When tonsillectomy is recommended
- Recurrent tonsillitis: frequent, well-documented episodes, typically 7 or more in a year, 5 a year for 2 years, or 3 a year for 3 years, affecting school or work.
- Obstructive sleep apnoea: snoring, pauses in breathing and disturbed sleep caused by large tonsils, especially in children; see child snoring.
- Peritonsillar abscess (quinsy): particularly if it recurs.
- Tonsil stones: persistent bad breath or discomfort not helped by other measures; see tonsil stones.
- Suspected tumour: a one-sided enlarged tonsil in adults.
Watchful waiting vs surgery
Many children grow out of frequent tonsillitis, and the number of episodes often decreases with age. Guidelines therefore recommend watchful waiting unless the episodes meet set criteria or there are complications. For sleep apnoea, surgery is often the first-line treatment in children, because poor sleep affects behaviour, learning and growth.
The decision is made with an ENT specialist, considering how often infections occur, how severe they are and their impact on daily life.
The operation
- Done under general anaesthetic, through the mouth, with no external cuts.
- Takes about 20 to 45 minutes.
- Tonsils are removed fully (tonsillectomy) or, in some children with sleep apnoea, partially (tonsillotomy), which may reduce pain.
- Often combined with adenoid removal in children; see adenoid removal.
- Most patients go home the same day or the next day.
Recovery day by day
- Days 1 to 2: sore throat, tiredness and sometimes nausea from the anaesthetic.
- Days 3 to 7: pain often worsens and may be felt in the ears; white or yellow patches (healing scabs) appear in the throat, and bad breath is common.
- Days 7 to 10: scabs come away; this is the time of highest bleeding risk.
- Days 10 to 14: pain eases and most people return to school or work.
Adults generally find recovery more painful and slower than children.
Pain relief
Take painkillers regularly, as prescribed, rather than waiting for pain to become severe. Paracetamol and ibuprofen are commonly used in combination. Taking a dose about 30 minutes before meals makes eating easier. Ear pain is common and is referred from the throat, not an ear infection.
Codeine is not used in children because of the risk of serious side effects.
Eating and drinking after tonsillectomy
- Drink plenty of fluids; dehydration increases pain and the risk of bleeding.
- Return to normal food as soon as possible; chewing helps healing and keeps the throat clean.
- Soft and cool foods may be easier at first: yoghurt, ice cream, pasta, scrambled eggs, soup that is not hot.
- Avoid very hot, spicy, acidic or sharp foods for the first days.
- Chewing gum can help with swallowing and ear pain.
Bleeding: what to do
Bleeding after tonsillectomy happens in a small percentage of people, most often 5 to 10 days after surgery when the scabs separate. Any bleeding, even a small amount of fresh blood or spitting blood, should be taken seriously.
Go to the nearest emergency department or call emergency services immediately. Sit up, lean forward and spit out blood rather than swallowing it. Small sips of cold water may help while seeking help.
Other risks
- Infection of the tonsil bed, with fever and worsening pain.
- Dehydration from not drinking enough.
- Temporary changes in voice or taste.
- Damage to teeth, lips or gums from instruments, uncommon.
- Risks of general anaesthetic, which are low in healthy people.
Returning to normal activities
- Most people need about 2 weeks off school or work.
- Avoid crowds and people with infections during recovery.
- Avoid strenuous exercise and contact sport for 2 weeks.
- Avoid travelling far from medical help, including flying, for 2 weeks after surgery.
Life after tonsillectomy
Most people have fewer sore throats and better sleep after surgery. You can still get throat infections such as pharyngitis, but recurrent tonsillitis stops. Children with sleep apnoea often show improvements in behaviour, concentration and sleep. Removing the tonsils does not meaningfully weaken the immune system.
When to seek urgent help
- Any bleeding from the mouth or nose, or vomiting blood.
- Inability to drink, or signs of dehydration such as very little urine.
- High fever.
- Severe pain not controlled by regular painkillers.
- Difficulty breathing.
Key points to remember
- Tonsillectomy is recommended for frequent tonsillitis meeting set criteria or sleep apnoea.
- Recovery takes about 10 to 14 days, with pain peaking around days 3 to 7.
- Regular painkillers, plenty of fluids and normal eating help.
- Any bleeding needs urgent medical attention.
Questions about tonsillectomy
These answers are general information and do not replace an examination or individual medical advice.
How long is recovery after tonsillectomy?
About 10 to 14 days; adults often take a little longer than children.
Is tonsillectomy painful for adults?
Yes, adults usually have more pain than children. Regular painkillers help.
When can I eat normally after tonsillectomy?
As soon as possible. Normal food helps healing.
Why does my ear hurt after tonsil removal?
Pain from the throat is referred to the ear through shared nerves.
What are the white patches after tonsillectomy?
Normal healing scabs, which come away after about a week.
Can tonsils grow back after removal?
Rarely, small amounts of tissue can regrow.
How many tonsillitis episodes do I need for surgery?
Typically 7 in a year, 5 a year for 2 years or 3 a year for 3 years.
Sources
- Mitchell RB et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg. 2019
- NHS · Tonsillitis
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.