Adult tonsillectomy: when it is recommended, what it involves and recovery

The tonsils are two small glands at the sides of the throat. NHS inform explains that in young children they help fight germs, and that as the immune system matures they become less important and usually get smaller. In most people the body is able to fight infection without them, and a Dorset County Hospital leaflet says removing the tonsils does not seem to affect the ability to combat infection.

A tonsillectomy removes the tonsils through the mouth, so there is no cut or scar on the outside of the neck. A Luton and Dunstable leaflet says bleeding is stopped by sealing the small blood vessels with heat or tying them off with threads that fall off by themselves.

The NHS says tonsillitis usually gets better on its own and that surgery is only considered for severe tonsillitis that keeps coming back. NHS inform adds that a tonsillectomy is usually only recommended if you have had several severe episodes over a long period of time, or if repeated episodes are disrupting normal activities.

The Dorset County Hospital leaflet gives an example of the thresholds that some units use: evidence of seven attacks in a year, five attacks a year for two years, or three attacks a year for three years. These figures come from one hospital leaflet and local criteria vary, so your own ENT team will explain what applies in your area.

The same leaflet lists other reasons for removal: a quinsy (an abscess next to the tonsil) in some cases, and some skin or kidney conditions that are worsened by tonsil infections. Quinsy is described by the NHS as a rare complication of tonsillitis that needs emergency attention.

Surgery is not the only choice. The Dorset leaflet says you may want to wait and see if the tonsil problem gets better by itself over time, that antibiotics may help for a while but frequent doses can cause other problems, and that a low dose of antibiotic for a number of months may help to keep infections away during particularly important times. It also says there is no evidence that alternative treatments such as homeopathy and cranial osteopathy help tonsil problems.

The NHS and NHS inform both suggest that most tonsillitis is viral, clears up with rest, fluids and paracetamol or ibuprofen, and does not need antibiotics. If a throat swab shows a bacterial infection, a GP may prescribe antibiotics. Keeping a diary of dates, severity, time off work and treatment can make a referral discussion much clearer.

The Dorset leaflet says admission is on the day of the operation, many operations are done as day cases and you will be seen by nursing staff, the anaesthetist and the surgeon. The operation is performed under a full general anaesthetic and takes about 30 minutes or so. Afterwards you go through to the recovery area and then the ward, where observations continue for a few hours.

The same leaflet says you need to remain on the ward for a minimum of 6 hours and that going home depends on how well you are, how far away you live and transport. It also explains that the operation may be cancelled if you have a raised temperature, a sore throat or an infection in the week before surgery, and that you should say if you have any bruising or bleeding problems, or a family history of them.

The Luton and Dunstable leaflet says the sore throat may last up to 2 weeks and can be very painful, the pain may be felt in the ears and it may be at its worst between days 3 and 7. The Dorset leaflet says the throat would normally be fully healed by about two weeks. A white or yellowish coating where the tonsils used to be is a normal and healthy appearance rather than a sign of infection.

• Take regular painkillers such as paracetamol and ibuprofen as directed, because staying on top of the pain helps you keep eating and drinking. Do not use aspirin, which can increase the risk of bleeding.

• Return to a normal diet as soon as possible. The leaflet says this helps keep the mouth and throat clear of infection and lowers the chance of bleeding. Cold drinks and ice lollies can soothe, while hot and spicy foods may irritate.

• Avoid smoking and alcohol for two weeks.

• Stay away from people with coughs or colds and from crowded, smoky places.

• Expect to take about 2 weeks off work and to avoid exercise and swimming for the same period.

• Stay within 45 minutes of an A&E department, as the Luton and Dunstable leaflet advises, and avoid driving for the first 24 hours.

The Dorset leaflet says the most serious problem is bleeding. About 1 in every 200 patients will have bleeding in the first few hours after surgery and need to return to theatre, and about 5 in every 100 will have some bleeding after going home, mostly towards the end of the first week and always by two weeks. About 1 in 100 will have to go back to theatre to have the bleeding spot sealed.

Other effects include nausea and vomiting in the first few hours, earache because the nerves to the throat also supply the middle ear, a throat infection if eating and drinking has been poor, temporary changes in taste or voice, and damage to teeth, gums or lips from the instruments used to hold the mouth open. The Luton and Dunstable leaflet says taste and voice changes tend to resolve over time.

The Luton and Dunstable leaflet says a small, self-limiting bleed may come before a larger one, so medical attention should be sought after any episode of fresh bright red bleeding, by returning to your nearest A&E department. Signs of infection, including fever, bleeding or a sudden increase in pain, mean you should attend A&E or contact your GP. If the pain is so bad that you cannot eat and drink despite regular painkillers, return to hospital for support with hydration. The signs of dehydration it lists include a dry mouth, passing less urine, dark urine, sunken eyes and tiredness.

In an emergency, such as heavy or continuous bleeding or difficulty breathing, call 999 rather than travelling yourself.