What are tonsils and why do they need to be removed?

The tonsils are two collections of specialised tissue, called lymphoid tissue, in the back of the mouth. Their exact function is still rather poorly understood, but it is thought that they are important in the first few years of life and help the body to recognise “bugs” that can cause infections. The tonsils are only part of this system and there is lots of other lymphoid tissue that can do this job once your tonsils have been removed.

The most common reason for removing tonsils is because of recurrent tonsillitis, (infection of the tonsils) this occurs when the tonsils themselves become infected and so rather than helping to fight infections, they actually become a source of infection.

Tonsillitis is a fairly common condition and many people will experience it at some time in their lives. This means that we only advise people who are having recurrent problems with tonsillitis to undergo a tonsillectomy.

What is a Tonsillectomy, and what can I expect from the operation?

This is the operation to remove the tonsils. It is performed under a general anaesthetic, which means that you will be asleep throughout your operation. The surgery is all carried out through the mouth. The tonsils are peeled away from the sidewall of the throat, there is always some bleeding at this point, and the surgeon will spend some time stopping this before you are woken up. Usually the surgeon will inject some local anaesthetic to numb the area so that when you wake up your throat will not be too sore.

After the tonsils have been removed there are two raw patches, one on each side of the throat. This area will form a scab, but unlike a scab on your skin which goes hard and acts as a protective layer to the wound, scabs in the mouth are soft and look white. This soft scabby layer is an ideal breeding ground for “bugs”.

You can expect to be sore after you operation but you will be encouraged to eat and drink as normally as possible. In particular we advise that you eat crunchy and chewy foods as this helps to reduce spasm in the muscles of the throat and also scrapes away a lot of the scabs where the tonsils were attached. It is most important that you take painkillers regularly for the first 10 days after your operation so that you can eat and drink properly.

It is not uncommon for the pain to get a bit worse on days 3 and 4 but by day 10 it will be almost gone. Whilst the area is healing up it is important that you stay away from people with coughs and colds and therefore off work / school. You should stay quietly at home for a week after your operation.

What are the risks?

Pain:

Tonsillectomy is a painful procedure and you can expect to need regular painkillers for 10–14 days after your operation. You may find that you get earache as well. This is due to a shared nerve supply between the ear and the tonsil and it does not mean that there is a problem with the ear its self.

Bleeding:

This is the most serious complication of the operation and it can occur at any time in the first 10 days after your operation. Bleeding can occur in the recovery area or on the ward on the day of your operation. This is usually because a blood vessel, which was in spasm during the operation, relaxes and then starts to bleed. In this case it is often necessary to take you back to the operating room in order to stop the bleeding.

However the most common time to bleed is in the first week and occurs in 1–2% of patients, this is usually in those people who struggle to eat properly after the tonsillectomy. Here, the slough, which covers the tonsillar beds, becomes infected and this makes the area more painful and prone to bleeding. In this case most patients will be admitted to hospital for observation and antibiotics, but on some occasions we need to take you back to the operating room once more. Very occasionally patients can bleed a lot in which case they can need a blood transfusion. If you notice any bleeding after your operation you should return immediately to the hospital.

Infection:

As describe above, this usually occurs in those patients who find it difficult to eat after their operation. It usually causes a worsening of the pain and a temperature. If you are concerned you should see your local doctor and see if you need antibiotics.

Further sore throats:

Removing the tonsils can only prevent tonsillitis and you may still experience the occasional sore throats, which accompany and cold or flu.

Change in voice:

Some patients find that their voice is slightly different after a tonsillectomy, this is usually very minor but can be along term problem to professional voice users.

What to do if you have any worries or concerns after the surgery

If it is within 48 hours or out of hours, phone the ward where you were admitted for surgery.