The tonsils are two pads of immune tissue at the sides of the throat. They are busy in childhood and shrink in adult life, and for most people they never cause trouble. For some they become a recurring problem: tonsillitis several times a year, each needing antibiotics and days off; abscesses that form beside them; stones that collect in their crevices and cause bad breath; or simply a size that blocks the airway during sleep.
Tonsillectomy removes them. It is one of the oldest operations in ENT, and while techniques have changed, the decision to operate still rests on a careful weighing of how much the tonsils are costing the patient against a recovery that is uncomfortable for about ten days.
Reasons to remove the tonsils
Recurrent tonsillitis. The usual threshold is seven episodes in a year, five a year for two years or three a year for three years, though the impact on life matters more than the arithmetic.
Obstructed breathing in sleep. In children especially, large tonsils and adenoids cause snoring, pauses in breathing, restless sleep and daytime tiredness. Removal is often the treatment of choice.
Abscess. A peritonsillar abscess, or quinsy, is painful and dangerous, and after more than one, removing the tonsils may be advised.
Tonsil stones. Persistent stones with bad breath or a foreign-body feeling that do not respond to simpler measures.
Asymmetry. A tonsil that is much larger than its partner may be removed so it can be examined.
The operation
Under general anaesthesia the tonsils are removed through the mouth, each separated carefully from its bed. Dr. Teker uses cold dissection or low-temperature radiofrequency depending on the case, and seals any bleeding points before the patient wakes. In children with sleep-related symptoms a partial, intracapsular removal can be chosen for a gentler recovery. There are no external incisions. Adults usually stay one night; children often go home the same day.
How recovery goes
The throat is sore for around ten days and the pain often peaks between the third and fifth day before easing. The keys are painkillers taken on a schedule rather than when the pain arrives, and plenty of fluids; with the pain under control, eating and drinking are easier. A white coating on the tonsil beds is normal healing. Adults return to work in about two weeks; children are usually back to normal sooner.
The bleeding risk
A small number of patients bleed from the throat, most often between days five and ten. It usually stops on its own but occasionally needs treatment, which is why patients are advised to stay within reach of the hospital and to avoid long journeys for the first ten days after surgery.