Tonsillectomy: Indications, Procedure, Recovery & Complications

Tonsillectomy is surgical excision of the palatine tonsils. It is one of the most common pediatric surgeries; adults also undergo it for recurrent infection or obstruction.

Indications (AAO-HNS Clinical Practice Guideline)

• Recurrent tonsillitis: ≥7 episodes in 1 year, ≥5/year × 2 years, or ≥3/year × 3 years (with fever >38.3°C, exudate, cervical adenopathy, or GABHS+).
• Obstructive sleep-disordered breathing: Documented OSA (PSG) + adenotonsillar hypertrophy.
• Peritonsillar abscess: Quinsy; often interval tonsillectomy 6–12 weeks post-drainage.
• Malignancy suspicion: Asymmetric tonsil, ulceration, neck mass.
• PFAPA syndrome unresponsive to medical therapy.

Procedure

• General anesthesia; mouth gag; dissection (cold steel, electrocautery, coblation, microdebrider, harmonic scalpel).
• Duration: 20–45 minutes.
• Hemostasis: suction cautery, ties, topical thrombin.

Recovery

• Children: 7–10 days; Adults: 10–14+ days (more pain).
• Pain management: scheduled acetaminophen + ibuprofen; opioids PRN (limited).
• Diet: cool, soft, non-acidic; advance as tolerated.
• Activity: no strenuous exertion 2 weeks.

Complications

• Primary hemorrhage: <24 hrs (0.2–2.2%); return to OR.
• Secondary hemorrhage: 5–10 days (slough separation); 1–4%; often self-limited, may need cautery.
• Dehydration, velopharyngeal insufficiency (rare), taste change, airway edema.

Shared decision-making with ENT surgeon balances benefits vs. morbidity.