Tonsillitis & Tonsil Treatment

The tonsils sit one on each side at the back of the throat and are part of the ring of immune tissue guarding the entrance to the airway and gut. They are most active in early childhood, and they shrink through the teenage years. Removing them does not leave a person without immune defence, because the rest of that ring and the wider immune system continue as before.

Trouble comes when the crypts, the deep folds on the tonsil surface, stop clearing themselves. Debris and bacteria collect in them, the tonsil becomes chronically colonised, and each new infection settles into the same place. At that point antibiotics clear the episode but not the reservoir, so the pattern repeats.

The decision about what to do is made on frequency, not on severity. Attacks are counted over a defined period, and the counting has to be reliable enough to be meaningful, so documented visits carry more weight than recollection. Enlarged tonsils that block the airway in sleep are a separate reason to act and are assessed differently.

The throat is examined for the size of the tonsils, the state of their surface and whether the surrounding tissue is inflamed, and the neck is felt for enlarged glands. A single examination between attacks often looks unremarkable, which is expected and does not contradict the history.

A throat swab or a rapid streptococcal test is used during an attack to identify a bacterial cause, since most sore throats are viral and do not need an antibiotic. Blood tests are added where glandular fever is possible, particularly in teenagers, because that illness looks similar and is managed quite differently.

What carries most weight is the record. The doctor asks for how many attacks there were, how each was confirmed, how many antibiotic courses were given and how much school or work was lost. Keeping a simple diary over the following months is often what settles the decision, and where sleep is disturbed a sleep study is arranged as well.

An individual attack settles over about a week with fluids, regular paracetamol or ibuprofen and rest, and an antibiotic where a bacterial cause is confirmed. Swallowing is the difficulty, and keeping fluids going matters more than eating.

After removal the recovery is well defined and honestly unpleasant. There is significant throat pain for ten to fourteen days, often worse on days five to seven as the white coating forms over the healing beds, and pain referred to the ears is normal and does not mean an ear infection. Regular painkillers taken by the clock, not when the pain arrives, make the difference.

Eating normal food is encouraged, since chewing keeps the beds clean. Adults take around two weeks off and children a little less. There is a small risk of bleeding up to about ten days afterwards, and any fresh blood from the mouth means going straight to hospital instead of waiting to see.