Tonsillectomy in adults: when it is advised, what happens and the realities of recovery

Most tonsillitis is viral and clears by itself. The NHS says symptoms usually go away after 3 to 4 days but can last longer, and that tonsil removal is very rare, considered only when tonsillitis is severe and keeps coming back. Antibiotics help only the bacterial cases.

A trust leaflet describes surgery as aimed at recurrent tonsillitis with enlarged tonsils, difficulty eating and sometimes breathing. Other reasons a surgeon may recommend removal include repeated abscess beside the tonsil, snoring and sleep apnoea caused by large tonsils, and tonsils that look suspicious for cancer. Standard referral criteria usually look at how many proven attacks you have had and how much they affect work or life, so a diary of episodes is useful at your GP appointment.

Watchful waiting is a real option, because the frequency of attacks often falls with time. Treating each infection promptly, with rest, fluids, paracetamol or ibuprofen and salt-water gargles, is the NHS approach to most episodes. The NHS advises seeing a GP if symptoms last beyond a week or recur often.

Less common alternatives include draining an abscess if one forms, or reducing tonsil tissue rather than removing it. Surgery brings a real risk of a painful recovery and bleeding, so the decision should weigh how disruptive the infections are against that.

You will usually attend a pre-assessment visit, where your health and medicines are reviewed. Tell the team about aspirin, anticoagulants, bleeding tendencies and any allergy. Tonsillitis within a few weeks of surgery may mean a postponement, so tell them if you have one.

Plan the recovery. Leaflets advise at least two weeks off work, so arrange cover. Stock up on soft, cool foods, and have paracetamol and ibuprofen at home, since you are advised to take regular pain relief. Arrange for someone to stay with you for the first night, and know where your nearest A&E is.

You are admitted on the day, fasted according to your letter, and you meet the surgeon and anaesthetist. A general anaesthetic is used and you are asleep. The surgeon removes each tonsil through the mouth, with no cut on the skin, and controls bleeding using stitches, heat or pressure. The operation itself is brief, although the leaflets do not give a single time.

You wake in recovery with a sore throat and are given a drink once you are alert. A trust leaflet says you spend at least six hours on the ward and go home that day if you are well, while another describes discharge the same day or the next morning. Pain relief is given before you leave.

Leaflets stress taking regular painkillers for the first seven days, even if you feel fine, because pain peaks around days three to six and can last up to two weeks. Earache is common because nerves are shared, and it is described as normal. A white or yellowish coating forms where the tonsils were; a trust leaflet calls it a normal and healthy appearance, not an infection.

Eat and drink normally as soon as possible. Leaflets say a normal diet helps by keeping the throat clear, with less chance of infection and bleeding. Crunchy food such as toast and cornflakes is suggested, with cold drinks and ice lollies for relief, while fizzy, acidic, very hot and spicy foods are best avoided early on. Avoid smoking and alcohol for two weeks, according to one trust, and avoid strenuous exercise for about two weeks.

Pain, difficulty eating, earache, nausea, and temporary changes in taste or voice are common. Bleeding is the main serious risk. It can happen in the first day, but more often appears between about days three and ten as the coating separates, and leaflets say up to two weeks. It is more likely if you are not eating and drinking, which is why eating matters.

Reactions to the anaesthetic, infection, and rarely damage to teeth or the lips are other risks. A trust leaflet describes post-operative bleeding as unusual but possible and does not give a percentage; adult figures appear in some other sources but we have not quoted any here.

Any fresh bright red bleeding after tonsillectomy should be treated as urgent. Go to the nearest A&E, or call 999 if it is heavy or you feel faint. One leaflet says to contact the ward if you spit out more than a tablespoon of fresh blood or clots. Also seek help for a high temperature, a foul smell with increasing pain, or if you cannot swallow fluids.

Questions to ask: Do I meet the criteria for NHS surgery? What technique will be used? Which hospital will treat bleeding if it happens at night? How much time off do I need? Private surgery is the same operation and may be available sooner; check that an emergency bleed would be managed locally and ask how readmission is covered.