Everybody's heard of tonsils. But not everyone knows what tonsils do or why they may need to be removed. Knowing the facts can help alleviate the fears of both parents and children facing a tonsillectomy.

What Are Tonsils and Tonsillitis?

Tonsils are glandular tissue located on both sides of the throat. The tonsils trap bacteria and viruses entering through the throat and produce antibodies to help fight infections.

Tonsillitis occurs when tonsils become infected and swell. If you look down your child's throat with a flashlight, the tonsils may be red and swollen or have a white or yellow coating on them. Other symptoms of tonsillitis may include:

• sore throat
• pain or discomfort when swallowing
• fever
• raspy voice
• swollen glands (lymph nodes) in the neck

But enlarged or swollen tonsils are normal for many children. Don't rely on your own guesses when it comes to your child's health - you may not be able to judge whether your child's tonsils are infected. If you suspect tonsillitis, contact your child's doctor. Recurrent sore throats and infections should also be evaluated by your child's doctor, who may order a throat culture to check for strep throat.

What Are Tonsillectomies and What Do They Involve?

Because of success with antibiotics, surgery is no longer the standard treatment for tonsillitis that it was years ago. Left alone, your child's enlarged tonsils may eventually shrink on their own. However, your child's doctor may suggest removal of the tonsils, called a tonsillectomy, if your child has one or more of the following:

• persistent or recurrent tonsillitis
• recurrent sore throats
• recurrent throat infections
• swollen tonsils that make it hard to breath
• difficulty swallowing
• obstructive sleep apnea (a condition in which your child may stop breathing for a few seconds at a time during sleep because enlarged tonsils are partially blocking the airway)

Surgery, no matter how common or simple the procedure, is often frightening for both child and parent. You can help prepare your child for surgery by talking about what to expect. During the tonsillectomy:

• your child will receive general anesthesia. This means the surgery will be performed in an operating room so that an anesthesiologist can monitor your child.
• your child will be asleep for about 20 minutes.
• the surgeon can get to the tonsils through your child's open mouth - there's no need to cut your child's skin.
• the surgeon removes the tonsils with a series of incisions and then cauterizes (or seals) the blood vessels.

Your child will wake up in the recovery area. In most cases, the total time in the hospital is 5 to 10 hours. However, children who have trouble breathing or show signs of bleeding will return immediately to the operating room. And kids under 3 years of age and kids with chronic disease, such as seizure disorders or cerebral palsy, will usually stay overnight for observation.

The typical recuperation after a tonsillectomy often involves a week or more of pain and discomfort due to the exposure of the throat muscles after the tonsils are removed. This can impact your child's ability to eat and drink and return to normal activities.

There is also a variation on traditional tonsillectomy techniques called intracapsular tonsillectomy. This procedure involves the controlled removal of all obstructing tonsil tissue - however, a small layer of tonsil tissue is purposely left in place to protect the underlying throat muscles. As a result, the recovery is much faster because most children experience less pain, don't need to use as much strong narcotic pain medications, and are more willing to eat and drink.

Since the residual tonsil tissue remains, there is a very slight chance that it can re-enlarge or become infected and require more tonsil surgery. This risk is small and occurs in less than 1% of children undergoing this procedure.

Updated and reviewed by: Steven Cook, MD
Date reviewed: April 2004
Originally reviewed by: Steve Dowshen, MD