The procedure is typically performed in a hospital, takes about 15 to 30 minutes, and requires general anesthesia. In cases of tonsillectomy in adults, patients usually remain in the hospital for several days for monitoring, as adults tend to have a slightly higher risk of postoperative bleeding compared to children. There are two main surgical approaches: tonsillectomy, in which the tonsils are completely removed and which generally requires a hospital stay, and tonsillotomy, in which the tonsils are partially removed and which may sometimes be performed on an outpatient basis. Various surgical techniques can be used. Some methods involve heat generation (diathermy), such as radiofrequency devices or lasers, which remove the tonsils while sealing the wound with heat. Other approaches use lower heat levels, such as coblation. Alternatively, non-heat techniques (dissection) involve removing the tonsils using surgical instruments like scissors or a loop.

Which is better: partial or complete removal?

Partial tonsillectomy (tonsillotomy) is generally gentler because less tissue is removed and the wound is smaller. In the days following this procedure, patients usually experience less pain and can resume eating sooner than after a complete tonsillectomy. The risk of post-operative bleeding is also likely lower.

However, it remains unclear how effectively partial removal prevents recurrent tonsillitis. Only a limited number of studies have compared partial and complete tonsillectomy. In cases of frequently recurring bacterial tonsillitis, doctors usually recommend complete removal of the tonsils.

How can discomfort after surgery be relieved?

Pain is the most common symptom after a tonsillectomy and usually subsides after a few days, although it can last up to one to two weeks in some cases. Pain-relieving medications in the form of tablets, suppositories, drops, infusions, or sprays can help. Medications are also available to treat nausea and vomiting.

To support healing and reduce the risk of bleeding, it is important to rest physically during the first few days after surgery. Heavy lifting and sports activities should be avoided for a few weeks. Hot showers and very warm baths are discouraged. Initially, only soft foods should be eaten to protect the wound. Spicy foods and acidic products, such as fruit juices and citrus fruits, may irritate the wound and should be avoided, as should gargling with mouthwash.

When is a tonsillectomy necessary?

Recurrent purulent tonsillitis can be serious. However, surgical removal of the tonsils also carries risks. The tonsils are part of the immune system and react to invading germs by becoming inflamed. Viruses and bacteria can trigger this inflammation, and bacteria can be detected with a throat swab. Symptoms of bacterial tonsillitis include fever above 38°C, swollen and painful cervical lymph nodes, pus-coated tonsils, and the absence of a cough.

If antibiotic treatment provides only short-term relief and inflammation recurs frequently, surgical removal may be considered. Five to seven purulent episodes per year are generally regarded as an indication for tonsillectomy. If the infection spreads deeper into the throat, abscesses may form and make swallowing or opening the mouth difficult. In rare cases, complications such as blood poisoning, meningitis, or airway obstruction can occur.

Risks and complications

The first few days after a tonsillectomy can be uncomfortable. Pain, difficulty swallowing, and sometimes nausea, vomiting, or taste disturbances may last for up to one to two weeks. Post-operative bleeding is a known risk and requires immediate medical attention. Even after complete removal, throat infections can still occur, although they are generally less frequent. Whether removing the tonsils weakens the immune system has not been scientifically proven. The tonsils play a more significant role in immune function during early childhood than in adulthood.

Conclusion

In the past, tonsillectomies were sometimes performed too hastily, occasionally leaving small remnants of tonsil tissue that may cause problems years later. If severe throat pain, swollen lymph nodes, and persistent soreness in the mouth and throat develop, these remnants may require surgical removal. Decisions about tonsil surgery should always be made carefully and individually. Consulting an experienced ear, nose and throat specialist ensures appropriate evaluation and selection of the most suitable treatment approach.