Do you get the same sore throat every year?

What is tonsillectomy?

The tonsils are structures made of lymphoid tissue located on both sides of the throat, just above the base of the tongue. Especially in childhood, they help the body get to know germs. In some people, however, the tonsils become inflamed often, enlarge or make breathing during sleep difficult. In that case, surgical removal of the tonsils comes into consideration.

This procedure, medically called tonsillectomy, is one of the most frequently performed operations in ear, nose and throat surgery. Even so, not every sore throat requires surgery. What determines the decision is how often and how severe the episodes are, how they affect your work and social life, and any breathing problems during sleep. That is why the first step is always a careful, individual assessment.

This page covers tonsillectomy in adults. Here you will find who the operation is recommended for, the process before and after surgery, what to pay attention to during recovery, and when to seek care without delay. If you are looking for information for your child, see our page on adenoids and tonsils in children.

Who needs a tonsillectomy?

There are two main reasons for tonsillectomy: frequently recurring tonsillitis and breathing problems caused by enlarged tonsils. In addition, some less common conditions may also require surgery. Because every patient's history is different, the decision is made by weighing the examination findings together with the complaints.

Recurrent tonsillitis

Tonsillitis shows itself with a sore throat, difficulty swallowing, fever, swelling in the neck and fatigue. One or two episodes usually clear up with medication. But when episodes become more frequent, quality of life drops and frequent antibiotic use becomes an issue.

According to the criteria used in international guidelines, having seven or more episodes of tonsillitis in the past year, at least five a year for the past two years, or at least three a year for the past three years are situations in which surgery is considered. It is important that these episodes come with findings such as fever, pus on the tonsils or enlarged lymph nodes in the neck, and that they are documented whenever possible.

Snoring and sleep apnea

Large tonsils can narrow the airway in the throat and cause snoring and pauses in breathing during sleep. Breathing pauses during sleep can lead to waking up tired, daytime sleepiness, difficulty with attention and concentration, morning headaches and high blood pressure. Your partner noticing that you snore or stop breathing is an important clue for assessment.

In adults, enlarged tonsils can be one of the causes of sleep apnea. In these patients, tonsillectomy can noticeably improve sleep quality. In children, the most common cause of snoring is enlargement of both the adenoids and the tonsils; for details, see our page on adenoids and tonsils in children.

One-sided enlargement and other reasons

One tonsil being clearly larger than the other is a finding that needs further investigation. In this case, surgery may be done both as treatment and for diagnosis. An abscess around the tonsil and frequently recurring tonsil stones that cause bad breath are also among the situations in which surgery is discussed.

Tonsil stones usually do not require surgery; simple methods are tried first. You can find safe ways to clean them at home in our article how to remove tonsil stones. If the stones keep coming back and affect your quality of life, surgery is considered as an option.

Non-surgical treatment options

Not every tonsil complaint requires surgery. When tonsillitis is infrequent, the aim is to treat each episode quickly and correctly. For bacterial infections, appropriate antibiotics, supportive treatment for pain and fever, plenty of fluids and rest are usually enough. Viral throat infections do not need antibiotics; telling the two apart is one of the most important parts of the examination.

For tonsil stones, regular oral hygiene, gargling with salt water and drinking plenty of water can reduce stone formation. If there are conditions that constantly irritate the throat, such as reflux, allergy or postnasal drip, these need to be treated first. If complaints continue despite these steps and affect your quality of life, the surgical option comes into consideration.

For patients followed without surgery, noting the dates and duration of episodes and the medicines used is very valuable. These records make it easier to reach the right decision later on. You can find more about the symptoms of tonsillitis in our article on symptoms of tonsillitis.

Tonsillitis or pharyngitis?

It is important to know that a sore throat is not always tonsillitis. Pharyngitis is inflammation of the back wall of the throat and is mostly caused by viruses. In tonsillitis, the tonsils themselves swell and turn red, and white or yellow spots of pus may be seen on them. High fever and tender lymph nodes in the neck are also more often present.

This distinction also matters for the surgical decision, because the episodes counted towards surgery are episodes confirmed as tonsillitis. In people who often have a sore throat but show no tonsillitis on examination, other causes are investigated. Reflux, sinusitis or mouth breathing due to a blocked nose can also cause constant irritation in the throat.

Preparing for surgery

Once the decision for surgery has been made, the first step is to assess your general health. Basic tests such as a blood count and clotting tests are done, and a consultation with the anesthesiologist is arranged. You must tell us about the medicines you take, especially blood thinners and herbal products.

Anesthesia is planned by an experienced anesthesia team according to age and general health. If you have asthma, heart disease, a bleeding tendency or have had a problem with anesthesia before, telling us in advance allows the day of surgery to be planned safely. For children, a parent can often stay with the child until anesthesia begins.

On the night before surgery, eating and drinking stop after a set time. For children, explaining the operation beforehand in words the child can understand helps the process go more calmly. If there is an active throat infection, surgery is usually postponed until the infection has cleared.

Preparing the cold and soft foods you will need in the first days after surgery makes recovery easier. You can find which foods are suitable in detail in our guide to eating after tonsillectomy.

How is tonsillectomy performed?

Tonsillectomy is performed under general anesthesia, which means the patient is asleep and feels no pain during the procedure. The operation is done through the mouth, and no external incision is made. The tonsils are carefully separated from the surrounding tissue and removed, and bleeding is controlled.

Today, different techniques are used for tonsillectomy, such as cold steel dissection, electrocautery, radiofrequency and coblation. Which method is chosen depends on the patient's age, the condition of the tonsils and the surgeon's experience. Each technique has its own advantages, and the aim is the safest recovery with the least pain.

The procedure is usually short. After surgery the patient is kept under observation for a while and is discharged once it is clear that there is no bleeding and they can drink fluids comfortably. In some cases, especially in young children or patients with sleep apnea, an overnight hospital stay may be recommended.

You can also find more general information about the operation on the Mayo Clinic tonsillectomy page.

Recovery after tonsillectomy

The recovery period usually lasts 10 to 14 days. During this time, pain, difficulty swallowing and pain radiating to the ear are common and expected. Knowing how recovery progresses day by day helps both patients and families get through this period more comfortably.

The first three days

In the first days, a sore throat and difficulty swallowing are the most noticeable complaints. The most important rule in this period is to drink plenty of fluids, because getting enough fluid both reduces pain and speeds up healing. Cold drinks, ice cream, pudding, yogurt and lukewarm soups are good choices.

Painkillers should be taken regularly as your doctor recommends, before the pain sets in. Mild fever, bad breath and ear pain can occur in this period. Talking is allowed; staying silent does not speed up healing.

Days five to nine

The white scabs that form in the surgical area are a natural part of wound healing and do not mean infection. These scabs usually come away between the fifth and tenth days. Pain may increase for a while as the scabs come off; this is also expected.

The risk of bleeding is relatively higher in this period. If you notice blood coming from your mouth or are constantly spitting blood, you should contact your doctor or go to the nearest emergency department without delay. Avoiding hard, crunchy and spicy foods reduces this risk.

Returning to daily life

Most patients return to their normal diet, school or work within 10 to 14 days. Waiting two weeks before heavy physical activity and sports is recommended. Temporary changes such as a change in voice or in taste soon resolve.

You can find more details about recovery time in our article how many days tonsillectomy recovery takes. The follow-up examination is usually done one to two weeks after surgery.

Pain management

The most effective way to keep pain under control after surgery is to take the recommended painkillers at regular times. Waiting for the pain to build up both reduces fluid intake and makes healing harder. Painkillers taken half an hour before meals in particular make swallowing easier.

Cold also eases pain. A cold compress on the neck, cold drinks and soft, ice-cold desserts are soothing in this period. Medicines that can increase bleeding, such as aspirin, should not be used unless your doctor recommends them. Pain radiating to the ear comes from nerves shared by the throat and the ear and does not mean there is a problem in the ear.

Eating and drinking advice

In the first days, cold and soft foods should be preferred. Yogurt, milk pudding, ice cream, mashed banana, mashed potatoes and lukewarm soups are suitable options. Acidic fruit juices and spicy or very salty foods can sting the throat, so they should be avoided for a while.

Hard foods with sharp edges, such as crackers, toast and crisps, can irritate the wound surface. These are usually reintroduced after two weeks. You can find in detail how to expand the diet day by day in our article what to eat after surgery.

When should you seek care immediately?

Most of the recovery period passes at home without problems. However, some symptoms should be assessed without waiting. Fresh blood coming from the mouth, constantly spitting blood or vomiting blood are the most important. Even if the bleeding is small, a doctor should be contacted without delay, especially for children.

Not being able to drink enough fluids, a marked decrease in urine output, a fever above 38.5 degrees that does not come down, difficulty breathing and severe pain that does not ease despite painkillers are also reasons to seek care. In these situations, contacting your doctor allows possible problems to be resolved early.

It is recommended that you keep the contact details you are given after surgery somewhere easy to find. If you have a question or concern, getting advice is always safer than waiting to see how symptoms develop. At the follow-up examination, the progress of healing is assessed and your return to normal life is planned.

Possible risks and things to watch for

As with any surgical procedure, tonsillectomy carries some risks. The most important is bleeding after surgery. Bleeding is most often seen on the first day or in the period when the scabs come off. That is why it is necessary to watch for signs of bleeding for two weeks after surgery.

Infection, weakness due to not drinking enough fluids and rare problems related to anesthesia can also occur. Drinking enough fluids, taking the recommended medicines regularly and attending the follow-up examination prevent most of these risks. Which symptoms require you to seek care is also explained to you in writing after surgery.

Overall, tonsillectomy is a safe procedure. What matters is that it is done in the right patient, at the right time and with careful surgical technique. You can find more information about tonsillitis and its treatment in the NHS guide to tonsillitis.

Are you looking for information for your child?

In children, the most common reason for tonsillectomy is not frequent infection but the adenoids and tonsils enlarging together and narrowing the upper airway. That is why in children the tonsils are often removed in the same session as the adenoids; frequent tonsillitis with fever is assessed as a separate reason. For symptoms, diagnosis and treatment specific to children, see our page on adenoids and tonsils in children, and for other childhood problems our pediatric ENT page.

Tonsillectomy in adults

Although tonsil removal is often thought of as a childhood operation, it is also frequently performed in adults. In adults, the most common reason is tonsillitis that has recurred frequently for years. Chronic tonsillitis can also show itself as a constant feeling of something stuck in the throat, bad breath and recurring tonsil stones.

In adults, recovery can be somewhat longer and more painful than in children. It is therefore recommended that you time the operation around your work and social life and set aside at least two weeks of rest. You can find more information about chronic tonsillitis in our article on recurrent tonsillitis in adults.

Peritonsillar abscess

In some adults, tonsillitis spreads to the area around the tonsil and forms an abscess. This shows itself with severe one-sided throat pain, difficulty opening the mouth, inability to swallow and a change in the voice. The abscess is first treated by draining it. In patients who have repeated peritonsillar abscesses or a previous history of frequent tonsillitis, tonsillectomy may be recommended to prevent new episodes.

Adults with sleep apnea

In adults with sleep apnea, the tonsils may be only one of the causes narrowing the airway. In these patients, the nose, palate and base of the tongue are assessed as well. The treatment plan is tailored to the individual based on the sleep study results and the examination findings.

Common mistakes and misconceptions

One of the most common misconceptions is that the tonsils must be removed with every infection. In fact, occasional episodes can usually be controlled with medication. The frequency and severity of the episodes are what determine the decision for surgery.

Another misconception is the worry that surgery will weaken immunity. Current evidence shows that removing the tonsils does not have a negative effect on the immune system. On the contrary, removing tonsils that are frequently inflamed reduces how often most patients get ill.

Finally, not drinking enough fluids during recovery is the most common mistake. Cutting down on fluids because of pain delays healing and can increase the risk of bleeding. That is why taking painkillers regularly and drinking plenty of fluids in the first days are so important.

When should you see a specialist?

If you have tonsillitis several times a year, lose school or work days every winter to the same sore throat, or your child snores at night and sleeps with their mouth open, it is recommended that you see an ear, nose and throat specialist. One tonsil being clearly larger than the other is also a finding that should be assessed.

Noting the episodes you have had in the past one or two years, the medicines you have used and any observations about your sleep before your visit makes the assessment more accurate. Whether surgery is right for you is decided individually, by considering this information together with the examination findings.

Prof. Dr. Mustafa Deniz Yılmaz makes the decision on tonsillectomy in light of scientific criteria and according to each patient's needs. By completing the short pre-assessment test at the top of this page, you can see which group your complaints fall into and contact us through the pre-assessment form.