When Do You Need a Tonsillectomy?

Like most people, you’ve probably had a sore throat at one time or another. Behind the scenes, your tonsils were likely hard at work. The tonsils are a special tissue in the back of the throat that help fight infection. In most cases, that sore throat goes away in a few days after you rest and drink plenty of fluids. But tonsillitis can occur when there’s infection or inflammation of the tonsils.

If you get frequent tonsillitis (inflammation of the tonsils) as an adult, you may need to visit your provider to see if you need a tonsillectomy. Let’s take a closer look at signs you need your tonsils removed as an adult and what you can expect before, during, and after the procedure.

What is a tonsillectomy? 

A tonsillectomy is a surgery to remove the tonsils in both children and adults. In the U.S., it’s one of the most common surgical procedures. Over half a million children under the age of 15 have their tonsils removed each year. 

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• Explore surgery for sleep apnea. Tonsillectomy is just one type of surgery used to treat obstructive sleep apnea. 

• Speed your recovery. Knowing what foods to eat (and which to avoid) after a tonsillectomy can help you feel better faster.

• Treat strep throat. Adults can get strep throat, too. Read about the causes, symptoms, and when to get treatment.  

What are signs and symptoms of tonsillitis?

When the tonsils are infected or inflamed, you may notice several changes. You can expect to see these symptoms of tonsillitis:

• Enlarged, red tonsils

• Pain with swallowing

• White spots on the tonsils

• Painful lymph nodes in the neck

In addition to throat symptoms, you may also notice related symptoms such as:

• Fever

• Cough or congestion

• Headache

• Stomach pain

• Ear pain

• Difficulty breathing while sleeping

Why do people get their tonsils removed?

A provider may recommend a tonsillectomy if your tonsils stay too big for a long time. This can be due to a number of conditions affecting the tonsils. Let’s review some of the more common reasons for tonsillectomy. 

Frequent strep throat infections 

Tonsillectomy may be an option if you have more than six sore throats in a year and any of the following:

• Fever

• Swollen lymph nodes

• Positive strep tests

If you have 5 or more sore throats in each of the past 2 years, that’s also a reason to consider tonsillectomy. It may help to reduce frequent throat infections.

Peritonsillar abscess

A peritonsillar abscess is a pocket of pus near a tonsil. It’s a common complication of tonsillitis, but dental infections can also cause it.

Symptoms of peritonsillar abscess are similar to tonsillitis, but you may notice severe throat pain that’s specific to one side.

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Peritonsillar abscesses can be drained. But your provider may recommend a tonsillectomy if you have recurrent throat infections.

Sleep apnea

Sometimes tonsils get so big that they can block off part of your airway during sleep. This is what happens in sleep apnea. Children and adults who have sleep apnea often have enlarged tonsils. 

If you snore and have big tonsils, your healthcare provider may recommend a sleep study. This test shows how well you breathe while you sleep. Depending on the results, you may need a tonsillectomy.

Tonsil cancer

Tonsil cancer is the most common type of throat cancer. Experts note that it’s being diagnosed more often — likely due to rising rates of HPV infection. Other risk factors for developing tonsil cancer include smoking and alcohol use.

Cancer in the tonsils sometimes has no symptoms and may be found on a physical exam. In most cases, symptoms of tonsil cancer include:

• Sore throat

• Ear pain on one side

• Enlarged tonsil on one side

• Sensation of a something in the throat

• A feeling that the jaw is stuck open

• Swollen lymph nodes  

Treating tonsil cancer may involve removing the tonsils, neck lymph nodes, and part of the throat. Radiotherapy, chemotherapy, and immunotherapy may also be a part of the treatment plan. 

What are the dangers of tonsil removal in adults?

While all surgery has some risk, tonsillectomy is a very common procedure. Adults have a higher rate of complications than children do, but it’s still very safe. Pain is common, and it can be severe in adults. 

In adults, there’s also an increased risk of pneumonia for up to 30 days after surgery. This isn’t a direct complication of removing the tonsils. It’s more likely due to underlying health conditions that are more common in adults than in kids.

Some of the biggest risks include complications related to:

• Anesthesia: It’s possible to have nausea or vomiting after anesthesia.

• Bleeding: Some bleeding after tonsillectomy is normal. But excessive bleeding can be serious. Most bleeding happens within a day of surgery but can happen up to 2 weeks after the procedure.

• Pain: This is the most common complication. Pain can last for up to 2 weeks as the tissue heals. 

• Dehydration: Pain can make it difficult to swallow, so you may drink much less fluid than your body needs. The best way to prevent dehydration is to control your pain. This lets you drink as much fluid as your body needs each day.

• Voice changes: Rarely, surgery can cause too much air to reach the nasal passages when you talk. The result is a nasal-sounding voice that’s difficult to understand. This usually gets better on its own within several months, but sometimes people need surgery.

How can adults recover from a tonsillectomy?

As an adult, it may take longer to recover from a tonsillectomy. Studies show that there may be more bleeding and pain when you have your tonsils removed as an adult. 

The pain will start to lessen a week after the tonsillectomy. Your healthcare provider will suggest that you take it easy and limit strenuous activity for a couple of weeks. It will take your body that long to heal completely. 

What follow-up care do you need after a tonsillectomy?

Your healthcare provider will give you specific instructions after your tonsillectomy. It’s important to follow them to help prevent any complications from the surgery. Your instructions will likely include information about:

• Pain control: Your provider will likely recommend certain medications for pain and give you a specific schedule so you know how often to take them.

• Hydration: Make sure to stay hydrated by drinking plenty of liquids. Keeping your pain under control makes this easier. 

• A soft diet: If you’re wondering what to eat, start off with foods that are easy to swallow, like ice cream, broth, Jell-O, or pudding. Avoid trying to swallow solid foods for several days after surgery. 

• Oral hygiene: Brush your teeth at least twice a day, and gargle with water each time you eat. This helps to keep the wound clean and decreases your risk of wound infection. It also helps to improve the bad breath that can come with surgery.

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Written by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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