• Mayo Clinic Q & A

    Mayo Clinic Q and A: What is a tonsillectomy and who needs one?

a sick white child with a sore throat having it examined

DEAR MAYO CLINIC: My 4-year-old son has had many episodes of painful sore throats, and his doctor recommended that his tonsils be removed. Why do kids have more trouble with their tonsils? Is there a right age to have the surgery done? I've heard that recovery from tonsil surgery is painful, so what can we expect?

ANSWER: Often when children complain of sore throats, their tonsils may be to blame. The tonsils are part of our immune system that is essential to keeping us healthy. Tonsils are small, oval-shaped pads at the back of the throat that make white blood cells. These cells attack and prevent germs that enter your body and make you sick.

While small in size, the tonsils can cause considerable pain and discomfort if they get inflamed. When this happens, a person is said to have tonsillitis. This usually occurs because of a viral infection, although bacterial infections also can cause tonsillitis.

Children are more prone to tonsillitis than adults for a few reasons. They are constantly surrounded by germs, whether at school, day care or at extracurricular activities. Additionally, children are not as good at hand-washing and sneezing or coughing etiquette, so there are more germs in their environments. They easily catch colds, which can cause runny noses and lead to tonsillitis. Also, their throats are smaller than adults. So, if they have bigger tonsils, this can lead to breathing problems and sleep apnea.

Sometimes, a person can have tonsillitis once or twice and recover with no issues. But for others, like your son, the inflammation occurs repeatedly and does not respond to treatments, or it causes complications. A common procedure called a tonsillectomy, which is the surgical removal of the tonsils, may be recommended in these cases.

There is no right age for a tonsillectomy. Some people think tonsillectomies are only for children under 12. While the procedure is more common in younger children, tonsils may be required to be removed at any age. Tonsillectomy is the second-most common procedure performed by otolaryngologists.

Children and adults who experience these issues may benefit from a tonsillectomy:

  • Recurrent or chronic sore throat
    A recurrent sore throat is having a sore throat several times a year, while a chronic sore throat lasts two or three months. These painful conditions don't seem to resolve on their own.
  • Frequent tonsillitis
    Usually, this is defined as at least seven episodes in the previous 12 months, at least five episodes per year for the last two years, or at least three episodes per year for the past three years.
  • Sleep apnea caused by enlarged tonsils
    When tonsils are too big, they can cause obstructive sleep apnea. The oversized tonsils block the airway, interrupting breathing and sleep.
  • Tonsils of different sizes
    Typically, tonsils are about the same size. When one is significantly bigger than the other, both tonsils should be removed to rule out throat cancer or other serious conditions.

A lot has changed since many adults had their tonsils removed as children. In the past, people needed to remain in the hospital after a tonsillectomy, sometimes for several days. Now most patients can return home on the same day as their surgery. The procedure takes about 30 to 45 minutes and is performed under general anesthesia in an operating room.

During recovery, most people experience some pain that is similar to a bad sore throat. This usually lasts about a week. I typically recommend that most of my patients stay home from school or work during this time, drinks lots of fluids and eat soft foods. The pain usually subsides, and most people are back to normal after about two weeks.

Overall, a tonsillectomy is a safe procedure, but there is a small risk of bleeding at the incision sites. Over time, a scab forms over the incision similar to one your body forms over a cut on your hand or arm. There is a slight risk of bleeding when the scabs fall off about seven to 10 days after surgery.

Your pediatrician can help you obtain a referral to a pediatric otolaryngologist who would be able to perform the surgery. The physician can give you more specifics after he or she evaluates your son. But, overall, many children have reduced episodes of illness after removal of tonsils. Dr. Pao Vang, Otolaryngology, Mayo Clinic Health System, Eau Claire and Rice Lake, Wisconsin