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Fast Facts

Don’t use aspirin or ibuprofen for one week before surgery, don’t use Painstop at all.

Stay within an hour of a hospital for 2 weeks after surgery.

Eat as normally as possible while recovering including solid food.

Take 2 weeks off to recover – this includes day-care/school/sport/work/study.

mitec-tonsil

What is this for and is it effective?

The tonsils sit on each side of the throat behind the tongue. The adenoid is like the tonsils and sits high in the throat behind the nose. They are part of the immune system, helping to recognize and start the immune response to viruses and bacteria that are inhaled through the nose or swallowed. They are important in the first year of life and can then be removed or reduced without affecting the immune system.

A large or inflamed adenoid can cause blocked nose, snoring or middle ear problems. Large tonsils can cause snoring, obstructive sleep apnoea and sometimes trouble swallowing. Infection of the tonsils can cause acute tonsillitis or chronic tonsil inflammation with smelly white debris in the creases of the tonsil surface. Occasionally, tumours can arise in the tonsils or adenoid.

Removing the tonsils stops tonsillitis and chronic infections and inflammation. Removing the tonsils and reducing the adenoid helps snoring. Reducing the adenoid can help blocked nose and middle ear problems. Surgery is most likely to be effective if the tonsils and adenoid are the only cause for the problem.

Most people don’t need tonsillectomy. Your GP will refer you to a surgeon if you have recurrent tonsillitis (7 episodes in one year, 5 episodes a year for 2 years, 3 episodes a year for 3 years) or snoring with daytime tiredness lasting more than 6 months.

There are 2 options for tonsillectomy: extracapsular or total tonsillectomy (most often done with diathermy) or intracapsular/ partial tonsillectomy (most often done with Coblation). Your surgeon will assess which procedure is best for you or your child, based on the symptoms that need treatment. Intracapsular Coblation tonsillectomy suits some people as there is less recovery time, less pain, lower risk of post op bleeding but there may be a higher chance of tonsil tissue growing back, with more surgery needed in future. Read more here.

See also Adenoidectomy

Frequently Asked Questions

What could go wrong? Is there a chance that surgery could make me worse?

Temporary side effects:   

  • 1:30 people feel sick or vomit after surgery. Two preventive drugs are given during surgery and more can be given if needed.
  • 1:50 people have bleeding from the throat while recovering. Bleeding is less common in children and more common in adults. Bleeding is often minor and settles. spontaneously but can be severe and need an operation to tie or clip a blood vessel.
  • 1:200 people need an operation to stop bleeding. Bleeding can happen any time from the day of surgery until two weeks later when healing is almost complete. Bleeding may be less likely if you eat as normally as possible, avoid medications and supplements that increase bleeding and avoid sport/work for 2 weeks.
  • 1:50 adults notice temporary change in taste.
  • 1:300 people come back into hospital for pain or dehydration. All patients have pain. Pain usually lasts for 2 weeks and can be worse 5-7 days after surgery. Occasionally pain is severe, eating and drinking is difficult and the patient needs to come back into hospital for intravenous fluid. This is more common in children less than four years old. Regular pain relief is the best prevention.
  • 1:500 people have problems breathing after surgery. This is more likely in children less than three years of age and in people with obesity, severe sleep apnoea or Down’s syndrome. Your surgeon will advise an overnight stay if you are at increased risk of breathing problems.
  • Other rare side effects include inflammation in the neck and jaw joints. This is more likely in patients with existing arthritis or ligament disease.

Permanent side effects: 

  • 1:500 children have a long term change in voice after adenoid surgery. For more information see adenoidectomy.
  • 1:2000 adults notice permanent change in taste. This is more common in people over fifty years of age.
  • 1:5000 people have damage to the teeth. The operation is done through the mouth. A device is attached to the top teeth to hold the mouth open. This can chip, loosen or discolour teeth especially if teeth are already loose or damaged.
  • <1:40,000 risk of death from anaesthetic or bleeding complications. This is a very rare event and I include this risk as parents often ask what is the worst case scenario, when making choices for their children’s treatment.
Could I need more surgery or treatment in the future?

The tonsils are completely removed and although they can’t grow back, sometimes other small areas of immune cells can grow near the tonsil area. It is rare for this to result in recurrent tonsillitis. I have seen this happen in 3 adults over the last 15 years. The tissue can be removed if needed.

The adenoid can regrow. For more information see adenoidectomy.

1:200 people need surgery to stop bleeding after tonsillectomy.

What are the alternatives to surgery? Are they appropriate for me?

For mild problems, exploring non-surgical treatments first is wise. Your surgeon will aim to treat other causes of blocked nose, snoring and ear disease before recommending surgery, for example, using a steroid nose spray for allergic rhinitis. Waiting for 3-6 months can be helpful; the adenoid and tonsils can enlarge after an upper respiratory tract infection then reduce in size over time and the adenoid tends to shrink with age. Sometimes patients have a bad run with recurrent tonsil infections then improve spontaneously without needing surgery.

Safer Care Victoria has helpful videos and a fact sheet for parents making decisions about surgery for their child.

What if I choose not to have surgery?

For patients with a suspected tumour of the tonsils or adenoid, surgery is essential. For mild disease, it may be ok not to have surgery. For severe disease, snoring or blocked nose there may be long term consequences of not having treatment. For example, dental development can be affected by persistent severe blocked nose and learning is affected by sleep apnoea.

See should I have surgery for more information.

How should I prepare for surgery?

If an episode of tonsillitis starts within two weeks of your surgery date, contact your surgeon or GP to start a course of antibiotic and continue until the time of surgery.

Stop using any supplements and medications that increase bleeding (like aspirin) one week before surgery and follow the fasting instructions provided by the hospital.

Stop smoking. Smokers are more likely to have side effects including heart and breathing complications, increased pain and bleeding and take longer to heal. The longer you have stopped smoking, the safer the surgery will be for you. If you smoke on the day of surgery, your surgery will be cancelled. Ask your surgeon for a Quit pack if needed. The nurses can help with nicotine patches while you are in hospital.

See preparing for surgery for more information.

When will I come into hospital? How long will the operation take? How long will I stay in hospital?

You will come into hospital on the day of surgery. The operation takes 40 minutes. You will go home around 6 hours after surgery.

If you are having another procedure at the same time (for example middle ear ventilation tubes or nasal surgery) you will need to read the information about these procedures as well.

How long will I need off work/school/sport?

You need two weeks off work (or school/kinder/day-care), sport and study. You should not drive for at least 24 hours after a general anaesthetic or on any day when taking strong pain killers.

Will I be awake or asleep for the operation? What kind of anaesthetic will I have?

Children and adults always have a general anaesthetic for this procedure.

See anaesthesia for more information.

How will I feel after surgery?

You will have throat pain. Pain lasts for two weeks. It is often mild initially and then gradually feels worse, peaking around 5-7 days after surgery. When throat pain is severe it can also be felt in the ears, tongue and neck.

It is normal to have white patches on each side of the throat where the tonsils were removed. Eating solid food helps keep these white patches clean.

Children often have a temporary change in the sound of their voice because they try to hold the throat muscles more still to relieve pain. The voice can sound higher pitched or squeaky for a few weeks and always improves.

What do I need to do to recover well?

The better you eat, the better you heal. Aim to eat as normally as possible, including vegetables and solid food as well as drinking water.

To enable you to eat normally, you need good pain relief. You will be given a combination of pain killers and instructions on how to take these. It is helpful to have a note pad to write down what you have taken and when the next dose is due. Take pain relief regularly and plan to eat half an hour after taking pain relief, when it is most effective.

These videos are great for tips on giving medicine to children safely and effectively: NPS 1, NPS 2, NPS 3. The Children’s Hospital have step by step guide on teaching your child to swallow tablets and capsules. You can work through this with your child in preparation for surgery.

Constipation is common and can be treated with medication from the pharmacy.

Rest at home for two weeks. Remain within one hour of a hospital for 14 days, in case help is needed for bleeding. Avoid medications and supplements that increase bleeding (Aspirin, Voltaren, fish oil, garlic and echinacea). If you have continuous bleeding from the nose or mouth suck on ice and take a dose of tranexamic acid. If bleeding stops, continue tranexamic acid 8 hourly for 6 doses. If bleeding doesn’t stop, attend your nearest hospital emergency department. It is ok to call an ambulance if needed. Parents should check on their child a couple of times overnight for the first few days after surgery.

Avoid medications containing codeine (Painstop, Panadeine, Panadeine Forte, and Chemist Brand Strong Pain Relief) as these medications increase the chance of serious breathing problems. Never use Painstop for children.

If you need to blow your nose, blow gently. If you use a nasal spray for rhinitis, you can continue to use this after surgery.

Brush, floss and rinse the teeth twice a day, as you usually would. Rinsing with water is enough; mouth washes are necessary.

When will I see the surgeon?

The surgeon will check on you in the recovery room and often on the ward before you go home from hospital. The hospital nurse may ring you the next day and the practice nurse will ring you one week after surgery and one month after surgery. The surgeon will see you again if you are having problems with your recovery.

What should I do if I need help or advice?

You can ring the surgeon or practice nurse during business hours on 55605411. For non emergency advice outside business hours, ring the nurse at the hospital where you had surgery. For urgent care outside business hours, attend your nearest emergency department.

Click here for information about Dr Clancy’s on call schedule.

Is there any more information specific to my situation?

Your surgeon will take into consideration your work, sports/hobbies, support at home and other health problems as well as past reactions or complications with anaesthesia and surgery.

Your surgeon will answer any specific questions you ask.

After tonsillectomy for adults

Take two weeks off work, sport and study. You need 24 hours off driving after a general anaesthetic. You shouldn’t drive/operate machinery or make important decisions on any day when you are taking strong pain relievers like Endone or Targin.

What do I need to do to recover well?

The better you eat, the better you heal. Aim to eat as normally as possible, including vegetables and solid food as well as drinking water.

To enable you to eat normally, you need good pain relief. You will be given a combination of pain killers and instructions on how to take these. It is helpful to have a note pad to write down what you have taken and when the next dose is due. Taking pain relief regularly and plan to eat half an hour after taking pain relief, when it is most effective.

  • Celecoxib 200mg, one capsule every 12 hours (for example 6am and 6pm). Stop taking this medication when your pain has gone. Next dose due at:

For breakthrough pain, between doses of celecoxib, use

  • Paracetamol 500 mg, 1-2 tablets every 4-6 hours as needed, no more than 8 paracetamol tablets per day
    • next dose due at:
  • Oxycodone or palexia immediate release 1-2 tablets release every 6 hours as needed, no more than 4 doses per day
    • next dose due at:

Constipation is common and can be treated with medication from the pharmacy.

Remain within one hour of a hospital for 14 days, in case help is needed for bleeding. Avoid medications and supplements that increase bleeding (Nurofen, Aspirin, Voltaren, fish oil, garlic and echinacea). If you have continuous bleeding from the nose or mouth suck on ice and attend your nearest hospital emergency department. It is ok to call an ambulance if needed.

What is normal? How will I feel after surgery?

You will have throat pain. Pain lasts for two weeks. It is often mild initially and then gradually feels worse, peaking around 5-7 days after surgery. When throat pain is severe it can also be felt in the ears, tongue and neck. There will be white or yellow patches in the healing area in the throat. This is normal and is not a sign of infection. 1:30 people feel sick or vomit after surgery. 1:50 adults notice temporary change in taste. It is common to have a change in voice for a few weeks.

What is not normal?

Contact your surgeon if there is or attend your nearest Emergency Department if there is:

  • Vomiting for more than a few hours.
  • Bright bleeding from the nose or mouth: if you have any bleeding from the nose or mouth suck on ice and take a dose of tranexamic acid. If bleeding stops, continue tranexamic acid 8 hourly for 6 doses. If bleeding doesn’t stop, attend your nearest hospital emergency department. Call an ambulance if bleeding is severe.
  • Severe pain not relieved by the prescribe pain relief and especially if you:
    • can’t eat and drink enough,
    • feel sleepy and dizzy or
    • have very concentrated urine
  • Your parent or partner notices noisy breathing or stopping breathing in sleep.
  • Stiff painful neck or jaw preventing normal activity.
  • Fever >38 degrees persisting for more than 24 hours.

You can also contact the practice nurse or surgeon if you run out of pain relievers. You need to allow 24 hours’ notice when requesting another script.

When will I see the surgeon?

The surgeon will check on you in the recovery room. The hospital nurse may ring you the next day and the practice nurse will ring you one week after surgery and one month after surgery. The surgeon will see you if there are any problems with your recovery.

What should I do if I need help or advice?

You can ring the surgeon or practice nurse during business hours on 55605411. For non emergency advice outside business hours, ring the nurse at the hospital where you had surgery. For urgent care outside business hours, attend your nearest emergency department.

Click here for information about Dr Clancy’s on call schedule.

Is there any more information specific to my situation?

The surgeon will include any extra information specific to you.

After tonsillectomy and adenoidectomy for children

Take 14 days off school, kinder, day care and sport. Rest at home with a parent or carer.

What do I need to do to recover well?

The better you eat, the better you heal. Aim to eat as normally as possible, including vegetables and solid food as well as drinking water.

To enable you to eat normally, you need good pain relief. It is helpful to have a note pad to write down what you have taken and when the next dose is due. Taking pain relief regularly and plan to eat half an hour after taking pain relief, when it is most effective. Your nurse and surgeon will fill in your child’s weight and when the last dose of each medication was given in hospital.

These videos are great for tips on giving medicine to children safely and effectively: NPS 1, NPS 2, NPS 3. Read here for more information about how to give medicines to children. The Children’s Hospital have step by step guide on teaching your child to swallow tablets and capsules. You can work through this with your child in preparation for surgery.

  • Any brand of paracetamol your child likes the taste of
    • Check the instructions on the bottle and give a dose according to your child’s weight (____kg) every 4-6 hours as needed. No more than 4 doses in one day.
    • Last dose given at:
  • If paracetamol is not enough to control pain, add ibuprofen, 6 hourly as needed, no more than 3 doses per day. Check the instructions on the bottle and give a dose according to your child’s weight.
  • for very strong pain not relieved by paracetamol and ibuprofen, add oxycodone liquid ___ ml, 6 hourly as needed. No more than 4 doses per day.
    • Last dose given at:

Remain within one hour of a hospital for 14 days, in case help is needed for bleeding. Avoid medications and supplements that increase bleeding (Aspirin, Voltaren, fish oil, garlic and echinacea). If you have any bleeding from the nose or mouth suck on ice and take a dose of tranexamic acid. If bleeding stops, continue tranexamic acid 8 hourly for 6 doses.  suck on ice and attend your nearest hospital emergency department. It is ok to call an ambulance if needed.

Parents should check on their child a couple of times overnight for the first few days after surgery. Avoid medications containing codeine (Painstop, Panadeine, Panadeine Forte, and Chemist Brand Strong Pain Relief) as these medications increase the chance of serious breathing problems. Never use Painstop for children.

Brush, floss and rinse the teeth twice a day, as usual. Rinsing with water is best, mouth washes aren’t necessary.

What is normal? How will I feel after surgery?

You will have throat pain and white patches in the throat. Pain lasts for two weeks. It is often mild initially and then gradually feels worse, peaking around 5-7 days after surgery. When throat pain is severe it can also be felt in the ears, tongue and neck. You may have mild blood stained or watery discharge from the nose for a few days after surgery then there should be no discharge or bleeding at all.

What is not normal?

Contact your surgeon or attend your nearest Emergency Department if there is:

  • Vomiting for more than a few hours.
  • Bright bleeding from the nose or mouth: if you have any bleeding from the nose or mouth suck on ice and take a dose of tranexamic acid. If bleeding stops, continue tranexamic acid 8 hourly for 6 doses. If bleeding doesn’t stop, attend your nearest emergency department. Call an ambulance if you need to.
  • Severe pain not relieved by the prescribed pain relief and especially if you can’t eat and drink enough, feel sleepy and dizzy or have very concentrated urine.
  • Your parent or partner notices noisy breathing or stopping breathing in sleep.
  • Stiff painful neck or jaw preventing normal activity.
  • Fever >38 degrees persisting for more than 24 hours.

You can also contact the practice nurse or surgeon if you run out of pain relievers. You need to allow 24 hours’ notice when requesting another script.

When will I see the surgeon?

The surgeon will check on you in the recovery room and often on the ward before you go home from hospital, if you stay overnight. The hospital nurse may ring you the next day and the practice nurse will ring you one week after surgery and one month after surgery. The surgeon will see you if you have any problems with recovery.

What should I do if I need help or advice?

You can ring:

  • Your surgeon or practice nurse in hours on 5560 5411 or after hours on the number provided on your appointment card.
  • Or the nurse at the hospital where you had surgery.

The surgeon also sends a summary to your GP with advice on how to manage problems after surgery.

Is there any more information specific to my situation?

The surgeon will include any extra information specific to you.

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