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Signs of needing tonsils removed: Signs It’s Time for a Tonsillectomy

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Signs It’s Time for a Tonsillectomy

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.

Tonsillectomy FAQs: Signs your child needs their tonsils out

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Some adults may remember a tonsillectomy (the surgical removal of the tonsils) as a rite of passage in childhood. While a tonsillectomy is still one of the most common surgical procedures for children, they are performed less frequently than in the past.

Amy Coffey, M.D., Pediatric Otolaryngologist at Children’s Health℠ and Associate Professor at UT Southwestern, regularly talks to parents about if or when their child needs their tonsils removed.

Here, she answers parents’ frequently asked questions including when a tonsillectomy should be performed and what they – and their child – can expect before, during and after surgery.

When should a child have their tonsils removed?

The two most common signs a child needs their tonsils removed is when the child has recurrent strep throat infections or obstructive sleep-disordered breathing.

  • Recurrent strep throat infections – If your child has had seven strep throat infections in one year; five infections a year for two years in a row; or three infections a year for three or more years, your pediatrician will likely refer you to an ENT surgeon for evaluation.
  • Obstructive sleep-disordered breathing (oSDB) – Also known as obstructive sleep apnea, oSDB is more than loud snoring. It can cause a child to stop and start breathing several times during the night and lead to serious health issues, including weight gain, pulmonary hypertension, behavioral problems and trouble paying attention.

Less common reasons a child may need a tonsillectomy include:

  • Peritonsillar abscess – A complication from an untreated strep infection that causes a pus-filled pocket to form near one tonsil. It is more likely to recur unless tonsils are removed.
  • Dysphagia – Difficulty swallowing due to large tonsil size

Reasons your child doesn’t need tonsils taken out include bad breath and large or swollen tonsils.

“Large tonsils in a child by itself isn’t an indication that a tonsillectomy is necessary,” cautions Dr. Coffey. “Though it’s a very safe procedure, tonsil removal is still surgery. The benefits must outweigh the risks of the procedure. Size doesn’t necessarily impact your child’s health.”

At what age can a child have a tonsillectomy?

A child at any age can have a tonsillectomy if the indications are severe. However, surgeons generally wait until children are 3 years old to remove tonsils because the risk of dehydration and bleeding is greater among small children.

Is a tonsillectomy safe?

A tonsillectomy is generally considered to be a safe procedure. As with any surgical procedure, there are risks associated. The most common risks include bleeding and dehydration.

How much bleeding is normal after a tonsillectomy?

Bleeding is most common within 24 hours after the surgery and then again anywhere from 5-14 days when scabs come off after surgery. Most of the time, children and parents aren’t even aware there is bleeding. It can irritate the throat and stomach and cause children to vomit, which is when parents usually become aware there is bleeding.

“Bleeding can be scary, but it doesn’t last long,” explains Dr. Coffey. “It does need medical attention to ensure there are no complications from the surgery, though. If your child has severe bleeding – bleeding that doesn’t stop – call 911. Otherwise, call your child’s surgeon to determine if your child needs to be seen.”

How can I encourage my child to drink after a tonsillectomy?

Children may be hesitant to drink after surgery because of throat pain. It’s important for them to drink regularly so they stay hydrated, which can help the healing process.

Dr. Coffey shares several do’s and don’ts with parents to help encourage fluids after surgery:

  • Do set a timer once or twice an hour the first few days after surgery so parents and kids remember to take a few sips
  • Do offer popsicles
  • Do offer water or 100% juice
  • Do give small amounts of water by syringe like medication if refusing to drink
  • Don’t offer thick drinks like milkshakes unless using a spoon
  • Don’t use straws or sippy cups as suction can irritate the throat

How can I help relieve my child’s pain after a tonsillectomy?

A sore throat and pain are the most common side effects of a tonsillectomy. Regular fluids can help ease a sore throat and pain, in addition to keeping kids hydrated after surgery.

Over-the-counter pain medicine is also effective pain relief after tonsils are removed. You can alternate children’s acetaminophen (such as Tylenol) and a non-steroid anti-inflammatory (such as ibuprofen) to help control pain. Be sure to follow your surgeon or nurse’s dosing instructions, including the amount and frequency.

“I often recommend parents wake children up the first night or two after surgery to stay on top of pain relief,” offers Dr. Coffey.

How long does recovery take after a tonsillectomy?

Generally, most children are back to normal about 10 days after a tonsillectomy.

“The first two or three days are very intense. That’s when your child needs the most attention,” says Dr. Coffey. “Keep them drinking fluids and limit activities those first few days.”

Your child should avoid contact sports or heavy physical activity for two weeks after surgery because of the risk of bleeding.

Children can return to school once the throat is completely healed, which can be anywhere from 10 days to two weeks. Your surgeon can help you determine the schedule that’s right for your child and family.

Learn more

The ear, nose and throat team at Children’s Health includes fellowship-trained, board-certified physicians, advanced practice providers, nurses and support staff who have special training to diagnose and treat children with ENT issues. Learn more about our ENT program, services and support we offer children and families.

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