The adenoids and tonsils are lymphatic tissues that, when enlarged in childhood, can cause a blocked nose, snoring, pauses in breathing during sleep and recurrent infections. Ear, nose and throat specialist Op. Dr. Süleyman Kumbasar, whose practice is in Bahçelievler, Istanbul, makes the decision to operate according to guideline criteria, such as at least seven documented throat infections in the past year or sleep-disordered breathing from large tonsils. The operation is done through the mouth; the most important risk is bleeding, which can occur on the first day or between days 5 and 10.
What are the adenoids and tonsils?
The palatine tonsils sit on either side of the throat and the adenoids at the back of the nose, in the nasopharynx; both are lymphatic tissue. They are part of the immune system’s first line of defence against germs entering through the mouth and nose. They are usually at their largest between the ages of 3 and 7 and shrink in adolescence. The adenoids are a different structure from the turbinates on the side wall of the nose.
What symptoms do they cause when enlarged?
Enlarged adenoids
- Blocked nose, sleeping with the mouth open and mouth breathing
- Snoring and pauses in breathing during sleep (see snoring and sleep apnoea)
- A nasal voice and a constantly runny nose
- Recurrent middle ear infections or hearing loss from fluid in the ear (see ear infections)
Enlarged and inflamed tonsils
- Frequent throat infections with fever
- Snoring, pauses in breathing and restless sleep
- Difficulty swallowing and eating slowly
- An abscess forming around the tonsil
When is surgery needed?
The decision to operate is based on international guideline criteria. The main situations for tonsillectomy are:
- A number of documented throat infections of at least seven in the past year, at least five in each of the past two years or at least three in each of the past three years. With fewer infections, follow-up is recommended.
- Sleep-disordered breathing from large tonsils: snoring and pauses in breathing that affect behaviour, school performance or growth
- Recurrent peritonsillar abscesses
Adenoidectomy (removal of the adenoids) is considered, at the right age, for enlargement that causes marked nasal blockage, recurrent nasopharyngeal infections, and in children who need ventilation tubes in the ear. Op. Dr. Süleyman Kumbasar makes the decision taking into account the examination, the record of infections and, if needed, hearing and sleep tests. Other ENT problems in children are summarised on the paediatric ENT page.
How is the operation done?
The operation is done under general anaesthesia, through the mouth; there are no external incisions. The adenoids are removed from the nasopharynx; the tonsils are removed with their capsule completely or, in selected cases, partially. If there is fluid in the ear, ventilation tubes can be placed under the same anaesthetic. Young children and those with sleep apnoea may stay one night in hospital for observation.
Tonsillectomy in adults
In adults, recurrent tonsillitis, peritonsillar abscess, large tonsils contributing to sleep apnoea and tonsil stones that persist despite treatment can also be reasons for surgery. In adults, recovery is usually more painful than in children.
What are the risks?
The most important risk is bleeding: it can occur in the first 24 hours or between days 5 and 10, when the scabs come away. If there is bleeding from the mouth, go to hospital without delay. There may also be throat and ear pain, weakness from not drinking enough fluids, a temporary nasal voice and risks related to anaesthesia. The risks are explained at the consultation before surgery and written informed consent is obtained.
The surgical process
General anaesthesia. Blood tests and an anaesthetic assessment are carried out before the operation.
Usually 30 to 60 minutes; a few minutes more if ventilation tubes are added.
Most patients go home on the same day; young children and those with sleep apnoea may stay one night for observation.
Paracetamol or ibuprofen as directed by the doctor are used for pain; codeine-containing medicines are not used in children under 12.
Recovery timeline
Sore throat and pain that spreads to the ear when swallowing. Drinking plenty of fluids is important; lukewarm, soft foods are preferred.
White scabs form where the tonsils were, which is normal. When they come away, pain may increase for a while; the risk of bleeding continues during this period.
Pain clearly decreases; most children return to school and adults to work.
The tonsil area has largely healed; normal eating and sport resume.
Frequently asked questions
Does removing the adenoids and tonsils weaken the immune system?
These tissues are part of the immune system, but the body has many other lymphatic tissues that continue to do this job. Studies have not shown a significant, permanent weakening of immunity after the operation.
Can the adenoids grow back after the operation?
Rarely, small remnants of tissue can grow back and cause symptoms. This mainly happens after operations done at a very young age.
At what age can a tonsillectomy be done?
There is no fixed age limit; the decision depends on the reason for the operation. In young children with sleep-disordered breathing it may be needed earlier. Very young children stay one night in hospital for observation after the operation.
What can be eaten after the operation?
In the first days, plenty of fluids, lukewarm soups, yoghurt, custard and other soft foods are preferred. For about two weeks, hard, crunchy, very hot and acidic foods are avoided. Drinking enough fluids is the most important thing for recovery.
What should I do if there is bleeding after the operation?
If fresh blood comes from the mouth or blood is spat out, go to hospital without delay. Bleeding is most common in the first 24 hours and between days 5 and 10, when the scabs come away.
Is tonsillectomy more painful in adults?
Generally, yes. In adults, pain during recovery is more marked than in children and returning to work can take 10–14 days.
Related treatments
Articles on this topic
Sources
- Mitchell RB et al. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngology–Head and Neck Surgery, 2019.
- Rosenfeld RM et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology–Head and Neck Surgery, 2016.
The information on this page is for general guidance only; diagnosis and treatment decisions are made by the doctor after a consultation. Results of surgical and interventional procedures vary from person to person.