Tonsil and adenoid removal
Your health expert: Mr Anil Banerjee, Ear, Nose and Throat Consultant
Content editor review by Rachael Mayfield-Blake, March 2021
Next review due March 2024
A tonsillectomy is an operation to remove your tonsils, which are small round lumps of tissue at the back of your throat. An adenoidectomy is a procedure to remove your adenoids, which are small lumps of tissue that lie where your throat meets the back of your nose. If you have both your tonsils and adenoids removed, this is called an adenotonsillectomy.
This topic may be relevant to you as an adult or to your children but, for simplicity, we will refer to ‘you’ throughout.
How an adenotonsillectomy is carried out
Adenotonsillectomy | Watch in 2:47 minutes
This animation shows how adenotonsillectomy is carried out. It is a procudure to remove your tonis and adenoids. Having your tonsils and adenoids removed can be an effective treatment for recurrent tonsillitis, ear infections and nasal blockages.
What are tonsils and adenoids?
Your tonsils and adenoids are part of your immune system, which helps your body to fight infections.
Tonsil removal
Tonsil removal (tonsillectomy) is one of the most common throat operations. Around two-thirds of tonsillectomies are in children. If you keep getting tonsillitis (a sore throat caused by inflamed tonsils), your GP may refer you to an ear nose and throat (ENT) surgeon. This is a doctor who specialises in identifying and treating conditions of your ear, nose and throat.
You may need to have your tonsils removed if you’ve had tonsillitis:
- regularly and/or it affects your breathing
- more than seven times in the last year
- five times or more in each of the last two years
- three or more times in each of the last three years
- that is so severe it stops you doing your usual activities
Your doctor may also recommend a tonsillectomy if you’ve had an abscess on your tonsil (a peritonsillar abscess or quinsy). This can be a complication of tonsillitis.
Adenoid removal
If your adenoids are large, they can cause:
- a blocked nose
- mouth breathing
- hearing problems
- regular ear infections
- problems sleeping
An operation to remove your adenoids will help with these problems. Most operations are done in children because your adenoids usually shrink when you’re a teenager.
Tonsil and adenoid removal
If you have big adenoids, you may develop a condition called obstructive sleep apnoea. This can cause breathing problems at night when you sleep. If this happens, your surgeon may recommend you have both your adenoids and tonsils removed.
Preparation for tonsil and adenoid removal
Your nurse or surgeon will explain how to prepare for your procedure. If you get an infection such as a cold or chest infection in the week before your operation, it's important to let your hospital know. You may need to delay your operation until you’ve recovered.
Your nurse will ask if you take any medicines such as aspirin. You may need to stop these before your operation. Your nurse will also ask if you have any allergies.
You’ll have the operation under general anaesthesia, which means you’ll be asleep during it. A general anaesthetic can make you sick, so it’s important that you don’t eat or drink anything for six hours before your procedure. Follow your anaesthetist’s advice and if you have any questions, just ask.
Your doctor will go over what will happen before, during and after your procedure, and any pain you might have. You should have all the information you need to give your consent for the procedure to go ahead. You’ll be asked to sign a consent form.
Tonsil and adenoid removal
How long the procedure takes will depend on whether you're having your tonsils or adenoids or both removed. It usually takes around half an hour to take your tonsils out and around 10 minutes to remove your adenoids.
Your surgeon will usually remove your tonsils or adenoids using one of the following methods.
- Traditional method – your surgeon will carefully cut out your tonsils and/or adenoids using surgical instruments. They’ll 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.
- A procedure similar to diathermy, called coblation, uses lower temperatures to remove your adenoids and/or tonsils.
- Power-assisted – your surgeon will use a microdebrider (a powered instrument with a very small rotating tip) to remove your tonsils or adenoids.
Aftercare for tonsil and adenoid removal
You’ll need to rest until the effects of the anaesthetic have worn off. You may need pain relief to ease any discomfort as the anaesthetic wears off. You’ll usually be able to go home when you feel ready, unless your surgeon recommends you stay overnight.
Make sure someone can take you home, and also ask someone to stay with you overnight. Try to drink and eat as soon as you feel ready.
Having a general anaesthetic affects everyone differently. You may find that you’re not so co-ordinated or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important. Always follow your surgeon’s advice.
If your surgeon used dissolvable stitches, they’ll disappear within about two weeks. If you have any questions about your stitches, ask your surgeon for more information.
Recovery from tonsil and adenoid removal
It will usually take around two weeks to recover from a tonsillectomy and a week to recover from an adenoidectomy. But this can vary, so ask your surgeon what to expect. You may feel tired for the first few days, so get plenty of rest. For the first couple of weeks, keep away from crowded, smoky places and from people with coughs and colds.
Your throat may feel sore for around 10 days after your tonsils are removed. The pain may get worse for a few days after the operation, before it gradually gets better. You’ll need to take painkillers to help but don’t take aspirin because it may cause problems with bleeding. Always ask your doctor or pharmacist for advice and read the patient information leaflet that comes with your medicine.
Try to drink and eat something as soon as you can. You could start with something soft like ice cream and jelly and then start to eat normal food as soon as possible. Eating normally will help your throat to heal. If it's uncomfortable to eat, you may find it helps to take a painkiller half an hour before a meal. Chewing gum may also help to ease the pain. For more information, see our FAQ: What can I eat after a tonsillectomy?
Your throat may look white as your skin heals and you might see some small threads in your throat – these will fall out by themselves. If you notice any bleeding from your throat, have a fever or a bad smell from your throat, contact your hospital immediately.
Side-effects of having tonsils and adenoids removed
Side-effects are unwanted but mostly temporary effects you may get after having your tonsils or adenoids removed.
Common side-effects of tonsil and adenoid removal include:
- feeling sick
- pain – this may ease a bit before it gets worse and then goes
- earache and a stiff jaw or neck
- a blocked nose after adenoids are removed – this usually clears within a week or so
- problems swallowing
- a change in your voice – your voice may sound muffled or as if you’re talking through your nose
- a change in your taste – this usually gets better with time but can sometimes take six months
Complications of having tonsils and adenoids removed
Complications are when problems occur during or after the procedure.
- You may bleed after the operation. During surgery, your surgeon will close your blood vessels with stitches or heat. If you’re still bleeding, they may give you some medicine to help stop it but you may need a second operation to stop the bleeding.
- Your teeth may be damaged. This can be caused by the devices that keep your mouth open during surgery. It’s more likely to happen if one of your teeth is loose, capped or crowned.
- You may develop an infection where your tonsils and/or adenoids were removed. If you have an infection, you may need to take antibiotics.
- You may have problems breathing because of swelling in your throat or because you inhale blood or bits of tissue during the operation.
- You may get dehydrated and lose weight if you can’t drink and eat properly because your throat is painful.
- Although uncommon, it’s possible that your adenoids could grow back again.
- Although very rare, fluid may leak through your nose when you have a drink. This usually only happens if you have a weakness in the back of your throat. Your doctor will check this before you have surgery. Even if this does happen, it usually gets better by itself.
Alternatives to tonsil and adenoid removal
If you have tonsillitis, there are other treatments besides surgery that you can try. Your GP may recommend you take painkillers such as ibuprofen or paracetamol to ease your symptoms. Your GP won’t usually recommend antibiotics because, for most people, they don’t ease tonsillitis symptoms or help clear up the infection more quickly. But your GP may offer them in certain situations.
Your surgeon may suggest you wait for six months to see if your symptoms get better without surgery.
Children’s tonsils and adenoids shrink as they get older, so an operation isn't always necessary in children. If your child gets only mild tonsillitis each time, you may want to wait and see if they grow out of the infections.
As soon as you’re alert after surgery, have some sips of cold water. It’s important to try to eat something as soon as you can and to drink plenty of fluids. Your throat is likely to hurt but if you eat and drink, it will help your throat to heal more quickly.
In the first day or two, you may find it more comfortable to eat soft foods, such as:
- ice cream
- jelly
- pasta
- mashed potato
- custard
- yoghurt
There are some things you may want to steer clear of because they can sting or irritate your throat. These include:
- very hot drinks
- alcohol
- spicy food
- acidic drinks like orange or grapefruit juice
You should be able to start to eat normally after a day or two. This is an important part of your recovery and should include rough and crunchy foods like cereal, toast, bread, biscuits and crisps, which often soften as you chew them. These help your throat heal by removing dead tissue.
If your child has had the surgery and finds it too painful to eat or drink normally, see your GP or surgeon. It’s important to get advice because children can become dehydrated or lose weight, which can make them ill.
If your child’s tonsils and adenoids are larger than average, this can affect how air flows through their airways and their voice may sound nasal. Immediately after their adenoids are removed, your child may still sound as if they’re talking through their nose. The nasal sound should go within a few weeks.
Your child’s voice may also sound more highly pitched after their operation. When enlarged tonsils and adenoids are removed, it allows higher frequency sounds to pass through their airways, rather than being blocked. This should go back to normal after two to four weeks but your child may need further treatment if doesn’t.
If you’re worried about changes to your child’s voice, contact their surgeon.
An adenotonsillectomy (removal of your tonsils and adenoids) may help, but it depends on why you’re snoring.
You snore when the soft tissues in your mouth, nose and throat vibrate while you’re asleep. When you’re asleep, your muscles relax, and this affects how the air flows through your airways. You’re most likely to snore if you have large tonsils and adenoids because these can block the flow of air.
Unless you have large tonsils, an adenotonsillectomy is unlikely to help you stop snoring. There may be better ways to solve the problem.
If your child’s tonsils and adenoids are removed, it may help their snoring. But surgery is usually only recommended if they also have obstructive sleep apnoea or tonsillitis that keeps coming back. Children’s tonsils and adenoids shrink as they get older, so their snoring may improve on its own.
Acute middle ear infection in children
If you’re a parent you’ll probably know that middle ear infections are common in children, and unfortunately they’re often painful.
Tonsillitis
Tonsillitis is inflammation of your tonsils, usually as a result of an infection. The infection may be viral or, less commonly, bacterial.
Over-the-counter painkillers
Glue ear
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