Tonsillitis & Adenoid Issues: Signs, Treatment & Surgery

Recurring sore throats, difficulty swallowing, and sleep disturbances could all point to issues with the tonsils or adenoids. While many cases resolve on their own, some children require intervention, including adenoidectomy (removal of the adenoids), tonsillectomy (removal of the tonsils) or adenotonsillectomy (removal of both adenoids and tonsils).

As a specialist adult and paediatric (children’s) ENT surgeon, I can discuss with you about recommended surgical options and come up with a plan to maximise your long-term health.

Many patients and parents ask me:

What is the purpose of the tonsils and adenoids and will there be any negative effects from removing them?

The tonsils are small glands at the back of the throat usually about the size of an olive/grape. There is one on either side of the throat. They form part of our bodies system to start and mount an immune response to an infection. They are important when we are very young and it is generally accepted that they become less important as we get older. Often shrinking completely so they can hardly be seen when we are adults.

Tonsillectomy is one of the most common operation in the United Kingdom. This is because the tonsils can cause issues where the benefits of removing the tonsils outweighs the potential negatives.

‘What are the adenoids?’

The adenoids are made of tissue very similar to the tonsils. However, the adenoids are behind the soft palate so cannot be easily seen. They are situated where the back on the nose opens and this is also the place where the eustachian tubes open. Enlargement of the adenoids can lead to difficulty breathing though the nose, glue ear, eustachian tube issues, mouth breathing and obstructive symptoms at night.

Interestingly, there is also similar tissue to the tonsils and adenoids across the very back on one’s tongue (tongue base). This area is termed the lingual tonsils. Even after removing a patient’s tonsils and adenoids, there is still some tonsil type tissue left in the throat. This may relieve some parents to know some of the immune tissue remains.

This also means that is still possible to have some sore throats after a tonsillectomy. Although, in my experience the infections appear to be less severe and much less frequent.

What is the recovery like after tonsillectomy?

I usually tell patients to expect at least 2 weeks to recover. Sometimes patients recover a little faster and sometimes it takes a little while longer. On the day of the operation, there is not a great deal of pain. Children and adults are usually pleasantly surprised that they can eat fairly easily a few hours after their surgery. The experience on the day of the operation is generally very routine and relatively pleasant.

Pain peaks at around day 3-5 then usually starts to improve after this. The pain can be quite severe and warn patient to expect this peak in pain. I recommend regular analgesia (pain relief) for at least 10-14 days. You will be advised on pain relief and other tips before leaving hospital.

The pain and post operative recovery depends somewhat on the technique used for the tonsillectomy.

Coblation tonsillectomy / adenotonsillectomy is now my preferred method for removal of tonsils in children when the indication (reason for operation) is sleep disordered breathing or OSA (obstructive sleep apnoea). This technique has been shown to have a faster recovery with less pain and lower chance of serious side effect (such as bleeding). One drawback is a very small chance of tonsil regrowth but this is very small and I feel the benefits of this technique outweigh this drawback.

Can I Fly after my operation

The chances of any complication (bleeding in particular) dramatically decreases after 2 weeks. After 2 weeks many patients would choose to fly. I would prefer if my patients wait 3 weeks before flying and ideally 4 weeks. We can talk more about the individual cases. For instance, if you have a holiday or work / business trip planned.

What will my mouth look like after a tonsillectomy

Following tonsillectomy sometimes there is pain or a small amount of swelling of the lips. This usually minor and short lived. In a few days the sides of your throat where your tonsils used to be can look white, with bits of grey and even a slight brown tinge of colour. This is the normal appearance. I warn my patients that their breath can be a little smelly during the recovery period due to the healing process and not to worry it will pass. It’s okay to brush your teeth as normal as this will help to keep your mouth clean. Eating as normal diet as possible including foods with a normal texture is thought to help the healing process. However, if solid foods such as toast is too painful, soft foods are still good.