When tonsillectomy is genuinely indicated
Tonsils are lymphoid tissue and part of the immune system. Most children have episodes of tonsillitis and outgrow them, so the threshold for removal is deliberately set high.
For recurrent infection, widely used benchmarks are around seven significant episodes in one year, five per year across two years, or three per year across three years. Episodes should be documented — fever, tonsillar exudate, enlarged neck nodes or a positive throat swab — rather than every sore throat counted.
For obstruction, the threshold is different and often more urgent. Tonsils large enough to obstruct breathing during sleep justify surgery regardless of infection frequency, because the consequences accumulate.
Adenoids and the mouth-breathing child
Adenoids sit high at the back of the nose, out of sight without a scope. When enlarged they block nasal airflow and obstruct the eustachian tubes, producing a distinctive picture: persistent mouth breathing, a nasal voice, snoring, restless sleep, and recurrent middle ear fluid with reduced hearing.
Because a child with glue ear from adenoid enlargement hears as though underwater, this frequently presents as inattention at school or delayed speech rather than as an ear complaint. Assessment is by nasal endoscopy, which shows the adenoid directly.
Adenoidectomy is often combined with tonsillectomy, and where persistent middle ear fluid is present, grommet insertion may be done in the same sitting. Improvements in sleep, behaviour and concentration are frequently reported by parents within weeks. See also snoring and sleep apnea.
Coblation tonsillectomy
Traditional tonsillectomy uses cold steel dissection or electrocautery. Coblation uses radiofrequency energy through a saline medium to dissolve tissue at a markedly lower temperature — around 60–70°C compared with several hundred degrees for electrocautery.
Lower temperature means less thermal injury to surrounding tissue, and in practice that generally translates to less post-operative pain, faster return to normal diet and quicker recovery. It is the technique used at the clinic.
No technique eliminates post-tonsillectomy pain. Coblation reduces it relative to hot techniques, but the throat still hurts for roughly a week to ten days, and days three to five are typically the worst. Expecting that makes it much easier to manage than being surprised by it.
The operation
Performed under general anaesthesia, through the open mouth — there are no external incisions or scars. Tonsillectomy alone takes around 30 to 45 minutes; combined with adenoidectomy, somewhat longer.
Many patients go home the same day. An overnight stay is more likely for young children, for significant obstructive sleep apnea, or where there are other medical considerations.
Recovery, day by day
- Days 1–2. Sore throat, often with referred ear pain — this is normal and does not mean an ear infection. Regular scheduled pain relief works far better than waiting for pain to build.
- Days 3–5. Usually the worst period. White or yellow patches appear where the tonsils were — this is normal healing tissue, not infection. Breath is often unpleasant.
- Days 6–10. Gradual improvement. The white patches separate away, and this is the period of highest bleeding risk.
- Days 10–14. Most children return to school and adults to work. Adults typically take longer than children.
Eating and drinking matters more than resting. Counter-intuitively, chewing normal food helps the throat heal and reduces pain over the week. Fluids are the priority — dehydration makes pain worse and is the commonest reason for readmission. Cold drinks, ice cream and soft food are encouraged early, then progressing to normal diet as tolerated.
Avoid crowds and unwell contacts for about two weeks, and avoid air travel and strenuous activity until cleared.
Warning signs needing urgent attention
- Any fresh bleeding from the mouth or coughing up blood — go to hospital immediately, even if it stops. Bleeding can recur suddenly.
- Inability to drink, or signs of dehydration — dry mouth, reduced urine, lethargy
- Fever above 38.5°C that persists
- Pain not controlled by prescribed medication
- Difficulty breathing
Secondary bleeding most often occurs between days five and ten as the healing surface separates. It is uncommon, but it needs immediate assessment rather than waiting to see.
Does removing tonsils weaken immunity?
This is the question parents ask most, and the reassurance is well founded. Tonsils are one small part of a large immune network that includes adenoids, lymph nodes throughout the body, the spleen and gut-associated lymphoid tissue. Removing them does not leave a child immunologically defenceless, and studies have not shown clinically meaningful increases in serious infection afterwards.
Set against that, repeated severe tonsillitis and untreated obstructive sleep apnea carry real costs — missed school, repeated antibiotic courses, disturbed sleep, and effects on growth and behaviour. When surgery is properly indicated, the balance favours it clearly.
Consultation and endoscopy at Sector 82A; surgery at Fortis Hospital, Manesar. Related: throat and voice care.