ABOUT THE CONDITION
What are tonsils?
Tonsils are small glands that sit at the back of your throat. You have two tonsils, one on the left side and one on the right side.
Normal tonsils
Each tonsil is about the size of a grape. Tonsils are part of the body’s system for fighting infection and are important when you are a child. As you get older the tonsils become less important in fighting germs and usually shrink. Your body can still fight infections without your tonsils.
Picture 1: normal tonsils
What is tonsillitis?
Tonsillitis is an infection or inflammation of the tonsils. Tonsillitis is caused by a viral or bacterial infection in the throat.
How might tonsillitis affect me?
Tonsillitis causes a fever, sore throat, smelly breath, difficulty swallowing, painful swallowing and tender glands in the neck. When your tonsils are swollen, you may breathe through your mouth, snore and have pauses in breathing while you are sleeping. Tonsillitis can make you feel very tired and unwell. These symptoms usually get better after three to four days but can last up to two weeks.
Tonsillitis is very common and most people can be treated with painkillers and rest. Some patients may also need antibiotics.
When you have tonsillitis, the tonsils usually look red and swollen. They may have white spots or pus that covers them partially or completely.
Picture 2: infected tonsils
Sore throats caused by viruses are very common and most people can be treated with painkillers and rest. But if you have tonsillitis caused by a bacterial infection, you may also need antibiotics.
Sometimes a collection of pus can develop next to the infected tonsil. This is called a quinsy, and can cause a very severe sore throat, high temperature, difficulty breathing and difficulty opening your mouth.
If you have a quinsy, this will need to be drained, usually under local anaesthetic, and you will need to take painkillers and antibiotics.
ABOUT THE PROCEDURE
Why has a tonsillectomy been recommended for me?
The operation to remove the tonsils is called a tonsillectomy. Tonsillectomy is one of the most common operations performed in the UK.
You have had the minimum number of episodes of severe tonsillitis or quinsy for the benefit of the operation (preventing further severe episodes) to outweigh the common risks (pain, bleeding and infection).
Most people do not get lots of episodes every year or lots of severe episodes. Tonsillectomy is recommended for the small number of patients who have lots of severe episodes of tonsillitis.
What are the benefits of having the operation?
The benefit of the operation is to prevent further episodes of bacterial tonsillitis. You may still get sore throats in the future, but you should get them less often and they should be less severe.
It is important to remember that mild sore throats are not caused by an infection of the tonsils and removing your tonsils will not prevent this type of sore throat.
What are the alternatives to surgery?
Tonsillitis can be treated with painkillers and antibiotics. Gargling with salt water can help to reduce the severity and number of episodes of tonsillitis.
Is there an alternative operation to tonsillectomy?
Tonsil tissue is sometimes removed using a technique called tonsillotomy. This technique may cause less pain and bleeding than a tonsillectomy, but it does not remove all of the tonsil tissue so there is a higher chance that it will grow back and cause tonsillitis. Tonsillotomy is usually used when tonsil tissue needs to be removed for reasons other than infection.
What if I decide not to have surgery?
You may continue to get severe sore throats and infections. Sometimes a severe infection can spread to the space next to the tonsil and cause an abscess (a collection of pus) called a quinsy. Sometimes the infection can spread to the glands in the neck and cause an abscess.
What if I decide not to have any treatment (including medication)?
You will continue to have symptoms. You may develop a complication of infection if the pus spreads to the neck. Very rarely, the bacteria can be carried in your blood and affect your heart and joints. This is called rheumatic fever and can develop two to four weeks after a sore throat. You may develop joint and chest pain, and you may feel breathless, tired, and as though your heart is racing.
ABOUT THE RISKS
What are the risks of tonsillectomy?
Tonsillectomy, like any other operation, has certain risks. The main ones to know about are bleeding and infection.
The complications and risks of any surgery are grouped into the following categories.
Bleeding can happen at any point in the two weeks after your operation. You may spit out small amounts of bloodstained saliva for the first day after your operation – this is normal.
About one in every five adults will need to stay in hospital for observation because of bleeding. One in 100 people will need a second operation to stop the bleeding. Bleeding can start very quickly, and you may need a blood transfusion if you lose a lot of blood.
- Infection in the throat can happen in the two weeks after the operation. Fever (a high temperature of 38oC/100oF or above) is common within the first 24 to 48 hours after tonsillectomy and will affect up to half of patients. You should not need antibiotics for a fever that quickly goes back to normal, but if the fever does not go down, it could be a sign of an infection. If you have a high temperature, you should see your GP or go to the nearest A&E department.
- Swelling of the uvula (the dangly bit at the back of your throat) can develop after the operation. This can feel like you have something stuck at the back of the throat, but should get better within a few days.
- Damage to teeth, lips and gums. The instrument used to keep your mouth open during the operation sits on the teeth. Please let your surgeon know if you have any loose, capped or crowned teeth.
- Altered taste. You may find that food and drink taste different after your operation. This usually gets better without any treatment.
- Complications of general anaesthetic. The operation is performed under general anaesthetic. Complications include blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism), heart attack, chest infection, stroke and death. The pre-assessment team and anaesthetist will explain what happens during a general anaesthetic, and the associated risks that are relevant to you. This link summarises the common events and risks of a general anaesthetic.
AFTER THE PROCEDURE
What happens after my operation?
After the operation, you will be transferred to the recovery ward. When your anaesthetic wears off, you will be taken back to the day-surgery unit if your surgery is planned as a day case or the ward if you are staying overnight.
When will I be able to go home?
Most tonsillectomy operations are performed as day cases, which means that you will probably be well enough to go home a few hours after you recover from the general anaesthetic. There are set goals that you must reach before you can leave hospital, for example eating and getting out of bed. The nurse looking after you will check how you are doing after surgery, and if you meet the goals, you will be able to go home. You will need to stay in hospital for at least six hours after your surgery.
What should I expect after surgery?
You should expect moderate to severe pain after a tonsillectomy. This can be on one side of the throat or both sides. Over half of patients also have pain in their ears. The pain tends to get worse in the first five to seven days after the operation.
Painkillers are more effective if you take them at regular intervals. After a week, you can gradually decrease the painkillers you take. You can stop taking painkillers after two weeks.
It is important that you do not take more than the recommended daily dose of any medication. Some of the medication you will be given contains paracetamol. You must not take other medicines that contain paracetamol.
Bad breath (halitosis) is very common after tonsillectomy, but bad breath alone does not mean you have an infection. Drinking plenty of water and chewing gum may help.
What will my throat look like after the operation?
After your operation, the back of your throat will develop a white coating. This is part of the healing process and is completely normal. It is not pus and you do not need antibiotics.
Picture 3: Normal appearance after tonsillectomy
You may have stitches or ties at the back of your throat after the operation, which will look like black thread. These don’t need to be removed as they usually dissolve after two weeks and fall out by themselves. Don’t worry if you swallow them.
Can I eat and drink as normal after a tonsillectomy?
Yes. It is very important to keep drinking plenty of fluids after the operation. You must be able to eat and drink before you can leave hospital. Taking painkillers 30 minutes before mealtimes will make it more comfortable to eat. Eating and drinking as normally as possible will help clean the back of the throat and reduce the chance of bleeding and infection. If you do not eat and drink you may become dehydrated.
You may feel sick after your operation. The hospital can give you anti-sickness medication to help with this.
How long will I be off work?
It is recommended that you take 14 days off work after your surgery to allow your throat time to heal. You are more likely to pick up an infection while your throat is healing, so during this 14-day period you should avoid large groups of people, people with colds or coughs, and smoky or dusty environments.
Can I exercise?
You should avoid strenuous exercise for 14 days after your surgery.
Can I fly?
It is recommended that you do not fly for 14 days after your operation.
Can I brush my teeth?
Yes. Brushing your teeth will help keep your mouth clean. Avoid mouthwashes that contain alcohol, as these will sting the back of your throat.
Can I smoke?
Avoid smoky atmospheres because cigarette smoke will irritate your throat while it is healing. We advise you not to smoke before or after your surgery.
Will I need to be seen at the hospital after my operation?
Not usually. The surgical team will tell you before you go home if you will need a follow-up appointment.
Who do I contact if I have problems in the two weeks after my tonsillectomy?
Please contact the day-surgery unit or your GP if you have any of the following problems.
- You find it difficult to swallow liquids.
- Painkillers do not control your pain.
- You have a fever of 38oC/100oF or above, which does not go down despite taking paracetamol as recommended.
ENT UK would like to thank the authors and reviewers for their contributions.
Disclaimer: This publication is designed for the information of patients. Whilst every effort has been made to ensure accuracy, the information contained may not be comprehensive and patients should not act upon it without seeking professional advice.