When to consider removing the Tonsils

Problems where an operation may be required to remove the tonsils

1. Recurrent acute tonsillitis

As a guide, surgical removal of the tonsils is considered once there has been

• a). 7 infections in a 12 month period, or
• b). 5 infections per year for 2 years in a row or more, or
• c). 3 infections per year for 3 years in a row or more

2. Chronic tonsillitis

This is where previous infection and scarring has lead to an ongoing low-grade infection of the tonsils. There can be a build up of debris within the tunnels that go from the surface of the tonsils deep into the tonsils themselves. This debris consists of old food being broken down by bacteria as well as white blood cells and dead skin cells, and appears as white flecks or even small stones (tonsilloliths) on the surface of the tonsils. Manifestations of this condition include an ongoing sore throat, bad breath, bad smelling/tasting debris on the tonsils, redness around the tonsils, and enlarged neck glands.

3. Upper airway obstruction

Where the tonsils have enlarged to the point where they are blocking the airway and causing difficulty breathing. This is often most evident at night with severe snoring and struggling to breathe when asleep (Sleep Disordered Breathing). The most severe form of this is Obstructive Sleep Apnoea, but even milder forms can cause problems.

4. Difficulty swallowing

At times the tonsils may be so enlarged as to also cause difficulty with swallowing.

5. Glandular fever

When someone has suffered with Glandular Fever, they often start having problems with the tonsils. They can develop recurrent or ongoing tonsillitis or they can develop problems with upper airway obstruction. Very rarely with a severe episode of Glandular Fever, the tonsils can be so enlarged that they have to be removed whilst there is active infection.

6. Previous quinsy (or peritonsillar abscess)

This is an abscess that forms just above/behind/beside the tonsil, between the tonsil and underlying muscles of the throat. This is a very painful condition and if this abscess has occurred once, then up to one in five patients may get a recurrence (although it’s impossible to predict who that will be!)

7. Suspicion of a tumour of the tonsil

This is very uncommon, particularly in children.