All about tonsils: tonsilitis, tonsil stones and tonsillectomy

The tonsils are made of lymphoid tissue and sit on each side at the back of the throat. They play a role in fighting infection, but are only important in the first two years or so of life. There are 100-200 lymph glands in the neck, and lymphoid tissue at the back of the tongue and nose, so there is plenty of surplus if the tonsils are removed. Tonsillectomy is an operation to remove the tonsils, and is one the commonest procedures I perform.

Tonsils are removed for a number of reasons:

  • Infection is the most common reason. Many people have recurrent problems with tonsillitis several times a year. Less commonly the tonsils can become chronically infection leading to a constant, usually low-grade, sore throat. Tonsillitis causes a sore throat and is often associated with fever. Occasionally an abscess, or collection of pus, can form around the tonsil. This is called a quinsy and usually requires drainage of the pus as an emergency. You can still have sore throats after having your tonsils removed, but they are usually much less frequent.

  • Snoring and sleep apnoea Large tonsils can cause the upper airway to become partially blocked when sleeping. This causes the soft tissues to vibrate, generating the sound of snoring. In extreme cases, the airway can become temporarily blocked, causing the person to stop breathing for a few seconds. In children large tonsils are often associated with large adenoids, which can be removed at the same time as removing the tonsils(hyperlink).

  • Different sized tonsils Most people have tonsils that are about equal in size. If one tonsil is obviously bigger than the other, it is usually advisable to remove the tonsils and send them for examination by a pathologist to identify why they are different in size. In the majority of cases there is no cause for concern.

  • Swallowing difficulty If the tonsils are very large, they can cause swallowing problems.

  • Less common reasons Occasionally tonsils can lead to bad breath (halitosis) due to food debris that becomes trapped in the tonsils. In some cases tonsil stones (tonsilloliths) can form. These are like white or cream pieces of grit in the tonsils that can be uncomfortable.

How are the tonsils removed?

The tonsils are removed whilst you are asleep under a general anaesthetic. There are many ways that the tonsils can be removed. The commonest way is with scissors and dissecting instruments (“cold steel” method). Cautery or ties (small pieces of thread) can be used to stop bleeding during the procedure. Coblation tonsillectomy is a newer technique that involves the use of a probe that dissolves the tonsil tissue at low temperatures (typically 40-60 degrees). All of the surgery is performed through the mouth. There are no cuts or scars to the skin. The operation usually takes about 15 minutes to perform. Tonsillectomy can be performed using the intra-capsular or extra-capsular technique.

What is the best way to remove tonsils?

The two principle problems that can occur after tonsillectomy are pain and bleeding. There is now a lot of evidence showing that intracapsular coblation tonsillectomy is associated with a shorter recovery time; a considerably reduced risk of bleeding; and less pain. For these reasons, intracapsular coblation tonsillectomy is my preferred technique.

Are there any alternatives to tonsillectomy?

Recurrent tonsillitis often improves with time, although this is difficult to predict and it can be a problem for many years. If you do not have your tonsils removed, there are other rare problems that can occur such as breathing difficulties, abscesses around the tonsils or in the lungs or rheumatic fever.

What are the risks of tonsillectomy?

There are risks associated with any type of surgery. The risks of surgery need to be balanced against the risks of not doing surgery and the benefits of surgery. Tonsillectomy is a routine procedure, and it is unusual for problems to arise. More common and serious complications of tonsillectomy include:

Bleeding. About one in twenty (5%) of patients will have some bleeding after surgery. In most cases this is minor, but about one in a hundred (1%) will need a second trip to the operating theatre to stop the bleeding. Bleeding can occur up to two weeks after the operation, and is usually caused by an infection.

Infection. This can cause a worsening of the sore throat often with a fever.

Injury to lips, tongue or teeth. This is unusual, but occasionally occurs as both the anaesthetist and surgeon need to put instruments into the patient’s mouth.

General Anaesthetic. Modern anaesthetics are usually very safe. If you have other health problems, this can increase the risk of anaesthesia. The anaesthetist will discuss the risks of anaesthesia before your operation.

What is recovery from tonsillectomy like?

After your procedure you will be taken from the operating theatre to the recovery room where you wake up. When you are properly awake, you will be taken back to your hospital room. You need to stay in the hospital for 6 hours before you can go home. It is not uncommon to spit out small amounts of blood stained saliva for 24 hours following surgery. If you spit out or vomit bright red blood or clots, you should go to the nearest Accident and Emergency department.

You should arrange to have two weeks off work, or clear of commitments after your operation. It is best to avoid crowded places, to minimise the chance of catching a cough or cold. Some discomfort is normal after tonsillectomy, and can be the case for two weeks. The soreness usually increases slightly for the first few days following surgery, before gradually getting better. Many patients have earache after five to seven days. This is due to the fact that the tonsils and ears share a nerve supply, and is called a ‘referred pain’. A day or two after the operation, you will notice some white material developing over the tonsil beds. This is a normal part of the healing process, and does not mean you have an infection. Many people find they have bad breath for several days after the operation.

It is important that you brush your teeth as usual after the operation. This may reduce the chances of getting an infection. You should eat a normal diet after surgery. Whilst you might not feel as hungry as usual, you should try and eat three times a day, and drink plenty of fluids.

How much does it cost to have your tonsils removed?

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Some useful information on tonsillitis and tonsillectomy can be found at the following links: