Difficulty swallowing solid food because enlarged tonsils narrow the throat
• Muffled speech or a persistent change in voice caused by very large tonsils
• A tonsil that looks abnormal and needs to be examined under a microscope (biopsy)

A tonsillectomy is generally not recommended in certain situations, and the surgeon will assess each case individually.

• Active, uncontrolled infection at the time of planned surgery — the operation is usually postponed until the infection has settled
• Bleeding disorders (conditions that make the blood clot poorly) that cannot be safely managed before surgery
• Serious medical conditions that make general anaesthesia (medicines that put the patient fully to sleep) too risky
• Very mild or infrequent tonsil problems where non-surgical treatment has not yet been tried

A tonsillectomy is a common and well-established operation, but like all surgical procedures it carries some risks that patients should understand before giving consent.

• Post-operative bleeding (the most important risk) — a small number of patients experience bleeding in the days after surgery, most often around the fifth to tenth day when the healing tissue (scab) falls off; this can require a return to hospital or a second procedure to stop the bleeding
• Throat pain — almost all patients have significant throat pain for one to two weeks after surgery
• Ear pain — pain felt in the ears is common and is referred pain (pain signals travelling along a shared nerve pathway) from the healing throat
• Swelling of the throat or tongue, which may briefly affect breathing, especially in the first hours after surgery
• Nausea and vomiting related to the general anaesthesia
• Dehydration, because throat pain can make it hard to drink enough fluids
• Infection of the healing wound in the throat
• Temporary change in voice or nasal tone while the throat heals
• Rare risks of general anaesthesia, including allergic reactions or breathing difficulties

Preparing well for a tonsillectomy helps the surgery go smoothly and reduces the risk of complications. Preparation covers what the patient does in the days before, the tests that are usually arranged, and what happens on the day itself.

In the days before surgery, the medical team will usually give the following instructions:

• Fasting — patients are typically asked to stop eating solid food and drinking anything (including water) for a set number of hours before surgery so the stomach is empty when anaesthesia is given; the exact fasting window is set by the anaesthetist (the doctor who manages the anaesthesia)
• Medications — the doctor will review all medicines, vitamins, and herbal supplements the patient takes; blood thinners and certain anti-inflammatory pain relievers (medicines that reduce swelling and pain) are commonly paused before surgery because they increase bleeding risk
• Smoking and alcohol — smoking irritates the throat and slows healing; alcohol can interact with anaesthetic medicines; the team will advise on when to stop both
• Active infection — if the patient has an active throat infection very close to the surgery date, the team may decide to postpone the operation

Before the operation is confirmed, the following assessments are commonly arranged:

• Blood tests to check general health and how well the blood clots
• A review of any known allergies, especially to anaesthetic medicines or latex
• In some cases, a sleep study (a test that records breathing patterns during sleep) if obstructive sleep apnoea is suspected
• A physical examination of the throat and neck by the ear, nose, and throat (ENT) surgeon

On the day of surgery, the procedure typically follows these steps:

• 1. The patient arrives and the nursing team checks identity, consent forms, and confirms the fasting period has been completed.
• 2. A small cannula (thin plastic tube) is inserted into a vein in the hand or arm to allow medicines and fluids to be given directly into the bloodstream.
• 3. The anaesthetist gives general anaesthesia, and the patient falls into a deep, controlled sleep.
• 4. The surgeon positions a small instrument to keep the mouth open and exposes both tonsils.
• 5. Each tonsil is separated from the surrounding muscle and tissue using a surgical technique chosen by the surgeon — common methods include a scalpel (surgical blade), electrocautery (a device using controlled heat), or a specialised dissection tool.
• 6. Any bleeding points are carefully sealed.
• 7. The anaesthetic is stopped, the patient is gently woken, and breathing is checked before the breathing tube (if used) is removed.
• 8. The patient is moved to a recovery area where nurses monitor breathing, pain, and any signs of bleeding.

Recovery from a tonsillectomy takes time, and throat pain is a normal part of healing for most patients. The first two weeks are the most important period, because the risk of bleeding is highest during this time, particularly around the fifth to tenth day when the healing tissue naturally separates. Following aftercare instructions carefully during this window makes a significant difference to recovery.

• Monitoring after surgery: most patients spend several hours in a recovery area before being discharged; children and patients with sleep apnoea may be kept overnight for closer observation
• Pain management: the medical team will prescribe pain relief suitable for the patient's age and health; keeping pain under control is important because it encourages patients to drink enough fluids
• Fluids and diet: cool or lukewarm soft foods and plenty of fluids are strongly encouraged from the first day; rough, hard, or very hot foods are avoided until the throat has healed fully, which usually takes around two weeks
• Activity restrictions: rest is important in the first week; strenuous physical activity (sports, heavy lifting, vigorous exercise) is typically avoided for at least two weeks because it can raise blood pressure and trigger bleeding
• School and work: most adults need one to two weeks off work; children usually need a similar break from school
• Wound care: there is no external wound to dress, but patients are advised to avoid blowing the nose forcefully, coughing hard, or clearing the throat aggressively, as these actions can disturb the healing tissue
• When to seek urgent care: any bright red bleeding from the mouth or nose, a sudden worsening of pain, or a high fever should prompt an immediate return to hospital — do not wait for a scheduled appointment
• Follow-up appointment: the ENT surgeon usually arranges a review visit within a few weeks to check that healing is progressing normally
• Smoking: if the patient smokes, the team will advise on staying smoke-free during the recovery period, as smoke significantly delays healing of the throat tissue