Surgical removal of the tonsils (tonsillectomy) is one of the most common surgeries performed in children. However, some adults may also benefit from tonsillectomy. Dr Gan shares his opinion on when you should consider having your tonsils removed and the risks and concerns associated with the procedure.

What are tonsils?

Tonsils are two oval-shaped glands located at the back of your throat (left tonsil and right tonsil (Figure 1). They are part of your immune system that protects you against infection and illness.

Figure 1 – A picture of the back of the throat showing the location of the tonsils

What is Tonsillectomy?

Tonsillectomy is the surgical removal of the tonsils. The operation is done through the mouth under general anaesthesia (patient asleep) and there will be no external visible cuts in the neck region.

When (or Why) do I need a Tonsillectomy?
If you do not have problems with your tonsils, they should be left alone. However,  if your tonsils are problematic such as the conditions listed below, they should be removed.

1. Recurrent (frequent) tonsillitis (Figure 2a&b)– Tonsillitis is an infection of the tonsils. Patients with tonsillitis usually experience bad sore throat, painful swallowing and fever. During an active infection, the tonsils are swollen, inflamed and may have patches of pus. Your doctor will usually need to treat the tonsillitis with a course of oral antibiotics, pain relievers as well as gargle and lozenges. If you experience frequent or severe tonsillitis, your doctor may recommend a tonsillectomy.

Figure 2a- A comparison between normal and infected tonsils

Figure 2b- White patches on a red and swollen tonsil, indicating a tonsil infection

2. Snoring and breathing problems
If your tonsils are big, they may block the upper airway, leading to breathing difficulties and snoring. It can also be a cause of obstructive sleep apnoea (OSA), a condition where a patient stops breathing for a short period during sleep.

3. Suspected cancer
If you have a growth on the tonsil or an abnormally enlarged tonsil (one tonsil much bigger than the other), the tonsils may have to be removed and tested for cancer.

4. Other problems with the tonsils
In some instances, the tonsils may be removed when there is an embedded foreign body (e.g. fish bone completely buried in the tonsil) or  to provide access for surgery in the mouth for other reasons.

Does removal of the tonsils weaken my immune system?
Tonsils play a very small role in your immune system. The lymphatic system, bone marrow, spleen and thymus are the key organs in your immune system. Removal of the tonsils will not make you more susceptible to infections. There are many studies that have shown that tonsillectomy is a safe procedure with no significant negative effects on the immune system.

What are the possible risks and complications from Tonsillectomy
Tonsillectomy is, in general, a common and safe surgical procedure. However, as with all surgical procedures, there are some risks involved. The most common risk is bleeding (less than 5% chance). Most cases of bleeding after a tonsillectomy can be stopped in the clinic. In rare occasions, the bleeding may have to be stopped in the operating theatre setting. Rarer complications of tonsillectomy include infection and injuries to the lip, teeth, gums and tongue (during retraction of the mouth and tongue)

What is the recovery like after tonsillectomy?
After removal of the tonsils, the surgical wound (area where the tonsils used to lie on) is exposed (no stitches placed). Hence, when you look at the back of your throat, you will see two large white patches (on the left and right side of your throat). Do not be alarmed as this is the normal appearance of a post-tonsillectomy wound. There will be pain during this period but your pain should be kept under control with painkillers, gargles and lozenges. The white patch (which look like large ulcers – Figure 3) will heal on its own and it usually take approximately 3-4 weeks for the wound to close completely.

Figure 3 – The appearance of the throat a few days after removal of the tonsils. The white patches (indicated by blue arrows) are the surgical wounds (where the tonsils used to lie on). This appearance is temporary and the wound usually heals completely over 3-4 weeks.

Is there any restrictions after tonsillectomy?
You can resume most of your activities of daily living after tonsillectomy. However, to ensure that your recovery is smooth, you should take the following precautions:

Food – Certain food will make your recovery more unpleasant. Spicy food, acidic food and alcohol can cause more pain to the surgical wound. Hence, it would be best to avoid these foods till your surgical wound heals in about 3-4 weeks’ time.

Exercise – It is advisable not to perform any exercise for at least 2 weeks after the surgery. As the surgical wound is raw during this period, there is a risk of bleeding from increased blood circulation to the head and neck region from exercise. Likewise alcohol consumption may also have the same effect and should be avoided.

Written by Dr Gan Eng Cern (Consultant Ear,Nose & Throat (ENT) Surgeon).