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Adenoid and tonsil removal

Key points

  • Adenoid and tonsil removal (adenotonsillectomy) are procedures for removing small lumps of tissue at the back of your nose and throat.
  • They are very commonly performed operations. They can be done separately or both your tonsils and adenoids may be removed at the same time.
  • The main reason for having your tonsils removed is because you keep getting tonsillitis (inflammation of your tonsils).
  • It’s usually children who have their adenoids removed – this can help with breathing problems.
     

Animation: how an adenotonsillectomy is carried out

Adenoid and tonsil removal are procedures for removing small lumps of tissue at the back of your nose and throat. 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.

You will meet the surgeon carrying out your operation to talk about your operation and following care. It may be different from what we’ve described here because it will be designed to meet your individual needs.

About adenoid and tonsil removal

Adenoids and tonsils are part of your immune system. They help fight ear, nose and throat infections especially in young 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.

Illustration showing the location of the adenoids and tonsils

Tonsil removal

Tonsil removal is one of the most commonly performed surgical operations. Around six in every 10 tonsillectomies are in children.

The main reason for removing your tonsils is because you keep having tonsillitis (inflammation of your tonsils). This causes a sore throat. In certain circumstances, your GP may refer you to an ENT surgeon (a doctor who specialises in identifying and treating conditions of the ear, nose and throat). He or she may offer you tonsil removal. This is most likely to happen in the following situations.

  • You have had tonsillitis more than seven times in the last year.
  • You have had tonsillitis five times or more in each of the last two years.
  • You have had tonsillitis three or more times in each of the last three years.
  • Your sore throat is severe enough to be disabling to you.
  • You have developed a quinsy (a collection of pus between a tonsil and the wall of your throat).

Having your tonsils removed as an adult can be an effective treatment for recurrent and persistent tonsillitis.

Adenoid removal

Most operations to remove adenoids are done in children.

Your child may be offered adenoid removal at the same time as having grommets inserted for glue ear. There is some evidence that this might improve your child’s hearing a little. However, it’s not clear whether the benefits of the procedure are enough to make it worthwhile.

There is no good evidence to show that adenoid removal will help if your child is having recurrent ear infections.

If your child has enlarged adenoids and tonsils, he or she may develop a condition called obstructive sleep apnoea – this causes breathing problems at night. If this happens, your surgeon may recommend adenoid and tonsil removal.

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

If you have tonsillitis, your GP may recommend painkillers such as ibuprofen or paracetamol. Antibiotics aren’t usually recommended to relieve the symptoms of tonsillitis. Your GP may offer antibiotics in certain situations, for example, if you have a raised temperature or swollen glands in your neck.

Children’s adenoids and tonsils shrink as they get older, so an operation isn't always necessary. You may want to wait and see if the problem sorts itself out in time. Discuss the pros and cons of these procedures with your GP before making a decision.

Preparing for adenoid and tonsil removal

Your surgeon will explain how to prepare for your procedure. 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.

You will have the operation 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 anaesthetist’s advice.

Your surgeon will discuss with you what will happen before, during and after your operation, and any pain you might have. If you have any questions at this stage, ask your surgeon – no question is too small and can help set your mind at ease. To confirm your consent for the procedure, you may be asked to sign a consent form.

What happens during adenoid and tonsil removal?

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

There are several different methods to remove tonsils and adenoids, which include the following.

  • Traditional method – your surgeon will carefully cut your tonsils and/or adenoids out using special instruments. He or she will apply pressure to stop the bleeding, and use dissolvable stitches or heat to seal the wound.
  • Diathermy – your surgeon will use heat from an electric current to cut out your adenoids and/or tonsils. He or she may gently suck the tissue out with a special instrument and will seal the blood vessels. A similar procedure, called coblation, uses lower temperatures to remove your adenoids and/or tonsils.
  • Lasers or ultrasound waves – your surgeon will use high-energy waves to cut out your adenoids and/or tonsils and will seal the blood vessels to stop any bleeding.
  • Power-assisted adenoidectomy – your surgeon will use a microdebrider (a powered instrument with a very small rotating tip) to remove your adenoids.

Animation: how an adenotonsillectomy is carried out

What to expect afterwards

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

You may need pain relief to help with any discomfort as the anaesthetic wears off. You will usually be able to go home when you feel ready, unless your surgeon recommends that you stay overnight. Before you go home, a nurse will give you a date for a follow-up appointment.

Make sure someone can take you home. And ask someone to stay with you for a day or so while the anaesthetic wears off.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you mustn’t drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.

If your surgeon used dissolvable stitches, the amount of time they will take to disappear depends on the type of stitches you have. Ask your surgeon for more information about when you can expect them to disappear.

Recovering from adenoid and tonsil removal

It usually takes about a week or two to make a full recovery from adenoid or tonsil removal. However, this varies between individuals, so it's important to follow your surgeon's advice. Rest for this time and stay at home. Keep away from crowded and smoky places, and from people with coughs and colds.

You may find that you feel discomfort for up to a week to 10 days after your tonsil removal. It’s not unusual for your pain to increase for up to six days after the operation. If you need pain relief you can take over-the-counter painkillers such as paracetamol or ibuprofen. Your surgeon may prescribe you stronger painkillers, as well as antiemetics (medicines that help stop you feeling sick). There’s no strong evidence that antibiotics will benefit you after tonsil removal. Always ask your doctor or pharmacist for advice and read the patient information leaflet that comes with your medicine.

Try to drink enough fluids and eat normally. Eating normally will help your throat to heal. 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 cause bleeding. See our FAQs for more information about eating and drinking.

Your throat may look white as your skin heals. If you notice any bleeding from your throat or nose, contact your GP or hospital immediately.

What are the risks?

As with every procedure, there are some risks associated with having your adenoids and tonsils removed. We haven’t said how likely these are to happen as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

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

  • feeling sick
  • pain – which may increase after a few days then ease
  • earache and stiff jaw or neck
  • 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 for around two to four 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 or an infection. Specific complications of operations to remove the adenoids and/or tonsils are uncommon. They include the following.

  • You may bleed after the operation and this may need a second operation to stop it. This is more likely to happen after tonsil removal.
  • Your teeth or jaw may be damaged. This can be caused by the instruments that are used to keep your mouth open during surgery.
  • You may develop an infection where your tonsil and/or adenoid tissues were removed.
  • You may have breathing problems because of swelling in your throat, or because you inhale blood or bits of tissue during the operation.
  • You may become dehydrated and lose weight if pain stops you drinking and eating properly.
  • Your surgeon may not be able to remove your adenoid tissues completely. This means that it’s possible for your adenoids to grow back and cause symptoms again (but this is very unlikely).

Reviewed by Natalie Heaton, Bupa Health Information Team, July 2014.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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