Tonsillectomy involves removal of the palatine tonsils. Adenotonsillectomy involves removing the adenoids along with the palatine tonsils. Removing the tonsils aims to prevent further episodes of tonsillitis, though patients may still experience sore throats.
A tonsillectomy procedure is often performed as a day case (with several hours of postoperative observation before going home), depending on patient factors and local policy.
Indications
The number of episodes of documented and significant tonsillitis for a referral for consideration of a tonsillectomy are:
- 7 or more in 1 year
- 5 per year for 2 years
- 3 per year for 3 years
Other indications are:
- Recurrent peritonsillar abscess (quinsy)
- Obstructive breathing during sleep due to adenotonsillar hypertrophy
Complications
Complications of tonsillectomy include:
- Sore throat (can last two weeks)
- Damage to teeth
- Infection
- Post-tonsillectomy bleeding
- Risks of a general anaesthetic
Post-Tonsillectomy Bleeding
Post-tonsillectomy bleeding is a significant complication after tonsillectomy. Significant bleeding occurs in up to 5% of patients after tonsillectomy. Bleeding can be severe and, in rare cases, life-threatening, due to aspiration of blood.
It can be primary or secondary:
- Primary bleeding: within 24 hours
- Secondary bleeding: after 24 hours, often days 5–10, commonly related to sloughing of dead tissue or infection
Post-tonsillectomy bleeding should be managed by experienced clinicians. The ENT registrar should be involved early. Anaesthetics should be called if the bleeding is severe or there is airway compromise. Intubation may be required. Ongoing or significant bleeding usually requires urgent return to theatre.
Key steps in management include:
- ABCDE assessment
- Getting IV access
- Sending blood tests, including an FBC, clotting screen, group and save and crossmatch
- Keeping the child calm and giving adequate analgesia
- Sitting them up and encouraging them to spit out the blood rather than swallowing
- Making them nil-by-mouth in case an anaesthetic and operation is required
- IV fluids for maintenance and resuscitation as required
- IV tranexamic acid may help reduce bleeding
- Topical local anaesthetic (e.g., lidocaine spray) to facilitate examination or topical treatment
- Adrenaline-soaked swab applied topically can slow bleeding while arranging a return to theatre if required
- IV antibiotics if infection is suspected
Last updated June 2026
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