FAQ - Tonsils and Adenoids

Tonsils and Adenoids What are Tonsils ?

Tonsils are a pair of glands situated in the mouth cavity on either side below the tongue. They function as one of the “defence mechanisms” of our body, fighting infections. They are active till the age of 8 or 10. Later, they slowly become smaller in size and are barely visible in majority of adults. Appearance of large tonsils between the age of 3 to 7 is not an indication of any illness.

Should tonsils be removed ?

Tonsils should not be removed if the child is healthy. If they get infected and become the cause of any illness, then they can be removed. Whether their removal will cure the illness or not should be determined. Only after confirmation should the “tonsil operation” be carried out.

Does removal of tonsils help the child to grow tall ?

There is no relationship at all between growing tall and removal of tonsils. What happens is that in most cases tonsils operation is done at the age of 7 or 8. This is a crucial period in the child’s growth. Therefore people mistakenly think tonsils operation helps the child to grow taller. In some children, the tonsils get infected repeatedly (almost once every month) and they develop fever, loss of appetite and difficulty in swallowing food. In such cases an operation would certainly help. But removing uninfected tonsils will not make the child healthy.

When should tonsils be removed ?

Removal of tonsils would be beneficial only under the following circumstances : When the child develops fever with irritation or pain in the throat, tonsils swell and they cause a sort of pain or stiffness in the neck. In medical parlance, this is called “acute tonsillitis”. It occurs six or seven times a year for a period of 2 years. When tonsils develop an abscess with pus it causes severe pain even while swallowing saliva. The abscess has to be drained of the pus by making a small cut on it. In such cases it is good to remove the tonsils to avoid such repeated occurrences. Sometimes, tonsils get excessively enlarged causing problem in swallowing food. And removal of tonsils does solve this problem. Infected tonsils which accumulate pus may sometimes release toxic substances in the body. These toxins may infect heart, kidney, skin and eyes. Before performing a heart operation or any other major operation tonsils are removed. If cancer of tonsils is suspected, tonsils are removed and examined.

Does removal of tonsils affect body’s defence against infection ?

No. Tonsils are removed only when they get infected. Infected tonsils are useless as a defence mechanism. And, removal of such tonsils does not cause any harm.

Is the operation risky ? What is the necessary care ?

The main risk is excess bleeding. The chances of death due to excess bleeding are 1 per 10,000 operations. Generally treated as a minor operation sometimes it is done without proper care or adequate equipment. This may cause complications. The following points make the operation quite safe. Insist upon a well-equipped hospital. Be sure that the surgeon and the anaesthetist possess appropriate qualifications. Give proper information, particularly regarding the bleeding tendency of the patient, to the doctor. Carry out all the essential pathological tests advised through a qualified pathologist. Strictly follow all the pre-and-post-operative instructions given by the doctor. Take all the prescribed medicines at the proper time and appropriate dose.

What are the ill-effects of this operation ?

Temporary ill-effects After the operation, the patient’s voice may change for some time. This is due to the stiffening of the muscles in the throat. Fever is known to occur on the day of the operation. There may be ear pain for 2 to 3 days. Permanent ill-effects These are known to occur only in rare cases. However it is not possible to predict in which patients it may occur. Repeated throat pains, swelling of other glands in the throat, acute throat pain due to damage to the nerves in the throat are some long-term ill-effects.

What is the proper age at which operation is performed ?

If the operation is a must, due to the reasons described above, then the age of the patient does not matter. Generally, it is performed between the age of 4 to 8 years. In some instances, it may have to be done at 2 or even at 55 years.

Which is the proper time ?

There is no specific time. Since it is not an emergency or a life saving operation, it can be done with due consideration to school vacation, leave from job, other family considerations. advised. The operation is usually performed in the morning. Eat nothing after the previous night’s meal. Anaesthesia and other drugs given may cause vomiting. Vomiting while still under the influence of anaesthesia can be risky as the vomit may enter the breathing passage. To avoid this, eat or drink absolutely nothing at least 4-6 hours before the operation. Go to the hospital at least one hour before the operation because an injection has to be given 30 to 40 minutes before the operation. It takes about 30 to 60 minutes for the operation (average 40 minutes).

What care should be taken after operation ?

The patient regains consciousness usually after 2-3 hours. Till that time he/ she should be kept in bed (lying on one side, and not flat on his/her back), so that the saliva and blood accumulate in the mouth and do not enter the breathing passage. After hours the patient is given cold water first and then ice cream. It is possible that on the first day the patient may have bloodstained saliva or even some blood in the spittle. The patient may vomit once or twice throwing out blackish blood. There is nothing to worry about it. On the first day, mild fever and pain in the ear is also known to occur. However, persistent red saliva or violent bloody vomiting should be viewed seriously and the doctor must be immediately informed about it. For a week after operation avoid hot, strong & spicy food. Eat only cold, mild and bland food such as kheer, rice, milk, curds etc.

Should tonsils and adenoid operations be performed at the same time ?

Since both tonsils and adenoids are made up of the same type of tissues, most of the time they get infected together. Therefore, the operations also are done together. However, if adenoids do not get enlarged at the time of tonsil operation, they are not removed. Sometimes the child suffers only due to adenoids. In such cases only adenoids are removed. At the time of tonsils operation, adenoids also have to be examined. And they should be removed if they are infected.

When to avoid tonsils operation ?

Persons suffering from hemophilia which stops the clotting of blood, should not undergo this operation. It can be fatal. And in patients suffering from a disease called submucous fibrosis, this operation may aggravate the disease.

What are Adenoids ?

At the opening of the passage inside our nose a gland, made up of tissues similar to those of the tonsils, can be seen. These are called “adenoids”. In simple terms, adenoids are called Tonsils behind the nose”. Like tonsils, adenoids can get infected and enlarged at the age of 4 to 8 years. Since they are located in the breathing passage close to the opening of the Eustachian tube (ear tube) they can be more troublesome than tonsils.

What is the trouble that adenoids cause ?

Enlarged adenoids obstruct breathing through the nose. Therefore, one tends to breathe through the month. This causes dryness in the throat, lips to become thick and even teeth tend to protrude, frequent cold and cough. The infection may spread to the sensitive inside ear through the Eustachian tube and it may cause deafness. This can affect the child’s studies and progress in the school. Sometime deafness is not diagnosed and the child is unnecessarily branded as a “duffer” or “slow-wit”.

How is the operation performed ?

Generally, it is done under general anaesthesia. Occasionally, it may be performed with the help of a local anaesthesia injection given inside the throat. Since the operation is done from inside of the mouth, there is no chance of any visible scar.

Preparation before operation ?

Examination of blood and blood clotting time, testing of urine are essential for all patients before the operation. If the doctor feels necessary, some other tests may also be


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