Tonsillectomy (Removal of the Tonsils)

The tonsils are lymph tissue on each side of the throat, held inside a capsule. Bacteria settle in the small pits on their surface. The tonsils then become a source of long-standing infection, and acute tonsillitis returns whenever the body’s resistance drops. Repeated infection also makes the lymph tissue grow, and large tonsils cause snoring, blocked breathing in sleep and pauses in breathing, which are called apnoea.

When the tonsils have to come out

• Repeated acute tonsillitis: more than five attacks in one year, or more than three a year for two years in a row
• Repeated acute tonsillitis together with heart valve disease
• Febrile convulsions
• Chronic tonsillitis that does not answer treatment
• Bad breath
• Sore throat that does not go away
• Painful swelling of the neck lymph nodes
• Carrying infection despite medical treatment
• An abscess that has formed around the tonsil
• Growth large enough to block the throat
• Snoring and long-standing mouth breathing
• Obstructive sleep apnoea syndrome
• Raised blood pressure in the lung arteries
• Difficulty eating
• A developing bite problem
• Suspicion of a tumour, when one side is bigger than the other

The operation

In the first three years of life the tonsils help the immune system develop. For that reason the surgeon delays the operation unless the tonsils block the airway, or reduces very large tonsils with plasma instead of removing them.

The operation is done under general anaesthesia. With preparation for anaesthesia, the control of bleeding after surgery and waking up again, the whole procedure takes 40 to 50 minutes.

The first two weeks

Some pain for two weeks is normal. Children have less pain and it lasts a shorter time, and it falls clearly within three or four days. The pain comes with swallowing and it can be felt in the ear. How strong it is changes from person to person. Simple painkillers are usually enough, though some patients need a stronger one.

Rest at home for two or three days. Children can go back to school six or seven days after the operation. They must not do sport for at least 14 days. Adults return to work after the check-up, seven to ten days after surgery.

What changes afterwards

The voice can change for a while. The air space in the throat changes shape, so the tone changes with it. Much of this returns to normal in time. Part of the change is in fact the voice the child should have had.

Some patients say that liquid comes back through the nose after the operation. This happens when the palate does not close fully. It is usually temporary and caused by the pain. In people whose palate muscles work weakly it can be permanent, because the adenoid that closed the gap has been removed. A permanent change is rare.

Studies find no difference in immunity or in how often infection happens between adults and children who have had the operation and those who have not.

Large tonsils and adenoids can shrink as a child grows. These years are years of fast growth, though, so waiting can disturb the development of the facial skeleton and leave the child snoring as an adult.