Fact sheet: Tonsil surgery in children
Most children only have tonsillitis every now and then. Although it is unpleasant, it usually gets better after a few days. But if tonsillitis keeps coming back over several years, the option of surgically removing the tonsils is often considered. This fact sheet describes the advantages and disadvantages of this operation in children who have tonsillitis.
When is it worth considering surgery?
Acute bacterial infections of the tonsils are associated with symptoms such as sore throat, difficulty swallowing, fever and tiredness. Breathing problems and snoring can disrupt sleep. Tonsillitis that keeps coming back within short spaces of time can be very distressful and greatly affect your wellbeing. But a sore throat might also be caused by a viral throat infection. Even doctors often find it difficult to distinguish between these two types of infections.
You can find more information on this topic in our feature.
Tonsillitis is far more common in children and teenagers than it is in adults. Some have tonsillitis 4 to 8 times a year, and each episode may last one to two weeks. As a result, children keep on having to stay home from school. Parents often have to stay home too, to take care of their child.
Some only have tonsillitis once, whereas others keep getting tonsillitis over several years. Sometimes tonsils become permanently inflamed, causing things like breathing problems. Painkillers and antibiotics might not provide enough relief. Some people do not want to keep having to use medication. Tonsillitis can lead to complications such as quinsy (also known as a peritonsillar abscess), which is where pus collects around the tonsils. Having a complication like this might be the reason why people end up thinking about having surgery to remove their tonsils. The medical term for this operation is tonsillectomy.
It can be hard to decide whether or not to have tonsils removed. On the one hand there is the hope that having tonsils out will mean you will have fewer infections, or even stop getting them altogether. On the other hand the surgery is associated with risks, and you cannot be sure that it will actually help.
What are the benefits of tonsil surgery?
Surgery can help reduce the number of throat infections. If tonsils have been taken out, they can no longer become infected – but the tissue surrounding the tonsils might still become infected.
Surgery is most likely to help reduce the number of throat infections in children who have more severe symptoms. The symptoms of tonsillitis are considered to be “more severe” if a child has had a sore throat and other tonsillitis-related problems for several days
· at least seven times within the last year,
· at least five times per year within the last two years or
· at least three times per year within the last three years
· and the sore throat is accompanied by
· a fever over 101° F (38.3° C),
· enlarged or hard neck lymph nodes,
· pus on the tonsils or
· the confirmed presence of certain bacteria.
The following was found to be true for children who have more severe symptoms:
Those who have their tonsils removed have an average of one throat infection within the first year following surgery.
Those who do not have their tonsils removed have an average of three throat infections within that same time period.
In other words, surgery can prevent an average of two throat infections within the first year.
Children who have milder symptoms, who do not have the problems listed above, can benefit from surgery too. But the benefit is smaller: they have an average of two rather than three throat infections within the first year following surgery.
What are the arguments against surgery?
A lot of children get tonsillitis less as they grow older, or they might stop getting tonsillitis altogether. But there is no way of knowing which children will simply “grow out of” having recurrent throat infections.
The surgical removal of tonsils is associated with discomfort and risks: the wound might hurt, and swallowing may be painful after the operation. About 20 to 50 out of 100 children say they have severe pain following the surgery. Temporary nausea, vomiting, swallowing problems and loss of the sense of taste might occur. And complications such as bleeding are possible too (see below). The wound usually hurts less after a few days.
Another thing to consider is that surgery is not always very effective. Whether an operation helps, and how much it helps, will depend on how severe the symptoms are and whether the throat infections mainly start in the tonsils or in the surrounding tissue.
What complications can surgery lead to?
The wound might start bleeding again after the operation. This kind of bleeding usually happens within the first 24 hours after surgery (primary hemorrhage) or about 5 to 28 days after surgery (secondary hemorrhage). If the child swallows the blood it often goes unnoticed at first. The child may then vomit blood later. Bleeding after surgery is an emergency and must be treated immediately. The child might need a blood transfusion or another operation. In very rare cases the bleeding could become very heavy, leading to life-threatening complications.
The likelihood of bleeding after an operation depends on various things, such as the surgical technique used, how old the patient is, and whether he or she already has certain other medical conditions. There is no reliable data on how common this kind of bleeding is in Germany. Data from other countries can help get an idea of how common it is on average:
About 4 out of 100 people have bleeding after tonsil surgery; one of those 4 will have bleeding within 24 hours of surgery, and the other three will have bleeding within 28 days of surgery.
One out of the four people will have another operation because of the bleeding.
Like with any operation, the procedure is associated with other risks, for example due to the anesthetic.
What does the surgery involve?
The operation is carried out in a hospital. Children usually have the operation under general anesthetic. The tonsils are removed using special surgical instruments. It takes about 15 to 30 minutes to perform the procedure. People who have their tonsils out typically stay in the hospital for about a week afterwards.
What are the different surgical procedures?
A lot of different surgical procedures are performed nowadays. Roughly speaking, the procedures can be divided up into two main groups:
Procedures that use heat (diathermy): These approaches involve removing the tonsils using radiofrequency energy to produce a lot of heat. The heat is used to seal the wound immediately after the operation. Newer approaches use a lower temperature. This is called coblation tonsillectomy.
Procedures that do not use heat (dissection): These approaches involve removing the tonsils using surgical instruments (scissors, snare).
Are some techniques better than others?
All of the different procedures have advantages and disadvantages:
Bleeding during surgery is less common with diathermy using high temperatures than it is with dissection. Bleeding after surgery is just as common in both approaches.
However, bleeding after surgery seems to be more common with diathermy using lower temperatures (coblation) than it is with dissection. Research has found that about 2 out of 100 people have bleeding following dissection, compared to about 5 out of 100 people who have diathermy using lower temperatures.
Research suggests that dissection is associated with less pain after surgery.
What can you do to feel more comfortable after surgery?
Pain is the biggest problem after surgery. It usually gets better after a few days. Until that happens, the pain can be relieved using medication in the form of tablets, suppositories, drops or an intravenous infusion (a “drip”). There is not enough good research to be able to say whether special throat sprays, mouth washes or mouth rinses can effectively relieve the pain. All that is known is that lidocaine spray can help with the pain in the first three days after surgery. People can also use medication for nausea and vomiting.
It is thought that doing certain things can help you recover faster and lower the risk of bleeding after surgery. For example, people are advised to rest during the first few days after the operation, and only start doing sports again after a few weeks. It can also make sense to avoid solid foods at first, to go easy on the wound. Spicy foods and acidic foods such as fruit juices and citrus fruits may irritate the wound. Using mouth rinses can have the same effect.
Children sometimes find it difficult to deal with not being able to speak or eat properly after surgery. It is then important that parents, other people close to them or medical caregivers are there for them. Chatting, reading to them or watching TV together can distract children, making it easier for them to feel more relaxed. Before the operation children should be informed about what will happen afterwards and how they can cope.
If tonsil surgery is planned, you can read about anxiety before surgery on our website.
You can find out more about the structure and function of tonsils in our information “How do the tonsils work?”
Published by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany)
Next planned update: April 2016. You can find out more about how our health information is updated in our text "Informed Health Online: How our information is produced."
IQWiG health information is based on research in the international literature. We identify the most scientifically reliable knowledge currently available, particularly what are known as “systematic reviews.” These summarize and analyze the results of scientific research on the benefits and harms of treatments and other health care interventions. This helps medical professionals and people who are affected by the medical condition to weigh up the pros and cons. You can read more about systematic reviews and why these can provide the most trustworthy evidence about the state of knowledge in our information “Evidence-based medicine.” We also have our health information reviewed to ensure medical and scientific accuracy.