Adenoid and tonsil removal

Published by Bupa's Health Information Team, May 2010.

This factsheet is for people who are having their adenoids and/or tonsils removed, or who would like information about it.

This factsheet is relevant for adults who are having their adenoids and/or tonsils removed and for parents of children who are having the operation. However, for simplicity, we refer to 'you' throughout.

Adenoids and tonsils are small lumps of tissue at the back of the nose and throat. An operation to remove the tonsils is called a tonsillectomy and an operation to remove the adenoids is called an adenoidectomy. An operation to remove both is called an adenotonsillectomy.

You will meet the surgeon carrying out your operation to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

The adenoids and tonsils

Adenoids and tonsils are small lumps of tissue that help fight ear, nose and throat infections in younger children. Your adenoids lie where your throat meets the back of your nose. Your tonsils lie at the back of your throat, one on each side.

When you have a cold or a throat infection, your adenoids and tonsils may become infected and swell up, causing symptoms such as a blocked nose and a sore throat. They can block your airways, making it difficult for you to breathe, especially when you're asleep. This can cause problems such as snoring. In severe cases, swollen adenoids or tonsils can stop you breathing for a short time while you're asleep - this is called sleep apnoea.

Swollen adenoids can also block your Eustachian tube (the tube that connects the back of your throat to the middle part of your ear). This can lead to ear infections and a build-up of sticky fluid in your ear - called glue ear. This can make it difficult to hear properly and, as a result, can cause learning delays in children.

Adenoids and tonsils usually shrink in size after the age of three.

About adenoid and tonsil removal

Most operations to remove the tonsils are done in children, but adults can have it done too.

Inflammation of your tonsils is known as tonsillitis. It’s recommended that if you have had tonsillitis more than seven times in the last year, five times or more the year before and three or more times the year before that, your doctor may refer you to an ENT surgeon (a doctor who specialises in the surgical and medical treatment of conditions of the ear, nose and throat) to remove your tonsils.

Most operations to remove the adenoids are done in children.

Some children get swollen or enlarged adenoids usually from allergies, an infection or problems at birth. For most children, swollen or enlarged adenoids don’t cause any problems but for some it can cause severe discomfort. Your child may find it difficult to breathe through his or her nose, have difficulty sleeping or get problems with hearing.

An operation to remove your tonsils is called a tonsillectomy and an operation to remove your adenoids is called an adenoidectomy. An operation to remove both is called an adenotonsillectomy.

Having your tonsils removed can be a very effective treatment for recurrent and persistent tonsillitis. Likewise, having your adenoids removed is an effective treatment for recurrent ear infections and nasal blockage caused by enlarged adenoids. However, surgery isn't always needed for children as they often grow out of these problems.

What are the alternatives to having your adenoids and tonsils removed?

Painkillers and antibiotics provide temporary relief, but they aren't normally used for long-term treatment.

In children, the adenoids and tonsils shrink as they get older, so an operation isn't always necessary. If children have enlarged adenoids and these block the airways in their nose, treatment with medicines called steroids may relieve the problem. Ask your GP for more advice.

Preparing for your operation

If you have a cold or infection in the week before your operation, it's important to let the hospital know. The operation may need to be postponed until you have fully recovered.

Your surgeon will discuss with you what will happen before, during and after your operation, and any pain you might have. You can ask questions about the risks, benefits and if there are any alternatives to the procedure. This will enable you to give your informed consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

The operation is done under general anaesthesia. This means you will be asleep during the operation. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.

At the hospital, a nurse may check your heart rate and blood pressure, and test your urine.

About the operation

The operation usually takes about 30 minutes but this will depend on whether you're having your tonsils or adenoids removed, or both.

There are several methods available for removing your tonsils and adenoids including the following.

• Traditional method - your surgeon carefully cuts your tonsils and/or adenoids out using specialised instruments. He or she applies pressure to stop the bleeding, and dissolvable stitches or heat are used to seal the wound.
  
• Lasers or ultrasound waves - your surgeon uses high-energy waves to cut out your adenoids and/or tonsils and seal the blood vessels to stop bleeding.
  
• Diathermy - your surgeon uses heat from an electric current to cut out your adenoids and/or tonsils and seal the blood vessels.
  
• Power-assisted adenoidectomy - your surgeon uses a microdebrider (a powered instrument with a very small rotating tip) to remove your adenoids.

How an adenotonsillectomy is carried out

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What to expect afterwards

You will need to rest on your side until the effects of the anaesthetic have passed. Try to drink and eat as soon as you feel ready.

You will usually be able to go home when you feel ready, unless your surgeon feels you should stay overnight. Before you go home, a nurse will give you a date for a follow-up appointment.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

Recovering from adenoid and tonsil removal

You should rest for around a week and stay at home. Keep away from crowded and smoky places, and from people with coughs and colds.

You may have a sore throat, earache and a stiff jaw for the first week or two. Your surgeon may prescribe pain killers and antibiotics. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Try to drink enough fluids and eat normally. If it's uncomfortable to eat, it may help to take a painkiller (such as paracetamol) half an hour before meals. Don't take aspirin as it may make you bleed.

A white or yellowish membrane will appear as your skin heals where your tonsils were.

If you notice any bleeding from your throat or nose, contact your GP or hospital immediately.

A complete recovery can take two weeks.

What are the risks?

Operations to remove your adenoids and tonsils are commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the operation. Common side-effects include:

• a sore throat, earache and stiff jaw
  
• a blocked nose - this usually clears within a week or so
  
• a change in your voice - you may sound like you're talking through your nose, this can last a few weeks

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection.

Specific complications of operations to remove the adenoids and/or tonsils are rare but include

• bleeding after the operation
  
• damage to your teeth or jaw - this can be caused by the instruments used to keep your mouth open during surgery
  
• chest infection and breathing problems - there's a risk that blood and tissue from the operation may get into your throat and down into your lungs
  
• damage to the muscle in the roof of the mouth - this can cause a long-term change in your voice
  
• injury to your Eustachian tube

The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.