Everything You Need to Know About Tonsils and Tonsillectomy

This story originally ran Sept. 16, 2019, and was updated Jan. 17, 2024.

Tonsillectomy—a surgery to remove tonsils—is one of the most common childhood surgeries. Currently, about 300,000 to 500,000 tonsillectomies are performed each year for children younger than 15 in the United States.

We talked to Christine DeMason, MD, an ear, nose and throat physician at UNC Hospitals in Chapel Hill, about what the tonsils do and why they sometimes need to be removed.

What Tonsils Do

There are a few types of tonsils in the throat, but when people refer to “the tonsils,” they typically mean the palatine tonsils, which are two oval-shaped masses at the back of the throat, one on each side. Tonsils vary in size from person to person.

Tonsils trap bacteria and viruses that you breathe in, helping prevent throat and lung infections. However, they aren’t your body’s main defense against infection.

“While they do provide a little bit of immune function, kids typically are not sick more often if their tonsils are removed,” Dr. DeMason says.

Tonsils shrink over time, usually starting at age 8. As a result, many people never consider their tonsils. For some, though, tonsils can become more hurtful than helpful.

Common Problems with Tonsils

Tonsils are connected with several health issues.

Tonsillitis is a viral or bacterial infection marked by swelling of the tonsils, sore throat, fever, pain, difficulty swallowing and swelling of the lymph nodes. Tonsillitis caused by bacteria, such as the one associated with strep throat, can be treated with antibiotics.

“Children are exposed to more infections in day care and school, which is why they have tonsillitis more often,” Dr. DeMason says.

Also, tonsils contain tiny holes where food and bacteria can become caught and form tonsil stones. Tonsil stones can create bad breath, throat and ear pain, and white or yellow spots on the tonsils. Gargling with salt water after eating or using a water flosser are ways to manage tonsil stones.

If tonsils are large, or if swelling doesn’t go down after infection, they can get in the way of breathing or swallowing. This frequently results in obstructive sleep apnea, when breathing frequently pauses or stops during sleep, disrupting restorative deep sleep. In children, sleep apnea can lead to behavioral issues, hyperactivity and difficulty in school.

Cancer can grow on the tonsils and cause difficulty swallowing and pain in the throat, ear and neck. Rates of tonsil cancer are rising, likely due to the spread of the human papillomavirus (HPV).

“If you see that one tonsil is bigger than the other, have a doctor check it out,” Dr. DeMason says.

Tonsillectomies for Children and Adults

Doctors generally recommend tonsil removal for recurrent tonsillitis, which for children is defined as seven infections in one year, five infections per year for two years or three infections per year for three years. Dr. DeMason says that certain factors, including abscesses, intolerances to antibiotics and tonsil infections that cause febrile seizures, may necessitate removal sooner.

Your doctor may also recommend a tonsillectomy if you experience obstructive sleep apnea because of your tonsils or if conservative management of tonsil stones isn’t helping.

“Many tonsil problems cause quality-of-life issues,” Dr. DeMason says. “While it’s not an emergency surgery, a tonsillectomy can improve symptoms like bad breath, pain and poor sleep.”

A tonsillectomy is performed under general anesthesia. During surgery, the physician uses a scalpel or heat to remove the tonsils. The operation is usually done on an outpatient basis, meaning the patient can go home on the day of the surgery. A sore throat is common after the surgery.

Adults tend to need a longer recovery time after a tonsillectomy compared with children.

“If a patient has had chronic infections for many years, they may have more scarring on the tonsils, which can make it more difficult to remove them,” Dr. DeMason says. “It is much more painful for adults, and I spend a lot of time before the surgery explaining to patients pain expectation and care.”

Many children can return to normal activities a week to 10 days after a tonsillectomy. Dr. DeMason recommends that adults plan to take at least two weeks off from work or school after the surgery.

If you’re experiencing recurrent sore throats, talk to your doctor. Need a doctor? Find one near you.