When is a tonsillectomy needed in children and adults?

What do the tonsils do, and is it a problem to remove them?

The tonsils are lymphatic tissue on either side of the throat that form part of the immune system, particularly in childhood. Because the body has plenty of other lymphatic tissue doing the same job, removing the tonsils is not considered to weaken overall immunity in any noticeable way.

Even so, tonsils are only removed when a real benefit is expected. An occasional sore throat, or tonsils that simply look large, is not a sufficient reason for surgery on its own.

Recurrent tonsillitis: where is the threshold?

With recurrent tonsillitis, the decision depends on how many episodes there have been and how severe they were. International guidelines commonly use these criteria:

A “documented episode” means one that a doctor has seen and recorded, with findings such as fever, inflamed tonsils or tender neck glands. These numbers are a guide rather than a strict rule. Missed school or work, allergy to antibiotics or febrile seizures during episodes can influence the decision. For borderline cases, a period of watchful waiting to see how the episodes develop is often reasonable.

Tonsillectomy for snoring and sleep apnoea

In children, the most common cause of snoring and pauses in breathing during sleep is enlarged tonsils and adenoids. For a child who snores regularly, sleeps with the mouth open, has breathing pauses, sleeps restlessly or struggles with attention during the day, removing the tonsils, usually together with the adenoids, is the most common treatment. In most children this clearly improves breathing during sleep.

If only the adenoids are enlarged, removing them alone may be enough; this is decided at the examination, with an endoscopic look where needed. In some children, reducing part of the tonsil (tonsillotomy) rather than removing it completely may also be an option.

In adults, snoring and sleep apnoea usually come from more than one level of the airway. Where large tonsils are a significant part of the narrowing, a tonsillectomy is often planned together with soft palate surgery. A sleep study and, if needed, sleep endoscopy guide this decision; you can read more on our snoring and sleep apnoea treatment page.

Abscess and one-sided enlargement: when else is surgery needed?

• Peritonsillar abscess (quinsy): a collection of pus next to the tonsil, causing severe, usually one-sided throat pain, difficulty opening the mouth and a muffled voice. The first treatment is draining the abscess and antibiotics. If the abscess comes back, or there is a history of frequent tonsillitis, removing the tonsils may be recommended.
• One-sided or rapid enlargement: if one tonsil is clearly larger than the other, grows quickly, has an ulcer that does not heal, or there is a lump in the neck, the tonsil may need to be removed and examined to find the cause. Most of these findings have a benign explanation, but assessment should not be delayed.
• Other situations: troublesome tonsil stones with persistent bad breath that do not respond to other measures may also be a reason to consider surgery once other causes have been ruled out.

How is it done, and how long is recovery?

A tonsillectomy is performed under general anaesthesia through the mouth, so there is no external incision. Patients usually go home the same day or after one night in hospital; young children with sleep apnoea are more often kept in overnight for observation.

What to expect during recovery:

• Pain on swallowing usually lasts 7–14 days, and pain referred to the ears on some days is normal. Children often recover faster than adults.
• A whitish layer in the throat is part of normal healing, not a sign of infection.
• Soft, lukewarm or cold foods and plenty of fluids are recommended. Drinking enough helps with both pain and the risk of bleeding.
• Use painkillers only as your doctor advises.
• Bleeding is the most important risk and can occur within the first two weeks, especially when the scabs come away.

For patients travelling to Izmir, we usually recommend staying in the city for around 10–14 days, as the risk of bleeding is highest in the first two weeks; the exact duration is discussed at the consultation, and later follow-ups can be done by video call.

When to see a doctor

After surgery, any bleeding from the mouth or nose, spitting or vomiting blood, even in small amounts, means going to hospital without delay. Being unable to drink, a high fever or, in a child, a clear drop in urine output are also reasons to contact a doctor.

Before any surgery is planned, we recommend an ENT examination for: several feverish bouts of tonsillitis a year, a child who snores regularly with breathing pauses, severe one-sided throat pain that makes it hard to open the mouth, or one tonsil that is clearly larger than the other. Questions about adenoids in children and returning to school are covered in our frequently asked questions.

The decision to remove the tonsils is not based on their appearance alone, but on how often symptoms occur, how they affect sleep and quality of life, and what the examination shows. After the examination, Dr. Özlem Yüksel Coşar discusses the expected benefits and risks with you, in English if you prefer.