Removing tonsils (tonsillectomy)

Tonsillectomy means surgical removal of the tonsils under a general anesthesia. Tonsils are located at the back of the throat and can be seen through the mouth. Surgery may be recommended if sleep apnea, snoring, or recurrent tonsil infections are present. If a doctor is considering removing both tonsils and adenoids, one procedure to remove both at the same time is often recommended.

What are the symptoms that may mean a tonsillectomy is needed?

There are multiple reasons tonsil removal surgery may be recommended, including sleep apnea, snoring, tonsil infections.

If there is concern about sleep apnea, your doctor may order a sleep study. This is an overnight test at a Children's Wisconsin Sleep Center that will check if your child has sleep apnea, or stops breathing during sleep. This test will also check if oxygen drops in the blood during sleeping as well as for other changes in the body during sleep.

Snoring is another reason why a tonsillectomy in children may be recommended. If snoring is loud and causes problems with getting a good night's sleep and/or problems with daytime fatigue or trouble with focusing, the tonsils may need to be removed.

Tonsillitis means infections of the tonsils. If a child has three episodes of tonsil infections a year for three years or more, or five tonsil infections for two years or more, or seven tonsil infections in one year, a tonsil removal may be recommended.

Other reasons to take out the tonsils include tonsil stones that case bad breath or throat pain, a history of an abscess or infection around the tonsils, swallowing problems due to large tonsils, or periodic fevers thought to be related to the tonsils.

If any of these concerning symptoms are present, your doctor will refer you to an Ear, Nose and Throat specialist to review the history, examine your child, and discuss if surgery is needed.

How is a tonsillectomy performed?

Removal of the tonsils by an Ear, Nose, and Throat Specialist happens under a general anesthesia. The tonsils are removed through the mouth with special equipment, and the surgery takes about 30 – 45 minutes. If your child has sleep apnea, is less than three years old, or you live more than 45 minutes away, you may be asked to stay overnight after surgery.

Tonsil removal recovery takes about one to two weeks. During this time a child may experience the following:

• Severe sore throat
• Ear pain referred from the throat
• Scabs where the tonsils were removed
• Bad breath
• Nausea and vomiting
• Low grade temperatures
• Bleeding from where the tonsils were removed can happen in up to 3% of children

Moderate to severe pain is expected after surgery. The primary medications used for pain after surgery are acetaminophen and ibuprofen. If needed, your surgeon may recommend a stronger pain medication.

Staying hydrated and managing pain helps the recovery go more smoothly and preventing complications of dehydration and pain.

Can I prevent the need for removal of tonsils?

If sleep apnea or snoring is present, tonsils should be removed due to stress of sleep apnea on the body. Untreated sleep apnea places children at risk for diabetes and high blood pressure. School performance and daytime behavior may also be negatively impacted.

If there is concern that obesity is causing sleep apnea or snoring, talk with your doctor about the best options for weight loss control.

Removing the tonsils for repeated infections is not mandatory, but can improve the quality of life and reduce the need for repeated antibiotics and missed days of school.

What is the prevalence of a tonsillectomy in children?

About 500, 000 children a year will need their tonsils removed. This is one of the most commonly performed surgeries in children.

How do tonsils develop?

Tonsils develop prenatally, and are very small when a child is born. The tonsils and adenoids are part of a whole system including the thymus and bone marrow that helps the body develop immunity. Removal of the tonsils will not interfere with your child's ability to fight infection. When a child is exposed to an infection, the tonsils and adenoids may enlarge.

When should I contact a doctor?

You should contact your doctor if snoring is present along with difficulty sleeping at night, and fatigue is present during the day. Another reason to contact your doctor is for repeated sore throats, or difficulty swallowing foods due to enlarged tonsils.

What happens after treatment?

Recovery after a tonsillectomy takes one to two weeks. During tonsil removal recovery, typically, a child will have a sore throat, pain, low grade temperatures, and scabbing. Avoidance of sharp, salty and spicy foods is recommended during the healing process. Sport activities should be avoided for two weeks. Pain control with acetaminophen (Tylenol) and ibuprofen (Motrin) will help prevent dehydration after surgery.

What is the long term outlook after tonsillectomy?

If tonsil removal is performed for repeated sore throats, this will help improve quality of life. In general, if surgery is being performed for sleep apnea, most children do well after surgery. However, if  snoring and obesity are present, the success rate for surgery may be lower. Your doctor may want to take an additional sleep study after your child has recovered from surgery.