Tonsillectomy

What are the benefits of removing tonsils?

Your doctor may offer a tonsillectomy operation if you (or your child) keep getting tonsilitis (an infection of your tonsils). Your doctor will want to know exactly how many times you (or your child) has had tonsilitis over a period of time.

They’ll also want to know how much of an impact it’s had in terms of needing time off school or work. A tonsillectomy will stop you from getting repeated attacks of tonsilitis. But it won’t be able to stop sore throats for other reasons or throat infections.

There are certain other times a doctor may recommend a tonsillectomy. These may include if you:

• develop complications, such as quinsy (a painful, pus-filled abscess behind your tonsils)
• get breathing problems including sleep apnoea (disrupted breathing when the muscles that support the soft tissues in your throat temporarily relax narrowing or closing the airway, causing breathing to be momentarily cut off)
• have severe bad breath (halitosis) caused by material collecting around the tonsils
• have one enlarged tonsil, to check for cancer

Your doctor will discuss the benefits and risks of having a tonsillectomy with you. It’s your choice whether to go ahead with the procedure. Following medical advice, some people decide to wait and see if things improve on their own.

How do I get a tonsillectomy?

Removal of the tonsils can be done privately or on the NHS. Either way, you’ll need a referral from a GP to see an ear, nose and throat (ENT)/otolaryngology specialist. They who will advise whether it’s a suitable option for you. Many private health care providers offer rapid access for tonsillectomy. Waiting times for tonsillectomy in the NHS will vary depending on where you live, but are usually several months.

Tonsillectomy surgery may be similar, whether it’s in the NHS or the private sector. But there will be differences in how you receive your care. Private healthcare facilities aim to offer comfort and privacy. You may also have greater access to more specialised techniques under private care.

Preparing for tonsillectomy

It’s important to make sure you’re in the best possible health before tonsillectomy surgery. If you smoke, it’s best to stop before the operation. It’s also good to lose any excess weight if possible, and to maintain a healthy diet. Try to keep physically active before your operation too.

A tonsillectomy is typically carried out under general anesthesia which means you will be asleep during the procedure. You usually need to stop eating and drinking before a general anaesthetic – your doctor will tell you exactly when. Tonsillectomy is usually done as an outpatient/day-case procedure, which means you go home on the same day. But sometimes you may need to stay overnight. This is more likely for tonsillectomy in children.

What happens during a tonsillectomy surgery procedure?

There are several different techniques that can be used for removing tonsils. These include the following.

• Cold-steel dissection – this is the traditional approach, which uses surgical instruments (e.g. a scalpel) to cut out your tonsils.
• Diathermy – this uses an electrical current to remove the tonsil tissue and control bleeding.
• Coblation – this works in a similar way to diathermy, but uses radiofrequency energy in a saline solution to remove the tonsils at a lower temperature.
• Laser – a laser tonsillectomy can be used to remove your tonsils completely, or make them smaller.

Tonsillectomy can also be done using an extracapsular or intracapsular technique.

• Extracapsular tonsillectomy means that the whole tonsil and surrounding capsule is removed.
• Intracapsular tonsillectomy (also called tonsillotomy) is a newer technique that removes tonsil tissue, but leaves the surrounding capsule intact.

The surgical procedure your surgeon uses will depend on availability as well as their own experience and preference.

Recovery and what to expect after a tonsillectomy

You, or your child, will usually be monitored in hospital for a few hours after surgery, before being discharged home. Sometimes you may need to stay overnight in hospital. If you do go home on the same day, you’ll need someone who can take you home and stay with you overnight.

It’s usual to have some pain and bleeding after a tonsillectomy. This may be less with certain techniques, such as intracapsular tonsillectomy. Sometimes the pain can get worse during the first week, before it gets better. You might get pain in your ears, as well as your throat. Follow the health information you are given, for instance take pain medication regularly as prescribed – even if your pain isn’t that severe at first.

You should eat and drink normally after a tonsillectomy, even if the pain in your throat makes this difficult. Eating normally can help your throat to heal. It’s important to encourage children to drink plenty of fluids to prevent dehydration. Sometimes people feel, or are, sick after a tonsillectomy. Your healthcare team may give you anti-sickness medicine before surgery to prevent this.

The recovery time from tonsillectomy can be up to two weeks. It’s important to rest while you’re recovering. You’ll need to take time off school or work.

What are the potential complications of a tonsillectomy?

Sometimes the pain or bleeding after tonsillectomy becomes so severe that you (or your child) may need to be readmitted to hospital. Another operation may be needed to stop the bleeding. This is more common in adults than in children.

It’s possible that you may need further surgery on your tonsils years later. This is more likely after coblation, when some of the tonsils are left behind, than dissection, which removes the entire tonsils.

How much does a tonsillectomy cost?

Tonsillectomy is often available through private medical insurance. Check with your insurer whether they will cover it.

You can also choose to self-fund a tonsillectomy. Typically, an initial consultation with the surgeon will cost between £175 and £220. Tonsillectomy costs in the UK vary depending on where you live. If you move forwards with the procedure, you’ll be offered one of the following.

• An all-inclusive ‘package price’, where you know the full costs before undergoing treatment. Not all consultants and hospitals offer this.
• A ‘fee-per-service’ deal, where you receive different invoices from the surgeon, the anaesthetist and the hospital. You often won’t know the full costs until you receive the invoices.

For more information, you can read our guide on self-pay.

References

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• Commissioning guide: Tonsillectomy. ENT UK. January 2021. entuk.org.
• Management of sore throat and indications for tonsillectomy. Scottish Intercollegiate Guidelines Network (SIGN). April 2010. sign.ac.uk.
• Keltie K, Donne A, Daniel M, et al. Paediatric tonsillectomy in England: A cohort study of clinical practice and outcomes using Hospital Episode Statistics data (2008-2019). Clin Otolaryngol 2021;46(3): 552-561. doi: 10.1111/coa.13707.
• Sore throat - acute. NICE Clinical Knowledge Summaries. cks.nice.org.uk, revised January 2021.
• Obstructive sleep apnoea syndrome. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2021.
• You and your anaesthetic. Royal College of Anaesthetists. February 2020. rcoa.ac.uk.
• Adult tonsil surgery. ENT UK. entuk.org (accessed 19 January 2022).
• Children tonsil surgery. ENT UK. entuk.org (accessed 19 January 2022).
• Tonsillectomy using laser. National Institute for Health and Care Excellence. July 2006. nice.org.uk.
• Electrosurgery (diathermy and coblation) for tonsillectomy. National Institute for Health and Care Excellence (NICE). December 2005. nice.org.uk.
• Ahmed J, Arya A. Lasers in tonsillectomy: revisited with systematic review. Ear, Nose & Throat Journal. 2021;100(1_suppl): 14S-18S. doi: 10.1177/0145561320961747.
• Ear, nose and throat surgery. GIRFT Programme National Specialty Report. November 2019. gettingitrightfirsttime.co.uk.