By Amit Patel, M.D.

Your tonsils play a role in your immune system, however – for some – tonsils can seem to cause more harm than good. If you’re someone who frequently gets severe, painful sore throats, you may be wondering whether you should consider having surgery to remove your tonsils. This type of surgery is known as a tonsillectomy.

While tonsillectomies are more common for children, there are times when an adult should consider getting a tonsillectomy for recurrent infections. It’s important to listen to your body and see a doctor when you’re experiencing certain symptoms.

If you’re experiencing one or more of these symptoms, you should consider seeing your primary care physician for evaluation:

• Severe throat pain
• White spots on your tonsils
• Painful or difficulty swallowing
• Fever
• Swollen, tender lymph nodes in your neck

If your physician runs a test and the results show an infection, it’s important to then remain mindful of how often you’re experiencing these infections. That rate will help us determine if you are in need of a tonsillectomy.

Here is the criteria for tonsillectomies, which you’ll see is linked to the rate of infection:

1. You’ve had seven or more episodes of documented bacterial tonsillitis in a year.
2. You’ve had five or more episodes per year of documented bacterial tonsillitis over the course of two consecutive years.
3. You’ve had three or more episodes per year of documented bacterial tonsillitis over the course of three consecutive years.

In addition to using that rate-of-frequency criteria, we will also take into consideration how much a person’s life is being affected by their tonsils. It is common to have a patient who comes in and reports that the enlarged size of their tonsils are causing issues with sleep apnea, swallowing and/or unwanted weight loss. This should always be reported to your physician.

Tonsillectomies for Adults Versus Children

Are tonsillectomies more painful for adults than children? The truth is the procedure itself is essentially the same for adults as it is for children. The recovery for adults tends to be more prolonged than it is for children. For adult patients, it can take about two weeks for patients to recover as the area needing to heal is larger. For children, they tend to get less sore following surgery and are usually back on their feet more quickly – often within one week.

For adults and children alike, following the procedure it’s usually recommended that the patient use pain medication, like Advil or Tylenol, to get the pain down to a dull ache. Recovery recommendations also include making sure you’re getting plenty of fluids after surgery, consuming foods that are easy to swallow – like pudding or Jell-O – and avoiding any strenuous activities.

The most worrisome complication of a tonsillectomy is to have bleeding after the operation. The tonsillectomy bed heals from a raw muscle bed and the soft scabs that form over this area tend to fall off after 5-7 days. During this time is when patients are at the highest risk of bleeding. The rate of bleeding after tonsillectomies varies in studies, but about 5-15 percent of patients bleed after a tonsillectomy. This can range from a small amount of bleeding which stops spontaneously, up to heavy life-threatening bleeding coming from the mouth which would need to be cauterized in the operating room. Fortunately, life-threatening bleeding after a tonsillectomy is rare.

Common Misconceptions

A common misconception is that, once a patient has a tonsillectomy, they will never get strep throat – or a sore throat at all – again. Unfortunately, it still is possible to get sore throats after a tonsillectomy. The good news is the surgery has proven to reduce the frequency and severity of sore throats and throat infections.

Next Steps & Resources

• Meet our clinical contributor: Amit Patel, M.D.
• To make an appointment with Dr. Patel or another physician, call 800-822-8905 or visit our website

Sources:

• American Academy of Family Physicians
• Faramarzi A, Heydari S.-T. (2010). Prevalence of post-tonsillectomy bleeding as day-case surgery with combination method;cold dissection tonsillectomy and bipolar diathermy hemostasis. Iranian Journal of Pediatrics.

The material provided through Health Hub is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.