Do You Need a Tonsillectomy or Adenoidectomy?

In the past, a tonsillectomy, the surgery that is performed to remove swollen and/or infected tonsils, was performed routinely, sometimes in a doctor’s office. This resulted in a concern within the medical community that too many tonsillectomies were being performed unnecessarily.

Today, there are guidelines for performing a tonsillectomy that should be met before surgery is performed. If these guidelines are not met, the patient may find that insurance will not pay for the procedure, as it is not considered necessary.

Even with the current guidelines, a tonsillectomy is a very common procedure with over 250,000 performed annually in the United States. Most tonsillectomy patients are children who have infected tonsils. Most adults who have their tonsils removed are doing so to improve sleep apnea, but there are the occasional but rare cases of adults who have their tonsils removed due to recurrent infections.

While tonsillitis does make your throat hurt, a sore throat isn’t necessarily tonsillitis. With tonsillitis at least one of the palatine tonsils are swollen and infected. The adenoids, a different set of tonsils, can also become infected and painful and may be removed with the palatine tonsils if necessary.

Young woman doctor checking patients oral cavity with otoscope
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Reasons for Tonsillectomy

  • Chronic bleeding: from one or both tonsils
  • Chronic tonsillitis: five or more bouts of tonsillitis in the course of a year OR three episodes per year for two years in a row OR tonsillitis does not respond to antibiotic therapy
  • Cryptic tonsils or tonsilloliths: tonsils that collect particles, which harden and become stone-like lumps
  • Abscess of the tonsil: a collection of pus within the tonsil
  • Chronic bad breath: caused by infection in the tonsils
  • Kissing tonsils: Tonsils so enlarged that they touch in the middle of the mouth/throat
  • Obstructive sleep apnea: large tonsils can narrow the airway, making sleep apnea worse
  • Suspicion of cancer

Reasons for an Adenoidectomy

  • Repeated infection of the adenoids
  • Adenoid infections that cause ear infections or hearing problems​
  • Adenoid infections that do not respond to antibiotics
2 Sources
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  1. Mitchell RB, Archer SM, Ishman SL, et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg. 2019;160(1_suppl):S1-S42. doi:10.1177/0194599818801757

  2. Podeur P, Mancini J, Delgrande J, et al. Role of tonsillectomy in the management of carcinomas of unknown primary of the head and neck: a retrospective study based on p16 analysis. Front Oncol. 2020;10:594168. doi:10.3389/fonc.2020.594168

By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.