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Tonsillectomy

By

Catherine Spader, RN

What is a tonsillectomy?

A tonsillectomy is the surgical removal of the tonsils. The tonsils are visible glands located in the back of your throat. Tonsils fight infection but can get infected and enlarged themselves. Infection of the tonsils is called tonsillitis. Frequent bouts of tonsillitis can lead to difficulty breathing, sleep apnea (pauses in breathing during sleep), difficulty eating, and ear infections. Your doctor may recommend a tonsillectomy if you or your child suffer from any or all of these conditions. 

Tonsillitis is most likely to occur in children because the tonsils are larger in children, but it can occur in adults as well. A common cause of tonsillitis is a bacterial infection of Streptococcus pyogenes, commonly known as strep throat. Certain viral infections, such as cytomegalovirus and adenovirus infections can also lead to tonsillitis.

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A tonsillectomy is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before you or your child has a tonsillectomy. 

Other procedures that may be performed

Your doctor may recommend removal of your adenoids along with a tonsillectomy. The adenoids are also infection-fighting glands located in the throat. Adenoids can get infected and enlarged along with the tonsils and cause similar problems. 

Why is a tonsillectomy performed?

Your doctor may recommend a tonsillectomy to treat a child or adult with problems related to the tonsils. These include: 

  • Antibiotic treatment failure, in which antibiotics do not cure a bacterial tonsil infection

  • Cancer of the tonsils

  • Difficulty eating or swallowing due to enlarged tonsils

  • Excessive and loud snoring due to enlarged tonsils that block the breathing passages

  • Frequent bouts of tonsillitis, in particular more than four tonsil infections over a year or five to seven over a two year period

  • Sleep apnea, or pauses in breathing during sleep caused by enlarged tonsils

  • Tonsillar abscess that does not respond to drug treatment

Your doctor may only consider tonsillectomy if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a tonsillectomy.

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Who performs a tonsillectomy?

The following specialists perform tonsillectomy:

  • Otolaryngologists (ENTs) specialize in the treatment of diseases and conditions of the ears, nose and throat.

  • Pediatric otolaryngologists (pediatric ENTs) specialize in the treatment of diseases and conditions of the ears, nose and throat in infants, children and adolescents.

  • Pediatric surgeons specialize in surgery for infants, children and adolescents.

How is a tonsillectomy performed?

Your tonsillectomy will be performed in a hospital or possibly an office or clinic setting. The surgery is generally an outpatient procedure. Some patients may need to stay overnight in the hospital for observation. 

Surgical approaches to a tonsillectomy

Your surgeon will remove or reduce the size of your tonsils through your mouth. Your surgeon will most likely remove all of your tonsil tissue if you have repeated tonsillitis. Surgeons sometimes only reduce the size of tonsils if they are enlarged. 

Your surgeon will advise you on which procedure is best for you based on your diagnosis, age, medical history, general health, and possibly your personal preference.  Learn about the different procedures and ask why your surgeon will use a particular type for you.

The types of tonsillectomy approaches include:

  • Electrocautery burns off tonsil tissue. It also helps reduce blood loss by cauterization, which seals the blood vessels.

  • Harmonic scalpel uses hot ultrasonic energy to vibrate a special blade. The blade cuts tonsil tissues and stops bleeding.

  • Laser tonsil ablation (LTA) uses a laser to destroy and remove tonsil tissue.

  • Microdebrider reduces the size of the tonsil with a rotary shaving device hooked up to suction.

  • Radiofrequency ablation (somnoplasty and coblation) procedures use radiofrequency energy to destroy tonsil tissue.

  • Scalpel removal of the tonsils is the most traditional tonsillectomy procedure.

Types of anesthesia that may be used

Your doctor will perform a tonsillectomy using either general anesthesia or regional anesthesia. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your tonsillectomy

The day of the surgery, you can expect to:

  • Talk with a preoperative nurse. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all of your clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.

  • A surgical team member will start an IV. 

  • The anesthesiologist or nurse anesthetist will start the anesthesia.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of tonsillectomy?  

As with all surgeries, a tonsillectomy involves risks and possible complications. Most tonsillectomy procedures are successful, but complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery 

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock

  • Infection and septicemia, which is the spread of a local infection to the blood

Potential complications of tonsillectomy

Complications of tonsillectomy include:

  • Ear pain

  • Injury to the back of the roof of the mouth (soft palate)

  • Pain or difficulty when swallowing, which typically goes away after a few days

  • Throat pain, which usually goes away after a few days

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery

  • Informing your doctor if you are nursing or if there is any possibility of pregnancy

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my tonsillectomy? 

You are an important member of your healthcare team. The steps you take before surgery can improve your comfort and outcome. 

You can prepare for the tonsillectomy by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include clotting blood tests and other tests as needed.

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

If your child is having a tonsillectomy, discuss what to expect during and after the surgery. Allow your child to express feelings. Tell your child that he or she will have a sore throat for a few days after the surgery. Reassure your child that medications will make him or her comfortable. Tell your child that the surgery will improve their health, such as improving breathing or reducing infections.

Questions to ask your doctor

Surgery is challenging for both children and parents, and you probably have a lot of questions. It is common to forget some questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need a tonsillectomy? Are there any other options for treating my condition?

  • How long will the procedure take? When can I go home?

  • What restrictions will I have after the surgery? When can I return to work and everyday activities?

  • What kind of diet can I eat after surgery?

  • What kind of assistance will I need at home?

  • What medications will I need before and after the surgery? How should I take my usual medications?

  • How will you treat my pain?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after the tonsillectomy?

Knowing what to expect can help make your road to recovery after tonsillectomy as smooth as possible. 

How long will it take to recover?

You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may stay for several hours so your care team can watch for bleeding and other problems. You will most likely go home the same day. 

Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes one to two weeks.

Will I feel pain?

Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Patients typically experience a sore throat that goes away gradually over several days. You may also have soreness in your ears, neck or jaw. 

Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up appointments after a tonsillectomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you or your child has:

  • Bleeding, spitting blood, vomiting blood, or blood coming from the nose

  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Change in alertness, such as passing out, unresponsiveness, or confusion

  • Chest pain, chest tightness, chest pressure, or palpitations

  • Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.

  • Inability to urinate, pass gas, or have a bowel movement

  • Increase in swallowing. This could mean you or your child is bleeding and swallowing blood.

  • Pain that is not controlled by pain medication or an increase in difficulty swallowing or sore throat

  • Unexpected drainage, pus, redness or swelling of the mouth or nose

How might tonsillectomy affect my everyday life?

A tonsillectomy should cure you condition or significantly reduce symptoms so you can lead an active, normal life. Tonsillectomy should help you breathe and sleep better, swallow easier, have fewer throat infections and be more active and engaged with activities and school or work.

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Aug 30, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Fact Sheet: Tonsillectomy Procedures. http://www.entnet.org/HealthInformation/tonsillectomyProcedures.cfm
  2. Tonsils and Adenoids. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/HealthInformation/tonsilsAdenoids.cfm
  3. Tonsils and Tonsillectomies. KidsHealth from Nemours. http://kidshealth.org/parent/medical/ears/tonsil.html#

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