What are the symptoms that indicate a child’s tonsils or adenoids may need to be removed? How is a tonsillectomy and/or adenoidectomy procedure performed, and what is the recovery like?

When Should You Consider Removing a Child’s Tonsils and/or Adenoids?

There are several reasons why tonsils and adenoid removal should be considered. The most common reason is when the tonsils are enlarged, creating an airflow blockage in the back of the child’s throat during sleep. The adenoids, similar to the tonsils but located in the back of the nose, can also cause reduced airflow and lead to snoring. This blockage can significantly impact the child’s sleep quality, heart development, lung function, and overall development.

Another common reason is recurrent tonsil infections. If the child experiences a significant number of tonsil infections, removing the tonsils (and possibly the adenoids) can lead to a significant improvement in quality of life and reduce the need for recurring antibiotic use.

What is a Tonsillectomy and/or Adenoidectomy Procedure Like?

A tonsillectomy and/or adenoidectomy procedure typically takes 30-45 minutes at Lurie Children’s Hospital. The child is fully asleep under general anesthesia, which has proven to be exceedingly safe in these circumstances. There are no cuts made on the skin, as the procedure is done through the mouth. The pediatric anesthesia team ensures the child receives pain medication and other medications to improve their post-operative experience.

Once the child wakes up, the hospital staff ensures they are eating, drinking, and that the pain is relatively controlled before they are allowed to go home. Most children go home the same day, but a minority may be kept overnight for observation in special circumstances.

What is the Tonsillectomy Recovery Like?

The recovery from a tonsillectomy feels like a bad sore throat. It is typically easier for younger children to recover from this procedure than older children. Post-procedure pain is usually controlled with acetaminophen (Tylenol) and ibuprofen (Motrin, Advil). In most cases, children can eat whatever they prefer after surgery, but a combination of popsicles, milkshakes, and ice cream can be soothing. Drinking lots of liquids afterwards tends to make the discomfort better.

What Do Tonsils and Adenoids Do?

Tonsils and adenoids are a type of tissue that helps filter bacteria and viruses. In some children, tonsils and adenoids can become enlarged and stay enlarged, resulting in snoring and sleep concerns, or they can become recurrently infected. Fortunately, the body has plenty of other tissue that also processes bacteria and viruses, so after tonsil and/or adenoid removal, the immune system is not weakened.

What Does It Mean if a Child Has Swollen Tonsils?

Swollen tonsils means that they are enlarged. This can happen for a variety of reasons, including natural growth, infection, and sometimes enlarged tonsils and/or adenoids are present in other family members.

How Do You Get Tonsillitis or Adenoiditis?

Tonsil and adenoid infections are caused by either bacteria or viruses. Many infections are passed between people, just like the common cold. Some children, however, are more prone to these infections compared to others. Because the tonsils and adenoids are responsible for filtering bacteria and viruses before they make it to the rest of the body, a sore throat is a common symptom of tonsillitis and adenoiditis.

Is There a “Best Age” to Get Tonsils Removed?

There is no definitive “best age” to get tonsils removed. If the tonsils are creating enough of a problem, regardless of the child’s age, then it is appropriate to consider proceeding with tonsillectomy and/or adenoidectomy. Younger children do tend to have an easier recovery, as their bodies heal faster and they often experience pain differently.

Ann & Robert H. Lurie Children’s Hospital of Chicago is recognized by the American College of Surgeons (ACS) as a Level I Children’s Surgery Center, demonstrating proficiency in surgical care at all levels. Board-certified pediatric specialists, including surgeons, anesthesiologists, critical care specialists, radiologists, and emergency medicine physicians, are available to patients around-the-clock, and the hospital maintains a quality improvement program to ensure the best quality of patient care.

Signs Your Child’s Tonsils or Adenoids May Need to be Removed

January 13, 2023

Medically reviewed by Drs. Doug Johnston and Taher Valika

When should you consider removing a child’s tonsils and/or adenoids?

There a several reasons why tonsils and adenoid removal should be considered. Most commonly tonsils are removed because they are enlarged and creating an airflow blockage in the back of a child’s throat when they are sleeping. The adenoids are similar to the tonsils, but in the back of the nose and can similarly cause reduced airflow. This blockage creates snoring, which can be mild, or could be causing a significant impact on the child’s sleep quality and even a child’s health and behavior.

Significant snoring that is associated with obstructive sleep apnea can significantly impact a child’s developing heart, their lungs and their overall development. Some children may also have recurrent tonsil infections and if this number is significant, then the child may experience a significant improvement in quality of life and be able to avoid recurrent antibiotic use, with tonsil (and possibly adenoid) removal.

What is a tonsillectomy and/or adenoidectomy like?

Getting your tonsils and/or adenoids taken out takes about 30-45 minutes at Lurie Children’s. Your child is fully asleep under general anesthesia, which has proven to be exceedingly safe in these circumstances. There are no cuts made on the on the skin as everything is taken out through the mouth. The pediatric anesthesia team makes sure to give the children pain medication and other medications to improve the way children feel. Once your child wakes up, we make sure they are eating, drinking and the pain is relatively controlled before you get to go home. Most kids go home the same day after surgery, but a minority are kept overnight for observation for special circumstances.

What is tonsillectomy recovery like? 

Getting your tonsils taken out feels like a bad sore throat. It is a lot easier for younger children to recover from this than older children. Post-procedure pain is usually controlled with acetaminophen (Tylenol) and ibuprofen (Motrin, Advil). In most cases, children can eat whatever they prefer after surgery, but a combination of popsicles, milkshakes and ice cream, can go a long way. Drinking lots of liquids afterwards tends to make discomfort better.

What do tonsils and adenoids do?

Tonsils and adenoids are a type of tissue that helps filter bacteria and viruses. In some children, tonsils and adenoids can get enlarged and then stay enlarged, resulting in snoring and sleep concerns, or they can become recurrently infected. Luckily, the body has plenty of other tissue that also process bacteria and viruses, so after tonsil and/or adenoid removal the immune system is not weakened. Simply put, tonsils and adenoids are like your appendix. If they are creating a persistent problem, then we often recommend removal.

What does it mean if a child has swollen tonsils?

Swollen tonsils means that they are enlarged. This can happen for a variety of reasons including natural growth, infection and sometimes enlarged tonsils and/or adenoids are present in other family members.

How do you get tonsilitis or adenoiditis?

Tonsil and adenoid infections are caused by either bacteria or viruses. Many infections are passed between people, just like the common cold. Some children, however, are more prone to these infections compared to others.  As the tonsils and adenoids are responsible for filtering bacteria and viruses before they make it to the rest of your body, it is why having a sore throat is such a common symptom of tonsillitis and adenoiditis.

Is there a “best age” to get tonsils removed?

There isn’t. If the tonsils are creating enough of a problem, regardless of how old you are, then it is appropriate to consider proceeding with tonsillectomy and/or adenoidectomy. Younger children do have an easier recovery as the body heals faster and they often experience pain differently.

Ann & Robert H. Lurie Children’s Hospital of Chicago is recognized by the American College of Surgeons (ACS) as a Level I Children’s Surgery Center. That means the hospital has demonstrated proficiency in surgical care at all levels. Board-certified pediatric surgeons, pediatric anesthesiologists, neonatal and pediatric critical care specialists, radiologists and trauma and emergency medicine physicians are available to patients around-the-clock. And the hospital maintains a quality improvement program with teams meeting regularly to review data related to safety to ensure the best quality of patient care.

Learn More About Our ENT Services

Do You Need To Have Your Tonsils Removed?

Are you suffering from recurring symptoms of tonsillitis or having difficulty swallowing or breathing? You may need those little things in the back of your throat removed. Most days you probably don’t give your tonsils much thought, but those things hanging out in the back of your throat are an important part in the health of your body. When they continuously get infected, they can become a big nuisance.

Although tonsillectomies are more common among children, some adults may benefit from the procedure too. In a recent conversation with Bruce Stewart, MD, an ear, nose and throat specialist at Banner – University Medical Center Tucson, he shared signs that you may need suregery to remove your tonsils.

Signs you may need surgery

1. Recurrent strep throat

“The biggest reason for adult tonsillectomies is recurrent strep throat that causes other problems, such as sleep apnea,” Dr. Stewart said. “It can vary among doctors, but I recommend surgery to my patients when they’ve had three or more infections in one year.”

2. Enlarged tonsils

Removing swollen tonsils has been found to be very effective in treating sleep apnea, however, your doctor may try less invasive treatments before exploring surgery.

3. Tonsil stones

It sounds a little gross, but sometimes debris, such as food, dead cells and other substances, can become trapped on the tonsils, creating tonsil stones. There are less invasive treatments, but the only way to permanently prevent them is with tonsillectomy.

4. Cancer of the tonsils

Whether you have your tonsils or not, you could develop tonsil cancer. About 70 percent of cancers in the oropharynx (tonsils, soft palate and base of tongue) are linked to the human papillomavirus (HPV), a common sexually transmitted virus. If you still have them, your doctors will remove as part of your cancer treatment.

Are there any risks?

Tonsillectomies are performed under general anesthesia, and although rare, there are some small risks, including possible bleeding, infection and a reaction to the anesthesia itself. Many patients experience nausea and vomiting, sore throat, low grade fever, bad breath, earaches and fatigue.

Dr. Stewart shared that some patients experience quite a bit of post-op pain, but it usually fades during the second week. That’s why he recommends taking your pain medication as prescribed and to stay hydrated.

“The procedure is no different for adults than for children, it’s just that adults take longer to heal,” he says. “As long as you keep on schedule with your pain meds, rest and stay hydrated the pain is manageable.”

When to seek medical attention

Life-threatening complications are rare, but Dr. Stewart said if you have bright red blood coming from your tonsil beds, a fever greater than 101, severe or persistent ear pain or symptoms of an upper respiratory infection, let your doctor know and seek immediate medical attention.

If you are concerned about you or your loved one, visit bannerhealth.com to find an ear, nose and throat specialist in your area.

For additional information, check out these related articles:

• All About Snoring: What Can You Do? 
• What Happens if You Get Strep Throat a Lot?
• What Are Tonsil Stones and How Are They Treated?

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Garant > Articles > Inflammation of the tonsils: treat or remove?

There are two methods of treating chronic tonsillitis: the first is the conservative treatment of the tonsils, the second is the removal of the tonsils. Is there a definite answer to the question of which of these methods is preferable?

The tonsils are lymphoid tissue located in the nasopharynx. They produce substances (so-called antigens) that serve to produce antibodies – an effective weapon against microorganisms. In the infant and young child, the tonsils play a very important role. However, as the child grows older, they produce less and less effective antibodies. During puberty, they are no longer so important in creating the body’s immunity. Therefore, the dilemma about removing the tonsils is especially acute for children.

Causes of inflammation of the tonsils

Inflammation of the tonsils, as a rule, is caused by pathogenic microbes or viruses that enter the mucous membrane during breathing. In response, the body tries to eliminate pathogens and damaged tissues and an inflammatory reaction occurs. Due to the fact that the immune system is weaker in children, they get sick more often.

In addition, both acute and chronic inflammation of the tonsils can contribute to the development of dental caries and other infectious diseases in the surrounding tissues.

If the tonsils are enlarged

It happens that the tonsils grow too large. This usually happens after frequent infections. Possible consequences are:

• difficulty swallowing due to a mechanical obstruction in the throat;
• Enlarged tonsils (called adenoids) can also make it difficult to breathe through your nose.
• blockage of part of the Eustachian tube by enlarged tonsils, which leads to otitis media due to impaired ventilation of the tympanic cavity. If you do nothing for a long time, fluid begins to accumulate in the ear. It ends with hearing loss or inflammation of the middle ear.

A simple symptom by which you can find out about the growth of the tonsils in a child is the presence of snoring during sleep. If snoring is accompanied by apnea lasting a few seconds, the tonsils should be removed. The danger of this situation should not be underestimated, because sleep apnea can lead to serious changes in the lungs, and in extreme cases even to cardiac arrest.

If hypertrophied tonsils seriously impede the child’s swallowing process, the baby does not want to eat, because he cannot swallow without problems. In such situations, it is customary to carry out a partial removal of the tonsils (cutting off), that is, their reduction by surgery.

Consequences of chronic inflammation of the tonsils

Even normal-sized tonsils can be the cause of a chronic inflammatory process. The tonsils are very porous, they have so-called niches in which bacteria accumulate, and it is from here that they enter the bloodstream. The tonsils are the focus of inflammation. Often this causes inflammation of the paranasal sinuses and larynx. If this condition is not treated, the child may develop inflammation of the joints, heart muscle, or membranes of the brain. But that is not all. Every few months, acute inflammation of the pharynx appears in the form of a sore throat. If angina stably recurs several times a year, you should consult with an ENT doctor and an immunologist on the removal of the tonsils.

How is tonsil removal performed?

The procedure for removing the tonsils is carried out with a special device. The removal must be done under anesthesia. Before the operation, it is necessary to do an ECG, chest x-ray, general urinalysis, a thorough blood test, taking into account blood clotting, as well as other factors informing about the state of the cardiovascular system. These analyzes are very important. The success of the operation or the recommendation to postpone it for a certain period depends on their results. It must be remembered that wounds after removal of the tonsils are not sutured, they must heal on their own. Therefore, if the blood does not clot well, it can lead to serious bleeding. For the next three weeks after the operation, you need to follow the diet, the food should be cool and soft, without hot spices.

Thus, the removal of the tonsils with their inflammation should be resorted to in cases where conservative treatment of the tonsils does not give positive results and their preservation can lead to serious complications.

You can also read the article “Tonsillectomy” on our website.

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How to treat tonsillitis and when should tonsils be removed?

Tonsils (aka palatine tonsils) are soft glandular tissue and are part of the immune system. They produce antibodies that help the body fight infection. When the tonsils become inflamed, the otolaryngologist diagnoses tonsillitis. In this article, we will look at what are the symptoms of this disease, how to treat tonsillitis, and in which cases it is necessary to remove the tonsils.

The tonsils are the body’s first line of defense against bacteria and viruses that enter the mouth. This is what makes the tonsils especially vulnerable to infection and inflammation.

The main causes of tonsillitis are bacteria and viruses. The main ones include:

• Streptococcus bacterium,
• Adenovirus (one of the types of viruses that cause SARS),
• Epstein-Barr virus, which causes infectious mononucleosis,
• Herpes simplex virus,
• Cytomegalovirus,
• Measles virus.

According to British doctors, children aged 5-10 and young people aged 15-25 most often experience tonsillitis. Usually it is children who suffer from this disease, although tonsillitis very rarely affects babies who are not yet 2 years old. According to the statistics of scientists from the American Academy of Otolaryngologists, usually bacterial streptococcal infection causes tonsillitis in children aged 5-15 years, and viral in younger children.

After puberty, the function of the tonsils decreases. This explains why tonsillitis is very rare in adults. By the way, sometimes inflammation affects not only the palatine tonsils, but also the lingual tonsils and adenoids.

This disease has several forms:

• Acute tonsillitis,
• Recurrent,
• Chronic,
• Peritonsillar abscess.

What are the symptoms of tonsillitis?

Symptoms of this disease appear depending on its form.

Acute tonsillitis has these features:

• Sore throat,
• Red, swollen tonsils,
• Bad breath,
• Dysphagia (difficulty swallowing),
• Hypersensitivity in cervical lymph nodes,
• Slight change in voice,
• Abdominal pain, especially in young children.

During acute tonsillitis, airway obstruction develops due to swelling of the tonsils. For this reason, the patient begins to breathe through the mouth and snore. The patient also develops sleep apnea. Usually, all of the above symptoms “keep” for 3-4 days, but can haunt the patient for up to two weeks.

If the child is too young to talk about his symptoms, parents may see the following signs of tonsillitis:

• Increased salivation,
• Unusual fussiness,
• Lack of appetite.

The recurrent form of the disease has symptoms identical to acute tonsillitis. It is diagnosed if during 1 year the patient experiences several episodes of inflammation of the tonsils.

Chronic tonsillitis causes the following symptoms:

• Persistent sore throat,
• Bad breath,
• Increased sensitivity in the cervical lymph nodes.

Peritonsillar abscess

Peritonsillar abscess is essentially a complication of tonsillitis. In this form of the disease, the patient has the following symptoms:

• Very severe sore throat,
• Fever,
• Bad breath,
• Strong salivation,
• Spasm of masticatory muscles, which makes it difficult for the patient to open his mouth,
• Strong change in the timbre of the voice – it becomes nasal and rougher.

Diagnosis of tonsillitis

At the appointment, the ENT examines the throat and analyzes the patient’s medical history. During the examination of the child, the doctor will pay special attention to some individual signs of the disease. This will help determine the form of the disease and establish the nature of its origin – bacterial or viral.

• A beta-hemolytic streptococcal infection (bacterial) causes tiny spots on the roof of the mouth. Also in this case, the cervical lymph nodes may increase. Note that the presence of spots on the palate may also indicate an infection caused by the Epstein-Barr virus.
• Change the tone of the voice. In acute tonsillitis, the voice does not change as much as in paratonsillar abscess. Also, in the acute form of the disease, the patient develops increased sensitivity in the cervical lymph nodes and hardening of the neck muscles.
• Occasionally, a teenager or young child will experience increased sensitivity in the cervical, axillary, and/or groin lymph nodes. This suggests a possible Epstein-Barr virus infection.
• If the patient’s tonsils are covered with a gray membrane, the cause of tonsillitis is most likely hidden in an infection caused by the Epstein-Barr virus.
• In patients with herpes simplex virus, small ulcers form on the surface of the red and swollen tonsils.
• With paratonsillar abscess, one-sided protrusion of one of the tonsils is observed. The patient at the same time hardly opens his mouth, and the pain can spread to the ear.

Often the diagnosis of tonsillitis requires not only a physical examination, but also some laboratory tests. Usually the patient is prescribed 2 tests:

1. Throat swab. This test is performed when a streptococcal infection is suspected.
2. Complete blood count. This test helps to determine the nature of the origin of tonsillitis – bacterial or viral. Very often, with obvious signs of streptococcal infection, a complete blood count is not prescribed.

How to treat tonsillitis?

Regardless of whether the illness is caused by a virus or a bacterium, managing symptoms at home can help relieve the patient’s condition. Moreover, if the cause of the disease is of a viral origin, patient care is the only thing to do. If a child gets sick, his immune system will cope with the disease within 7-10 days without taking antibiotics.

Recommendations for the treatment of viral tonsillitis include:

• Get more rest,
• Drink plenty of fluids,
• Drink warm, decaffeinated drinks or ice cream to soothe a sore throat,
• Gargle with salt water,
• Use a humidifier to keep dry air from irritating and without that sore throat. If you don’t have a humidifier, you can fill the bathroom with hot water and breathe in the steam for a few minutes.
• Suck on lozenges to help soothe a sore throat. It is not recommended to give lozenges to a child under 4 years old, as the baby may choke,
• Take paracetamol or ibuprofen to bring down a fever and sore throat. If the temperature rises slightly, do not give the child any pills.

Unless strictly indicated, children under 18 should not take aspirin. If you give this drug to children during a cold or flu season, they may develop a very rare but life-threatening disease called Reye’s syndrome.

Treatment of tonsillitis with antibiotics

If the disease is caused by a bacterial infection, the ENT prescribes antibiotics to be taken for 10 days. It is very important to complete the entire course of therapy so that the medicine completely destroys the bacterium. In no case do not deviate from the treatment plan prescribed by the doctor, otherwise the infection may spread to other organs and systems.

When should tonsils be removed ?

Tonsil surgery is performed only in the following situations:

1. If the tonsils are constantly inflamed (recurrent form of the disease),
2. In the case of chronic tonsillitis,
3. If antibiotics cannot eliminate the bacterial infection.

What are the complications of tonsillitis?

Persistent inflammation and swelling of the palatine tonsils can cause some complications. These include:

• Otitis media,
• Obstructive sleep apnea,
• Spread of infection into the tissues surrounding the tonsils (tonsillar cellulitis),
• Peritonsillar abscess – accumulation of pus behind the tonsil,
• Rheumatic fever – a disease that affects the heart, joints and other tissues,
• Post-streptococcal glomerulonephritis – inflammation of the kidneys,
• Scarlet fever.

Some of the complications of tonsillitis are also indications for the removal of tonsils.

When should I see a doctor?

If an adult falls ill and the symptoms “do not go away” after 3-4 days, it is necessary to see an ENT. If a child is sick, it is best to bring him to the doctor as soon as possible.

When symptoms appear from the list below, you need to seek medical help as soon as possible:

• Very severe sore throat,
• Problems with breathing or opening mouth,
• Large difficulties with swallowing saliva,
• High temperature
• Excessive salivation
• Severe malaise, especially if the throat hurts on one side only.