Adult Tonsillectomy

Adults who come to see me about their tonsils are often dealing with a frustrating cycle of repeated throat infections, repeated antibiotics, time off work, and uncertainty about whether surgery is really the right next step. I have performed nearly 1000 tonsillectomies, and an important part of my role is helping each patient decide whether surgery is appropriate and, if so, which technique is likely to suit them best. For some people, tonsillectomy is genuinely life-changing. For others, the better option is continued medical treatment, watchful waiting, or a more limited procedure. The right decision is always made on an individual basis.

Why might an adult need a tonsillectomy?

In adults, the commonest reason for tonsillectomy is recurrent tonsillitis that is severe enough to affect work, sleep, travel, social life or general quality of life. In the UK, surgery is often considered when there have been 7 significant episodes in 1 year, 5 per year for 2 years, or 3 per year for 3 years, but these are guides rather than rigid rules. Severity, time off work, repeated antibiotics, hospital attendances and complications such as quinsy (an abscess next to the tonsil) all matter.

Other reasons include:

• a previous quinsy (an abscess next to the tonsil) or repeated severe infections

• persistent tonsil symptoms, including chronic soreness, troublesome tonsil stones or bad breath in selected cases

• enlarged tonsils contributing to snoring, poor sleep or airway obstruction

• an asymmetrical or abnormal-looking tonsil that needs proper assessment

What are the benefits of surgery?

For the right patient, tonsillectomy can reduce the number of future severe throat infections and improve quality of life. Studies in adults with recurrent tonsillitis have shown that tonsillectomy can significantly reduce further sore-throat episodes over time.

It is worth remembering that tonsillectomy reduces tonsillitis-related sore throats, but it does not prevent every future sore throat, because not all sore throats come from the tonsils.

How can the operation be done?

Tonsil surgery is performed under a general anaesthetic and through the mouth. There are different ways of removing tonsil tissue, and the best technique is chosen on an individual basis.

Bipolar tonsillectomy

This is a standard extracapsular or total tonsillectomy. The whole tonsil is removed, including the capsule. In adults with recurrent infection, this remains the traditional and most established operation because it removes the tonsil tissue completely.

Coblation tonsil surgery

Coblation uses radiofrequency energy to remove tissue at lower temperatures than traditional diathermy.

Intracapsular coblation

With intracapsular coblation, most of the tonsil is removed but a thin layer is left behind over the throat muscle. For some patients this can mean less pain and an easier recovery, with potentially less bleeding. The trade-off is that a small amount of tonsil tissue remains, so there is a small chance of persistent symptoms, regrowth or the need for revision surgery later.

In my practice, I tailor the operation to the problem I am trying to solve. There is no single “best” operation for everyone.

What about tonsil cysts?

Tonsil cysts can be treated, but they do not always require a full tonsillectomy.

That depends on what the lesion appears to be, whether it is causing symptoms, whether it is clearly benign, and whether the safest option is observation, targeted excision, drainage, biopsy, or full removal of the tonsil. In some cases a full tonsillectomy is appropriate, but in others a more limited procedure may be enough.

What about the adenoids?

The adenoids are similar to the tonsils in that they are also made of lymphoid tissue. They sit higher up, behind the nose rather than at the sides of the throat. In some patients, especially where nasal blockage, mouth breathing, snoring or ongoing infection are part of the picture, the adenoids may also need to be addressed. Surgery to remove the adenoids is called an adenoidectomy.

Does tonsillectomy weaken the immune system or increase infection risk long term?

This is a very common concern. Reassuringly, current adult evidence is broadly reassuring. The body can still fight infections without the tonsils, and studies in adults have not shown that tonsillectomy leads to a meaningful increase in long-term infection risk. Overall, there is no good evidence that adults who have a tonsillectomy become generally more prone to infection in day-to-day life.

What are the main risks of adult tonsillectomy?

Tonsillectomy is a very common operation, but adult recovery is often tougher than patients expect. The main serious risk is bleeding. Bleeding can happen at any point in the 2 weeks after surgery. A proportion of adults who bleed will need to stay in hospital for observation, and a smaller number will need a second operation to stop the bleeding. If a large amount of blood is lost, a blood transfusion may occasionally be required. Any bleeding significant enough to require hospital admission, further surgery or transfusion will usually make recovery longer and more difficult.

Other important risks include:

• pain for 10 to 14 days

• dehydration if swallowing becomes difficult

• infection or delayed healing

• nausea, constipation or drowsiness from pain relief or anaesthetic

• temporary change in voice

• altered taste, which is usually temporary

• rare injury to the lips, teeth, tongue or gums

• the usual risks of a general anaesthetic

Aftercare

Good aftercare makes a real difference to recovery.

Pain relief

Expect a sore throat for around 10 to 14 days. Pain often peaks around days 5 to 7 before starting to improve. Ear pain is very common and is usually referred pain from the throat rather than an ear infection. Take pain relief regularly as advised rather than waiting for pain to become severe.

Eating and drinking

It is important to keep drinking and to return to a normal diet as soon as you reasonably can. Regular swallowing and chewing help the throat heal and can reduce debris collecting at the back of the throat. Some patients also find that chewing gum helps keep the throat moving and may make swallowing a little easier. Dehydration makes recovery harder and often makes pain worse.

Time off work

Most adults should plan for around 2 weeks away from work, exercise, travel and social commitments.

What is normal during healing?

It is common to have:

• a sore throat

• earache

• bad breath

• a white or yellow coating at the back of the throat

• pain that feels worse on one side than the other

• a mild temperature in the first 24 to 48 hours

When should I seek urgent help?

Fresh bleeding after a tonsillectomy is not something to watch at home. If there is any bleeding, going to the nearest A&E is advised.

You should also seek urgent help if you cannot keep fluids down, are becoming dehydrated, or have pain that is not controlled despite appropriate medication. If bleeding is heavy or breathing is affected, call 999.

Useful links

• ENT UK: Tonsillectomy because of repeated infections

• ENT UK: Making a decision about recurrent tonsillitis

Disclaimer

This page is intended as general information for adults considering tonsil surgery. It does not replace a consultation, examination or individual medical advice.