Tonsillectomy removes the tonsils in adults and teenagers with recurrent tonsillitis, abscesses beside the tonsil, tonsil stones, sleep apnea or a tonsil that needs examination. In a randomized trial, adults who had surgery had half as many sore throat days over two years. At Biruni Hospital in Istanbul, our ENT surgeons use cold or coblation techniques to lower bleeding risk, plan pain control for the two-week recovery and follow you after you return home.
About This Department
ENT
Repeated tonsillitis costs adults weeks of work and sleep every year. Tonsillectomy halves the days lost to sore throat.
Tonsillectomy, or tonsil removal surgery, removes the two palatine tonsils at the back of the throat. In adults it treats recurrent tonsillitis, abscesses beside the tonsil, tonsil stones and bad breath that do not settle, obstructed breathing during sleep and a tonsil that needs examination for disease. The strongest evidence comes from adults with recurrent tonsillitis. In the NATTINA trial of 453 adults in 27 British hospitals, those who had their tonsils removed had 47 percent fewer sore throat days over two years than those managed without surgery, and surgery was also cost-effective (Wilson and colleagues, Lancet, 2023). Recovery in adults takes two weeks and is more painful than in children. Technique matters, and a Swedish national register of 98,979 operations found more bleeding after hot tonsillectomy techniques (Lundström and colleagues, Acta Oto-Laryngologica, 2020). This page explains reasons for surgery, the evidence, techniques, partial tonsillectomy, pain, bleeding, recovery, and how patients from abroad arrange tonsillectomy at Biruni Hospital in Istanbul.
53
Percent as many sore throat days after tonsillectomy compared with no surgery over two years
453
Adults in the NATTINA randomized trial of tonsillectomy
14
Days to plan for recovery after adult tonsillectomy
Free
Review of your history and throat photographs by our ENT team
The tonsils are two pads of lymphatic tissue at the back of the throat. Adults who lose them keep a full immune defense through the many other lymph tissues of the throat and body.
Tonsil surgery at a glance
Feature
Detail
Note
Approach
Through the open mouth
No skin incision
Anesthesia
General
Forty to sixty minutes
Hospital stay
Same day or one night
Most adults stay one night
Recovery
Ten to fourteen days
Pain peaks around days five to seven
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Adults and children differ
Adults have more scarred tonsils from repeated infections, feel more pain afterward and have a higher risk of bleeding than children. Planning reflects this.
This page covers adults and teenagers. Our separate page on tonsillectomy in children explains surgery for snoring, sleep apnea and infections in young children.
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Who performs it
ENT surgeons, also called otolaryngologists, with an anesthesia team experienced in airway surgery.
Recurrent tonsillitis in adults
Criteria used to recommend tonsillectomy for recurrent tonsillitis
Frequency
Over
Each episode
Seven or more episodes
One year
Disabling sore throat, fever, swollen glands or pus
Five or more a year
Two years
Same features
Three or more a year
Three years
Same features
Each episode of tonsillitis in an adult means several days of severe sore throat, fever, difficulty swallowing and time off work. Antibiotics shorten episodes slightly but do not prevent the next one.
Do I need to meet these numbers exactly?
The numbers guide the decision, and fewer, more severe episodes with complications, missed work or antibiotic allergy also count. We review your history, records from your doctor and photographs taken during episodes.
Surgery or waiting
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The NATTINA trial
The first large randomized trial of tonsillectomy in adults, run in 27 British hospitals and published in 2023.
NATTINA trial, 453 adults with recurrent tonsillitis, over 24 months
Outcome
Tonsillectomy
Conservative management
Median sore throat days
23
30
Adjusted rate of sore throat days
About half
Reference
Cost-effectiveness
Cost-effective
Reference
Bleeding after surgery
19 percent of patients, most minor
Not applicable
The days of sore throat in the surgical group include the recovery period after surgery. After recovery, many patients had almost no further episodes.
The trial found tonsillectomy clinically effective and cost-effective in adults referred with recurrent tonsillitis (Wilson and colleagues, 2023). The authors also noted that falling tonsillectomy rates in Britain coincided with more emergency admissions for tonsillitis complications.
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What this means for you
If tonsillitis keeps returning, surgery offers fewer sore throats and fewer lost days, at the price of a painful two-week recovery.
Who benefits most
Adults with frequent, severe episodes, those who have had an abscess beside the tonsil, and those whose work or studies suffer most gain the clearest benefit.
Why adults wait too long
Many adults put surgery off for years.
Fear of pain, worry about time off work, the belief that tonsillectomy is only for children and advice that the problem will fade keep adults living with repeated infections, courses of antibiotics, missed work and nights of poor sleep, while the infections themselves scar the tonsils and make the eventual operation and recovery harder, so the decision deserves an honest discussion of the trial evidence, the expected recovery and the alternatives, at a time when you can plan two weeks of rest.
A planned recovery beats an unplanned infection.
Other reasons for surgery
Besides recurrent tonsillitis, adults have tonsillectomy for several other problems, and some need it soon.
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Peritonsillar abscess
A collection of pus beside the tonsil, called quinsy, is drained first. Tonsillectomy is advised after a second abscess, or after a first one in people with recurrent tonsillitis.
Other indications in adults
Condition
Why surgery
Note
Tonsil stones and bad breath
Persistent debris in deep crypts
After rinsing and hygiene fail
Obstructive sleep apnea with large tonsils
Opens the airway
Part of sleep surgery planning
One tonsil larger than the other
Diagnosis of lymphoma or cancer
Removal for pathology
Chronic tonsillitis
Persistent sore throat, swollen glands
Months of symptoms
A tonsil that grows on one side, especially with a lump in the neck, weight loss or ear pain, needs prompt examination and often removal for diagnosis.
Before surgery
The consultation
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Examination
The surgeon examines the throat, neck and nose, reviews your history and records, and, for sleep problems, a sleep study.
Tests
Blood count and clotting tests are done for adults, with further tests for bleeding disorders if you or your family bruise or bleed easily. Blood thinners, aspirin, anti-inflammatory painkillers and some supplements are stopped before surgery on medical advice.
Should I have surgery during an infection?
No. Surgery is planned at least two to three weeks after an episode of tonsillitis has settled, because infected tissue bleeds more. If an infection starts close to the date, we move the operation.
Surgical techniques
Cold steel dissection removes the tonsil with fine instruments and ties or seals vessels.
Coblation uses radiofrequency energy at lower temperatures to remove tissue.
Monopolar or bipolar diathermy, the hot techniques, cut and seal at high temperature.
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Why technique matters
In 98,979 Swedish tonsil operations, hot tonsillectomy techniques carried a higher risk of bleeding afterward, and the use of cold techniques increased over the decade (Lundström and colleagues, 2020).
Our approach
We use cold dissection with careful sealing of bleeding points, or coblation, chosen for each patient, and avoid high temperature techniques for the whole tonsil.
Technique comparison
Technique
Bleeding risk
Pain
Cold steel
Lowest in registry data
Moderate
Coblation
Low to moderate
Moderate
Hot diathermy
Higher
Higher in many studies
Pain control starts in the operating room, with local anesthetic and long-acting painkillers given before you wake up.
The removed tonsils go to the pathologist when there is any doubt about their appearance.
Partial tonsillectomy
Total against partial tonsillectomy, five-year follow-up
Outcome
Total tonsillectomy
Partial tonsillectomy
Tonsillitis in remaining tissue
Not applicable
None in the first year, consistent over five years
Pain and bleeding
More
Less
Quality of life
Improved
Improved
In partial tonsillectomy, also called tonsillotomy or intracapsular tonsillectomy, the surgeon removes most of the tonsil but leaves a thin layer and its capsule, which protects the muscles underneath. Pain and bleeding are lower.
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Evidence
A German trial removed one tonsil completely and the other partially in the same patients, and after five years the partially removed side showed no more tonsillitis than the fully removed side (Kisser and colleagues, European Archives of Oto-Rhino-Laryngology, 2025).
Partial tonsillectomy suits many adults with enlarged tonsils and selected patients with recurrent tonsillitis. After an abscess or for a suspicious tonsil, complete removal remains the standard.
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In the Swedish register
Patients needed far fewer contacts for pain after tonsillotomy, 4.5 percent in 2018, than after full tonsillectomy, up to 34.5 percent.
The day of surgery
A typical day
Your day of surgery
Step
Timing
Note
Admission
Morning
Fasting from midnight
Surgery
Forty to sixty minutes
General anesthesia
Recovery room
One to two hours
Cold drinks, ice
Ward
Overnight for most adults
Pain control, observation
1
Eating from day one
Soft and normal foods are encouraged from the first day. Eating keeps the throat moving, reduces pain over time and helps healing.
You go home the next morning with painkillers on a fixed schedule, written instructions and the direct number of our team.
Will my voice change?
The voice can sound different for a few weeks because of swelling. Singers and speakers notice a slight change in resonance in rare cases, so we discuss this before surgery when your voice is your work.
White patches form where the tonsils were removed. These are healing scabs and fall away over seven to ten days.
Pain after surgery
Managing pain at home
Medicine or measure
How
Note
Paracetamol
Regular doses around the clock
Base of pain control
Anti-inflammatory painkiller
Regular doses when prescribed
Safe in most adults
Stronger painkiller
For the worst days
Short course only
Cold drinks and ice
Before meals
Eases swallowing
Pain in adults peaks between days five and seven, often with ear pain from shared nerves, and settles by the second week. Taking painkillers on schedule, instead of waiting for pain, keeps you eating and drinking.
Not eating and drinking because of pain is the main reason adults return to hospital. Call us if swallowing becomes impossible.
Practical tips
Chewing gum before meals, cold water, ice cream and soft foods at room temperature help, and sleeping with the head raised reduces morning dryness and pain.
Bleeding after surgery
Bleeding after tonsillectomy
Type
When
What to do
Primary
First 24 hours
Managed in hospital
Secondary
Days five to ten, as scabs fall
Spit, do not swallow, go to the emergency department
Return to theater
Rare
Under anesthesia
In the NATTINA trial, 19 percent of adults had some bleeding after surgery, most of it minor, and adults bleed more than children. Any fresh red blood in the mouth after discharge needs assessment the same day, even if it stops.
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Reducing the risk
Cold technique, stopping blood thinners on medical advice, eating normally, avoiding strenuous activity and staying near medical care for two weeks.
Recovery timeline
Recovery after adult tonsillectomy
Activity
When
Note
Office work
After ten to fourteen days
Physical work after two weeks
Exercise and gym
After two weeks
Avoid straining before
Flying
After ten to fourteen days
Bleeding risk in the first days
Alcohol and smoking
Avoid for two weeks
Delay healing
1
Breath and taste
Bad breath and an odd taste are common in the first week, from the healing area, and disappear as it heals.
A follow-up check at two to three weeks confirms healing, after which no further care is needed and the throat looks smooth.
Life without tonsils
Most adults wish they had done it sooner.
Once the throat has healed, the cycle of sore throats, fevers, antibiotics and missed work stops in the large majority, sleep improves for those who snored, tonsil stones and the bad breath they cause are gone, and the immune system continues to work through the other lymph tissues of the throat and body, with no increase in other infections in long-term studies. Colds and viral sore throats still happen, but they are milder and shorter.
The two-week recovery is the hard part.
For patients from abroad
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Length of stay
Plan for ten to fourteen days in Istanbul. Fitness to fly follows the risk period for secondary bleeding, which peaks between days five and ten.
What to send
Send a summary of your tonsillitis episodes, records of antibiotic treatment, photographs of your throat during an episode if available, and a list of medicines. For sleep problems, send any sleep study.
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After you return home
We review your recovery by video and message, and any later concern is answered on the same WhatsApp number.
Hotels close to the hospital allow quick return if bleeding occurs. We advise staying in Istanbul until day ten at least.
One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number after you return. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.
Patients combining tonsillectomy with nasal or sinus surgery should allow the same two weeks, with recovery for both at once.
Cost
What a quote for tonsillectomy covers
Item
Included
Priced separately
Surgery
Surgeon, anesthesia, operating room, pathology when needed
Combined nasal surgery
Hospital
One night stay
Extra nights
Aftercare
Painkillers, follow-up check, video follow-up
Hotel stay
We send a written quote after reviewing your history, before you travel.
Compare quotes for the same technique and hospital stay, and check that bleeding care in the first two weeks is included without extra charges.
References
Wilson JA, O'Hara J, Fouweather T, et al. Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA), a multicentre, open-label, randomised controlled trial. Lancet. 2023;401(10393):2051-2059.
Lundström F, Stalfors J, Østvoll E, Sunnergren O. Practice, complications and outcome in Swedish tonsil surgery 2009-2018. An observational longitudinal national cohort study. Acta Otolaryngol. 2020;140(7):589-596.
Kisser U, Stelter K, Lill C. Total versus subtotal tonsillectomy for recurrent tonsillitis, 5-year follow up of a prospective randomized noninferiority clinical trial. Eur Arch Otorhinolaryngol. 2025;282(3):1421-1425.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Assistant Professor Taner MOLLA, Gynecology and Obstetrics.
