Tonsillectomy - Tonsil Removal Surgery
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
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.
What tonsillectomy is
An operation through the mouth
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.
| 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 |
Recurrent tonsillitis in adults
| 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 |
Do I need to meet these numbers exactly?
Surgery or waiting
| 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.
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
| 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 |
Before surgery
The consultation
Tests
Should I have surgery during an infection?
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.
Our approach
| Technique | Bleeding risk | Pain |
|---|---|---|
| Cold steel | Lowest in registry data | Moderate |
| Coblation | Low to moderate | Moderate |
| Hot diathermy | Higher | Higher in many studies |
The removed tonsils go to the pathologist when there is any doubt about their appearance.
Partial tonsillectomy
| 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 |
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.
The day of surgery
A typical day
| 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 |
Will my voice change?
Pain after surgery
| 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 |
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
| 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 |
Recovery timeline
| 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 |
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
What to send
Hotels close to the hospital allow quick return if bleeding occurs. We advise staying in Istanbul until day ten at least.
Patients combining tonsillectomy with nasal or sinus surgery should allow the same two weeks, with recovery for both at once.
Cost
| 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.
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 Merve Aktar, Nephrology.
Medically reviewed by
Merve Aktar
Nephrology
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