Adenoids and tonsils
Your adenoids and tonsils are part of your immune system, which helps to protect your body from infection. 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.
Types of adenoid and tonsil removal
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 is one of the most commonly performed operations. Around six in every 10 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 between one of your tonsils and the wall of your throat)
- your tonsils are very large and block your airways – this is only in adults
Most operations to remove adenoids are done in children.
Your child may be offered adenoid removal when they have grommets (small plastic tubes inserted into the ear drum, which can equalise the pressure in the ear and allow your child to hear properly) inserted for glue ear. This may stop the glue ear coming back.
Your child may also be advised to have their adenoids removed to stop a blocked nose and sinus problems when they have a cold.
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. If this happens, their surgeon may recommend adenoid and tonsil removal.
Deciding on adenoid and tonsil removal
You and your doctor need to work together to decide whether adenoid and tonsil removal is right for you or your child. Knowing the pros and cons of the surgery will help you make a decision. Think about how important each particular issue is to you. Your decision will be based on your doctor’s expert opinion and your own values and preferences.
- Having your tonsils removed can treat tonsillitis that keeps coming back.
- If your child has breathing problems linked to obstructive sleep apnoea, having their adenoids and tonsils removed may reduce their symptoms.
- Having adenoids removed at the same time as having grommets inserted for glue ear may prevent glue ear.
- You’ll need to be off work, or your child will need to be away from school, for up to two weeks.
- You’ll feel some pain and may need painkillers for up to 10 days after the operation, especially with tonsil removal.
- There’s a small chance that you’ll have bleeding after your tonsils are removed. You may need a second operation to stop this.
- Your child’s adenoids and tonsils shrink as they get older, so they may not need the operation.
- Your surgeon may not be able to remove your adenoid tissues completely. This means your adenoids may grow back and cause symptoms again (but this is very unlikely).
Preparing for adenoid and tonsil removal
Your nurse or surgeon will explain how to prepare for your procedure. If you have any infections 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.
You’ll be asked about any medicines you’re taking, such as aspirin, and you may need to stop these before your operation. You’ll also be asked whether you, or your child, have any allergies.
You’ll have the operation under general anaesthesia, which means you’ll be asleep during it. You’ll be asked to follow fasting instructions. This means not eating, usually for about six hours, beforehand. You may be able to drink water up to two hours before your operation, but it’s important to follow your anaesthetist’s advice.
Your nurse or surgeon will discuss with you what will happen before, during and after your procedure, including any pain you might have. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you feel happy to give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.
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, as they don’t ease tonsillitis symptoms or clear up the infection more quickly. But your GP may offer them in certain situations, such as if you have a raised temperature.
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 removed, or both. Tonsil removal usually takes around 30 minutes. Adenoid removal takes only around 10 minutes.
You or your child may have your tonsils and/or adenoids removed by one of the following methods.
- Traditional method – your surgeon will carefully cut out your tonsils and/or adenoids using special instruments. They 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. 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 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 for a day or so while the anaesthetic wears off.
Having a general anaesthesic 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
It’ll usually take you a week or two to recover fully from your operation. But this varies from person to person, so it's important to follow your surgeon's advice. You may feel tired for the first few days, so rest as much as you can. Keep away from crowded and smoky places and from people with coughs and colds.
You may feel uncomfortable for up to 10 days after your tonsils are removed. The pain may get worse for up to six days after your operation. Your surgeon may prescribe you painkillers, as well as anti-emetics (medicines to stop you feeling sick). 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 as soon as you can. Eating normally will help your throat to heal. If it's uncomfortable to eat, you may find it helps to take a painkiller (such as paracetamol) half an hour before meals. Don't take aspirin as this may cause bleeding.
If your child has had their adenoids or tonsils removed, see our FAQs for more information about when they can eat and drink after surgery.
Your throat may look white as your skin heals. If you notice any bleeding from your throat or nose, contact your hospital immediately.
Side-effects of adenoid and tonsil removal
After your surgery, you may have some side-effects, which should be mostly temporary. If you experience any side-effects, it’s important to discuss these with your surgeon.
Common side-effects include:
- feeling sick
- pain – which may increase after a few days then ease off
- earache and a stiff jaw or neck
- a blocked nose – 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 more serious, unexpected problems occur during or after your 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 or jaw 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 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.
- Sometimes surgery doesn’t remove your adenoids completely, which means they could grow back again.
FAQ: Will an adenotonsillectomy stop my snoring?
An adenotonsillectomy (removal of your adenoids and tonsils) is only recommended for adults if their 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, as 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 corticosteroid 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 these don’t work, talk to your doctor for advice about other treatments. There could be other physical reasons for your snoring that your doctor can treat. See our topic on snoring for more information about causes and treatments.
FAQ: How soon can my child eat after surgery?
As soon as your child is alert after surgery, they can have some sips of cold water. They should try to eat something as soon as they can. Their throat is likely to hurt, but eating and drinking will help their throat heal more quickly. Giving your child painkillers (such as paracetamol) half an hour before meals should make it easier for them to swallow. Chewing gum may also help to ease the pain.
To start with, your child may find it more comfortable to eat ice cream and jelly. As the pain subsides, you can introduce some soft foods. Start with bland food for a few days because spicy foods may irritate your child's healing wound.
Speak to your GP or surgeon if your child is in too much pain to eat or drink normally. Otherwise, they can become dehydrated or lose weight, which can make them ill.
FAQ: Will surgery affect my child's voice?
If your child’s adenoids and tonsils are too big, this may affect how air flows through their airways and their voice may sound nasal.
Straight after their adenoids are removed, your child may still sound as if they’re talking through their nose. This affects one in every two children. It’s more common in children who have their tonsils and adenoids removed at the same time. The nasal sound should go within 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.
- ENT UK
0207 404 8373
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- ENT UK
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