Tonsillectomy in Adults: Causes, Risks, and Recovery

Recurrent purulent tonsillitis can be dangerous. However, surgical removal of the tonsils (tonsillectomy) also carries certain risks, especially when performed later in life. Tonsillectomy in adults is usually recommended when infections become frequent or severe enough to affect daily life. The tonsils act as sentinels of our immune system — they react to invading germs and signal the need for antibody production through inflammation. When this happens, the tonsils swell and can become infected. Both viruses and bacteria can trigger inflammation, and bacterial infection can often be confirmed through a swab test. Common symptoms include fever above 38°C, swollen and painful cervical lymph nodes, purulent coating on the tonsils, and absence of cough.

When a tonsillectomy may be necessary

If antibiotic therapy only provides short-term relief from bacterial infections and the inflammation recurs, surgical removal of the tonsils may be necessary. Five to seven purulent tonsillitis episodes per year are considered an indication for tonsillectomy. If the inflammation spreads further into the throat, abscesses can form, making it impossible to open the mouth and swallow. If the pus fails to drain, tonsillitis can, in rare cases, become life-threatening: blood poisoning, meningitis, or suffocation are possible consequences.

What to consider after a tonsillectomy

Tonsillectomy is a short operation lasting 20 to 30 minutes – the most common procedure in the ear, nose, and throat area. During the procedure, the two tonsils are removed from the palate. The operation is performed under general anesthesia in adults, rarely under local anesthesia, on an outpatient or inpatient basis. The wound is not stitched and takes several days to heal. To avoid irritating the open wound, the following are prohibited:

• carbonic acid

• Fruit juices

• sour fruit

• hot or hard foods.

Furthermore, one must avoid anything that can increase blood pressure in the head, such as warm water or bending forward while showering, because this can quickly lead to severe bleeding or wound infection. To speed up healing, doctors recommend drinking plenty of fluids and rinsing the mouth several times a day with sage or chamomile tea.

Tonsil removal: Risks and complications

The first few days after a tonsillectomy are not pleasant: pain, difficulty swallowing, and sometimes nausea, vomiting, and taste disturbances can last for one to two weeks in some cases – and there is also a risk of post-operative bleeding. Even after a complete tonsillectomy, inflammation in the throat can still occur. However, those who have had a tonsillectomy are less likely to suffer from sore throats. Whether removing the tonsils weakens the immune system and increases the risk of respiratory infections has not yet been proven. However, the tonsils are more important for the immune system in children.

After surgery, Remnants of the tonsils can cause inflammation

In the past, tonsillectomies were often performed too hastily, leaving remnants of the tonsil in the palate that can cause problems decades later. If severe, stabbing throat pain, swollen lymph nodes, and a sore feeling in the mouth and throat occur, these remnants must be surgically removed.

Tonsillitis: What helps with tonsillitis?

Symptoms of tonsillitis include reddened and swollen mucous membranes in the throat, as well as a sore throat. When are home remedies helpful, and when are antibiotics necessary? And how long is tonsillitis contagious? The palatine tonsils, which are clearly visible around the uvula when the mouth is open, are part of the immune system and protect us from pathogens that enter the body through the nose and mouth via the air we breathe or food we eat. Tonsil inflam mation typically affects children and adolescents between the ages of five and 15, and occasionally adults as well. The medical term for tonsillitis is tonsillitis. Colloquially, the term angina is also used synonymously, derived from angina tonsillaris. Tonsillitis usually heals within one to two weeks. The appropriate treatment depends on whether the tonsillitis is caused by bacteria or viruses.

Symptoms: How do I recognize tonsillitis?

A common sign of tonsillitis is a sore throat. This is caused by swollen and reddened mucous membranes in the throat and pharynx. Other symptoms of acute tonsillitis include:

• Difficulty swallowing

• swollen lymph nodes in the neck

• Headache

• Fatigue

• Fever, occasionally also chills

• bad breath

yellowish-purulent coating on the swollen and reddened tonsils (purulent tonsillitis)

In addition to swollen tonsils, fever is typical of bacterial tonsillitis. However, those affected do not have a cough. The symptoms, especially at the beginning, can resemble those of the flu.

When viruses cause tonsillitis, such as the Epstein-Barr virus in infectious mononucleosis (glandular fever ), coughing and hoarseness are common accompanying symptoms. Sometimes a bacterial infection can develop on top of a viral one – experts then refer to this as a superinfection.

Diagnosis: Tonsillitis is usually caused by viruses

To diagnose tonsillitis, a simple examination of the throat is often sufficient. A yellowish-white coating on the tonsils suggests a bacterial infection, such as with streptococci. To be certain, the bacteria can be detected with tests. Rapid tests are available that allow doctors to determine within minutes whether streptococci are the cause. Statutory health insurance covers the rapid test for children up to the age of 16. Alternatively, the bacteria can be detected in a laboratory; the results take two to three days. However, tonsillitis caused by viruses rather than bacteria is more common than strep throat: in children it accounts for 70 to 85 percent of cases, and in adults for 90 to 95 percent.

Therapy: Antibiotic treatment for bacterial tonsillitis

Tonsillitis caused by a bacterial infection is treated with antibiotics and pain relievers, and fever reducers such as paracetamol and ibuprofen. Antibiotic treatment can shorten the duration of illness in cases of bacterial tonsillitis. Those affected quickly become less contagious, and rare complications such as a tonsillar abscess or middle ear infection occur even less frequently. However, the overall effect of antibiotics in uncomplicated tonsillitis is limited. Therefore, patients can discuss with their doctor whether or not to take them. Antibiotics are ineffective against tonsillitis caused by viruses; in these cases, anti-inflammatory painkillers are used. Pain-relieving and anti-inflammatory lozenges can also be helpful.

Which home remedies help with tonsillitis?

As with any infection, those suffering from tonsillitis should drink plenty of fluids. Gargling with sage and marshmallow tea helps soothe a sore throat, as the essential oils they contain inhibit bacterial growth. Gargling with salt water is also helpful: it has anti-inflammatory properties and fights bacteria. To do this, add a teaspoon of salt to a glass of warm water. Sucking on hard candy, warm compresses on the throat, cool drinks, or ice cream can also be soothing. Soups and soft foods like mashed potatoes make swallowing easier. When taking antibiotics, probiotic lactobacillus preparations can support the intestines and thus protect the gut flora. Sore throat with difficulty swallowing: Woman holds her neck and grimaces in pain.

How long is tonsillitis contagious?

If people with strep throat are treated with antibiotics, they are no longer contagious after 24 hours and can leave the house again. However, without antibiotic treatment, or if viruses are the cause of the tonsillitis, those affected can remain infectious for up to three weeks – even after the symptoms have disappeared. To protect others during this time, those affected should stay home or wear a face mask. This is because the pathogens are transmitted via aerosols, similar to the coronavirus. These small saliva bubbles are produced when speaking, coughing, sneezing, or kissing. The pathogens can easily spread through close contact.

When is surgery helpful for tonsillitis?

For children and adults who repeatedly suffer from strep throat, removing the palatine tonsils can be beneficial. These recurring infections not only strain the body and immune system but can also trigger rheumatic fever. More than three infections requiring antibiotics within twelve months is considered a guideline. An experienced ENT specialist West Yorkshire can help assess whether tonsil removal is the right option based on your medical history and frequency of infections. It’s important to understand that tonsil removal carries certain risks — pain may occur after surgery, and in rare cases, bleeding can develop, requiring further treatment. Additionally, removing the palatine tonsils means losing a small but significant part of the immune defense system.