Tonsillectomy is a surgical procedure in which both palatine tonsils are fully removed from the back of the throat. The procedure is mainly performed for recurrent tonsillitis, throat infections and obstructive sleep apnea (OSA). For those with frequent throat infections, surgery results in 0.6 (95% confidence interval: 1.0 to 0.1) fewer sore throats in the following year, but there is no evidence of long-term benefits. In children with OSA, it results in improved quality of life. While generally safe, complications may include bleeding, vomiting, dehydration, trouble eating, and trouble talking. Throat pain typically lasts about one to two weeks after surgery. Bleeding occurs in about 1% within the first day and another 2% after that. Between 1 in 2,360 and 1 in 56,000 procedures cause death. Tonsillectomy does not appear to affect long-term immune function. Following the surgery, ibuprofen and paracetamol (acetaminophen) may be used to treat postoperative pain. The surgery is often done using metal instruments or electrocautery. The adenoid may also be removed or shaved down, in which case it is known as an "adenotonsillectomy". The partial removal of the tonsils is called a "tonsillotomy", which may be preferred in cases of OSA. The surgery has been described since at least as early as 50 AD by Celsus. In the United States, as of 2026, tonsillectomy is performed less frequently than in the 1970s, although it remains the second-most common outpatient surgical procedure in children. The typical cost when done as an inpatient in the United States is US$4,400 as of 2013. There is some controversy as of 2019 as to when the surgery should be used. There are variations in the rates of tonsillectomy between and within countries.
Medical uses Tonsillectomy is mainly undertaken for sleep apnea and recurrent or chronic tonsillitis. It is also carried out for peritonsillar abscess, periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA), guttate psoriasis, nasal airway obstruction, tonsil cancer and diphtheria carrier state. For children, tonsillectomy is usually combined with the removal of the adenoid. However, it is unclear whether the removal of the adenoid has any additional positive or negative effects for the treatment of recurrent sore throat. In cases of chronic tonsillitis in adults, there is strong evidence of increased quality of life, reduction of symptoms, and economic benefit. A randomised controlled trial of tonsillectomy versus medical treatment (antibiotics and pain killers) in adults with frequent tonsillitis found that tonsillectomy was more effective and cost effective. It resulted in fewer days with sore throat.
Sore throat Surgery is not recommended for those with fewer than seven documented throat infections in the last year, fewer than five each year for the last two years, or fewer than three each year for three years. Severely affected children who undergo surgery on average have one fewer sore throat per year in the subsequent one or two years, compared to those who do not. Specifically one review of five randomized controlled trials, found a decrease from 3.6 to 3.0 episodes in the year following surgery. In less severely affected children, surgery results in an increase, rather than a decrease of sore throats when the sore throat directly following surgery is included. Surgery results in a reduction in school absence in the following year, but the strength of evidence is low. Surgery does not result in an improvement in the quality of life. Benefits of surgery do not persist over time. Those with frequent throat infections often spontaneously improve over a year without surgery. Therefore, a certain number of people who undergo surgery will do so unnecessarily as they would not have had further episodes of tonsillitis had they not had surgery. Evidence in adults is unclear.
In 2019, the American Academy of Otolaryngology & Head and Neck Surgery (AAO-HNS) recommended:Caregivers and patients who meet the appropriate criteria for tonsillectomy as described here should be advised of only modest anticipated benefits of tonsillectomy, as weighed against the natural history of resolution with watchful waiting, as well as the risk of surgical morbidity and complications and the unknown risk of general anesthesia exposure in children [younger than] four years of age. In considering the potential harms, the guideline panel agreed that there was not a clear preponderance of benefit over harm for tonsillectomy, even for children meeting the Paradise criteria [seven episodes in the past year, five episodes per year in the past two years, or three episodes per year in the past three years]. Instead, the group felt there to be a balance that allows either tonsillectomy or watchful waiting as an appropriate management option for these children and does not imply that all qualifying children should have surgery. The role of tonsillectomy as an option in managing children with recurrent throat infection means that there is a substantial role for shared decision-making with the child's caregiver and primary care clinician.Many cases of the sore throat have other causes than tonsillitis, and tonsillectomy is therefore not indicated for those cases. The diagnosis of tonsillitis is often made without testing for bacteria. The UK National Health Service states that it is very rare that someone needs to have their tonsils taken out, and it is usually only necessary in case of severe tonsillitis that keeps recurring.
Obstructive sleep apnea Tonsillectomy improves obstructive sleep apnea (OSA) in most children. A 2015 Cochrane review found moderate quality evidence for benefits in terms of quality of life and symptoms, but no benefit in attention or academic performance. It is recommended that physicians and parents should weigh the benefits and risks of surgery, as OSA symptoms may spontaneously resolve over time. An AHRQ review however did find improvements at school. The procedure is recommended for those who have OSA that has been verified by a sleep study. Studies have shown that treatment success of uvulopalatopharyngoplasty with tonsillectomy increases with tonsil size.
Other There is no good evidence for other uses such as tonsil stones, bad breath, trouble swallowing, and an abnormal voice in children.
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