Adenoid and tonsil removal

Expert reviewer, Mr Anil Banerjee, Consultant Ear, Nose and Throat surgeon
Next review due December 2021

A tonsillectomy is a surgical procedure to remove your tonsils, which are small lumps of tissue that lie at the back of your throat. You may need to have your tonsils removed if you regularly get tonsillitis – a sore throat due to inflamed tonsils.

An adenoidectomy is a surgical procedure to remove your adenoids. Adenoids are small lumps of tissue that lie where your throat meets the back of your nose. If your adenoids are large, they can cause a blocked nose, mouth breathing, hearing problems, regular ear infections and sore throats. Removing your adenoids will help with these problems.

You’ll meet the surgeon carrying out your procedure to discuss your care. It may be different from what’s described here, as it will be designed to meet your individual needs.

This topic may be relevant to you as an adult or to your children but, for simplicity, we will refer to ‘you’ throughout.

Adenoids and tonsils

What are tonsils and adenoids?

Your tonsils and adenoids are part of your immune system, which helps to protect your body from infection. Your tonsils lie at the back of your throat, one on each side. Your adenoids lie where your throat meets the back of your nose.

An image showing the soft tissues of the mouth and throat

Tonsil and adenoid removal

Why have them removed?

The operation to remove your tonsils is called a tonsillectomy. If only your adenoids are removed, this is called an adenoidectomy. If both your tonsils and adenoids are removed, this is called an adenotonsillectomy.

Tonsil removal

Tonsil removal is one of the most commonly performed throat operations. Around two-thirds of tonsillectomies are in children.

If you keep having tonsillitis (a sore throat caused by inflamed tonsils), you may need to have your tonsils removed. Your GP may refer you to an ENT surgeon. An ENT surgeon 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 more than seven times in the last year
  • you’ve had tonsillitis five times or more in each of the last two years
  • you’ve had tonsillitis three or more times in each of the last three years
  • your sore throat is severe enough to stop you doing your usual activities
  • you’ve developed quinsy (a collection of pus that can develop alongside your tonsil)
  • your tonsils are very large and block your airways

Adenoid removal

Most operations to remove adenoids are done in children as the adenoids usually shrink during your teenage years.

Your child may be offered adenoids removal when they have grommets inserted for glue ear. Grommets are small plastic tubes that are put into the eardrum to equalise pressure in the ear and allow your child to hear properly. Having the operation may stop the glue ear coming back.

Adenoid and tonsil removal

If your child has big adenoids, they may develop a condition called obstructive sleep apnoea. This causes breathing problems at night when they sleep. If this happens, their surgeon may recommend adenoid and tonsil removal.

Preparing for adenoid and tonsil 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 the hospital know. Your operation may need to be delayed until you’ve fully recovered.

Your nurse will ask if you’re taking 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 already have gone through everything in detail before you get to the point where you go for your procedure. They’ll also have given you the opportunity to ask questions about the risks, benefits and alternatives to it. Once you get to hospital, they’ll 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 beforehand.

What are the alternatives to adenoid and tonsil removal?

If you have tonsillitis, your GP may recommend you take painkillers such as ibuprofen or paracetamol to ease your symptoms. Antibiotics aren’t usually recommended 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 improve without surgery.

Children’s adenoids and tonsils shrink as they get older, so an operation isn't always necessary. If your child gets only mild tonsillitis each time, you may want to wait and see if they grow out of the infections.

What happens during adenoid and tonsil removal?

How long the procedure takes will depend on whether you're having your tonsils or adenoids or both removed. Tonsil removal usually takes around half an hour. Adenoid removal takes around 10 minutes.

Your surgeon will usually remove your adenoids or tonsils 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. They 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.
  • Power-assisted adenoidectomy – your surgeon will use a microdebrider (a powered instrument with a very small rotating tip) to remove your tonsils or adenoids.

What to expect afterwards

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

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. 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 overnight.

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.

Recovering from adenoid and tonsil removal

Tonsillectomy recovery or recovering from an adenoidectomy will usually take around one to two weeks. You may feel tired for the first few days, so rest as much as you can. For the first couple of weeks, keep away from crowded, smoky places and from people with coughs and colds. How long it takes to recover varies from person to person, and will depend on the type of operation you had. Follow your surgeon’s advice.

You may feel uncomfortable for up to 10 days after your tonsils are removed. The pain may increase for a few days after the operation before gradually improving. You’ll need to take painkillers to help but don’t take aspirin as 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.

If your child has had their adenoids or tonsils removed, 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, contact your hospital immediately.

Side-effects of adenoid and tonsil removal

Side-effects are unwanted but mostly temporary effects you may get after having your tonsils or adenoids removed.

Common side-effects include:

  • feeling sick
  • pain – this may ease a bit before it get worse and then goes
  • earache and a stiff jaw or neck
  • a blocked nose after the 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

Complications of adenoid and tonsil removal

Complications are when problems occur during or after the procedure.

  • You may bleed within the first two weeks 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. It’s very rare, 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. Sometimes bleeding after surgery is a sign of an infection. If you have an infection, you’ll be given 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 become dehydrated and lose weight if pain stops you drinking and eating properly.
  • Sometimes surgery doesn’t remove your adenoids completely. This means they could grow back again.

Frequently asked questions

  • 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 eating and drinking will help your throat heal more quickly. It might help to take painkillers (such as paracetamol) half an hour before a meal as it should make it easier to swallow. Chewing gum may also help to ease the pain.

    In the first day or two, you may find it more comfortable to eat soft foods. For example, you can try:

    • ice cream
    • jelly
    • pasta
    • mashed potato
    • custard
    • yoghurt

    There are some foods and drinks you may want to steer clear of because they can sting or irritate your healing wound. These include:

    • very hot drinks
    • alcohol
    • spicy food
    • acidic drinks like orange or grapefruit juice

    You should be able to start eating normally after a day or two. This is important for your recovery and should include rough and crunchy foods like cereal, toast, biscuits and crisps. These help your wound heal by removing dead tissue.

    If your child has had their tonsils or adenoids out and it’s too painful to eat or drink normally, see your GP or surgeon. It’s important to get advice as they can become dehydrated or lose weight, which can make them ill.

  • If your child’s adenoids and tonsils are larger than average, this may affect how air flows through their airways and their voice may sound nasally.

    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 about two to four weeks.

    Your child’s voice may also sound higher pitched after their operation. This is because removing enlarged adenoids and tonsils allows for higher frequency sounds to pass through their airways, rather than being blocked.

    If you’re worried about changes to your child’s voice, contact their surgeon.

  • An adenotonsillectomy (removal of your adenoids and tonsils) is only recommended for adults if your snoring is definitely caused by large tonsils. It may help some children, but it depends on why they’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 block the flow of air.

    Unless adults have large tonsils, an adenotonsillectomy is unlikely to help their snoring. There may be more effective ways to resolve the problem. Lifestyle changes, such as losing excess weight, stopping smoking and sleeping on your side, may help. If you’re prone to a blocked nose, your doctor may be able to prescribe a decongestant or steroid nasal spray.

    Removing children’s tonsils and adenoids 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 adenoids and tonsils naturally shrink as they get older, so their snoring may improve on its own.

    If you are still having problems talk to your doctor for advice about other treatments. There could be other physical reasons for your snoring that your doctor can treat.

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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, December 2018
    Expert reviewer, Mr Anil Banerjee, Consultant Ear, Nose and Throat surgeon
    Next review due December 2021