Can You Get Tonsillitis Without Tonsils

The first few days after having tonsil surgery are often unpleasant because the wounds hurt and it can be painful to swallow too. These problems may go away after a few days, but they sometimes last one to two weeks. Temporary nausea, vomiting, swallowing problems and loss of taste might occur. There may also be complications such as bleeding.

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Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-.

Tonsillitis: Learn More – When is tonsil surgery a good idea in adults?

Last Update: January 2, 2023 ; Next update: 2025.

Recurrent tonsillitis not only occurs in children, but in adults too. Although surgery can prevent tonsillitis, it is associated with certain risks. The main one is bleeding after surgery.

Inflammation of the palatine tonsils can lead to a sore throat and difficulty swallowing. If the inflammation is caused by bacteria, it is often treated with antibiotics at first. If the tonsils keep on becoming inflamed, doctors may suggest having them (partially) removed instead. It is important to carefully consider this option before making a decision: On the one hand, there’s the hope that surgery will reduce the number of throat infections or make them go away completely. On the other, the surgery carries risks and there’s no guarantee that it will help in the long term.

Surgery is only considered if

the person has bacterial tonsillitis at least three to five times a year,
they have taken antibiotics for it several times, and
the symptoms greatly affect their everyday life.

If possible, it is also important to rule out that the infections are being caused by a virus. It is not always easy to tell the difference between bacterial and viral tonsillitis. Bacteria can be detected using a throat swab.

The typical symptoms of bacterial tonsillitis are:

Fever (above 38°C / above 100.4°F)
Swollen and painful lymph nodes in the neck
A white or yellow coating on the tonsils

Surgery may also be considered if complications occur, such as a build-up of pus around the tonsils (known as a peritonsillar abscess or quinsy).

What are the benefits of tonsil surgery?

Surgery to completely remove the tonsils (total tonsillectomy) can help to reduce the number of throat infections. The tonsils can no longer become infected – but other areas of tissue in the throat can still become infected.

Two small studies suggest that adults who have their tonsils removed are less likely to have throat infections afterwards. But the studies only lasted half a year, so it’s not clear whether the benefits of tonsil surgery last in the long term too. The studies showed the following:

Without surgery: The people in the study who didn’t have surgery had about 2 to 7 sore throats in the six months after the study started.

With surgery: The people who had surgery had about 1 sore throat in the first six months after the procedure. Depending on the study, they also had between 10 and 35 fewer days of illness than the participants who didn’t have surgery.

How much the surgery helps will depend on how severe the symptoms are and whether the infections tend to start on the tonsils or in the surrounding tissue.

What are the reasons not to have surgery?

Sometimes people start having fewer episodes of tonsillitis after a while anyway, even without surgery. It is not possible to say whether that will happen, though. So it may be a good idea to wait and see whether things get better on their own. If they don’t, you can still consider having surgery then.

The first few days after having tonsil surgery are often unpleasant because the wounds hurt and it can be painful to swallow too. These problems may go away after a few days, but they sometimes last one to two weeks. Temporary nausea, vomiting, swallowing problems and loss of taste might occur. There may also be complications such as bleeding.

Some people are afraid that removing their tonsils will weaken their immune system, increasing the risk of coughs and colds. There’s not enough scientific research in this area to be able to say whether that’s true, though. But the tonsils are known to play a more important role in the immune system in the first few years of life than they do later in life.

What are the possible complications of tonsil surgery?

The wound might start bleeding again after the operation. This “post-operative bleeding” usually occurs in the first week after having the procedure, but it is still possible up to four weeks after tonsil surgery. The main warning signs are frequent swallowing and blood in your saliva (spit). The blood may also get into your airways or be vomited up.

Post-operative bleeding is considered to be an emergency because it can lead to a lot of blood loss. So it’s important to go to a hospital immediately – either by asking someone to drive you there or calling for an ambulance (112 in Germany and many other countries, 911 in the U.S.). Although bleeding sometimes stops on its own, a blood transfusion or another operation may be needed.

The risk of post-operative bleeding will depend on things like the surgical technique that is used, the age of the patient, and whether there are other factors that increase the likelihood of bleeding. Studies have found the following:

Post-operative bleeding occurs in about 5 out of 100 adults.
About 1 out of those 5 adults needs to have another operation.

Your voice may sound nasal for a while. Sometimes food and liquids come out of your nose, but that will stop – usually after a few days or weeks.

Like all operations, tonsil surgery is associated with general risks such as wound healing problems, infections or side effects of the anesthetic.

What happens during tonsil surgery and what are the different approaches?

The operation is usually done in a hospital, under general anesthetic. It takes about 15 to 30 minutes.The tonsils are operated on using special surgical instruments. You will then stay in the hospital for a few days.

The tonsils can be removed in many different ways. There are two main approaches:

Total tonsillectomy: The tonsils are removed completely. This is done in a hospital.

Partial tonsillectomy (tonsillotomy): The tonsils are only partially removed. This is sometimes done as a day procedure.

There are different surgical techniques as well:

Procedures that use heat (diathermy): These approaches involve removing tonsil tissue using radiofrequency or laser energy. Both of these devices produce a lot of heat, which is used to seal the wound immediately after the operation. Other approaches use a lower temperature. This is called coblation.

Procedures that do not use heat (dissection): These approaches involve removing tonsil tissue using surgical instruments such as scissors or a snare.

Which is better: Partial or complete surgical removal of the tonsils?

The partial removal (partial tonsillectomy) is somewhat more gentle because less tissue is removed overall and the surgical wound is smaller. In the days following the procedure, you have much less pain and can start eating sooner than after a total tonsillectomy. The risk of bleeding after surgery is probably lower too.

It is not clear how effectively partial tonsillectomy can prevent future tonsillitis, though. There has hardly been any research comparing the effectiveness of the two approaches. As a result, statutory health insurers in Germany generally don’t cover the costs of partially removing tonsils.

If the tonsillitis comes back often and is bacterial, doctors usually suggest removing the tonsils completely (total tonsillectomy).

How can I reduce the problems after surgery?

Pain is the biggest problem after tonsil surgery. It usually gets better after a few days. Until that happens, the pain can be relieved using medication in the form of tablets, suppositories, drops, an intravenous infusion (a “drip”) or a throat spray. People can also use medication to reduce nausea and vomiting.

It is thought that doing certain things can help you recover faster and reduce the risk of bleeding after surgery. For example, people are advised to rest during the first few days after the operation, to avoid carrying heavy objects and only start doing sports again after a few weeks. It can also be a good idea to avoid having hot showers or very warm baths. Spicy foods and acidic foods, including fruit juices and citrus fruits, may irritate the wound. Gargling with mouth rinses can have the same effect.

How can a second medical opinion help?

Various factors will influence the decision about whether to have tonsil surgery: How often do you get tonsillitis? How severe are the symptoms? How likely is the procedure to be successful? What are the chances that you will start having tonsillitis less often anyway, even without surgery?

Sometimes different doctors give different advice. If you are advised to have tonsil surgery, the doctor has to inform you that you have a right to seek a second medical opinion – in other words, to consult a doctor in a different practice or hospital. Our decision aid may be helpful, too. It provides a brief summary of the main pros and cons of the different treatment options.

Sources

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Tonsillotomy for recurrent acute tonsillitis and for hyperplasia of the tonsils: Final report; Commission N15-11. 2017.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services. Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations. Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Tonsillectomy

A tonsillectomy is surgery to remove the tonsils. Tonsils are lumps of tissue on both sides of the back of the throat that help the immune system protect the body from infections.

Tonsillectomy (tahn-suh-LEK-tuh-mee) is one of the most common surgeries kids and teens get.

Why Are Tonsillectomies Done?

Kids usually have a tonsillectomy because:

1. Their tonsils are so big they block the airway and make it hard to breathe. Swollen tonsils can make it hard to breathe, especially during sleep. A child might snore and stop breathing for short periods while asleep when the tonsils get in the way. This is called obstructive sleep apnea. Apnea can make kids miss out on healthy, restful sleep, which can lead to learning, behavior, growth, and heart problems.
2. Their tonsils get infected often. A health care provider might recommend removing the tonsils if a child gets a lot of tonsil infections (called tonsillitis). Experts define “a lot” as when a doctor diagnoses a child with at least 7 infections a year, more than 5 infections a year for 2 years in a row, or three infections a year for 3 years.

What Happens Before a Tonsillectomy?

Your health care provider will let you know if your child should stop taking any medicine in the week or two before the surgery. You’ll also be told when your child should stop eating and drinking because the stomach must be empty on the day of the procedure.

Surgery, no matter how common or simple, can be scary for kids. Help prepare your child by talking about what to expect.

What Happens During a Tonsillectomy?

An ear, nose, and throat (ENT) surgeon will do the surgery while your child is under general anesthesia. This means an anesthesiologist will keep your child safely and comfortably asleep during the procedure.

The surgery is done through your child’s open mouth. There are no cuts through the skin and no visible scars.

The two main types of tonsillectomy surgery are:

1. Traditional tonsillectomy: Both tonsils are completely removed.
2. Intracapsular tonsillectomy: The surgeon removes all the affected tonsil tissue, but leaves a small layer to protect the throat muscles underneath. There’s a very slight chance that the remaining tissue can re-grow or become infected and need more tonsil surgery, but this isn’t common.
   With this type of surgery, kids:
   • recover faster
   • have less pain
   • don’t need as much pain medicine
   • have a lower risk of bleeding
   • are better able to eat and drink after the procedure

Sometimes, when they remove the tonsils, doctors also remove the adenoids.

Can I Stay With My Child During a Tonsillectomy?

Usually, you can stay with your child until just before the surgery. Then you’ll be with them again as they wake up after it’s over.

What Happens After the Tonsillectomy?

Your child will wake up in the recovery area. Many kids go home the same day, though some may stay overnight. In general, kids under 3 years old and those with serious sleep problems (like apnea) usually stay overnight.

Depending on the type of surgery done, recovery after a tonsillectomy may take a week or more. Expect some pain and discomfort after the tonsils are removed, which can make it hard for kids to eat and drink.

Are There Any Risks From Tonsillectomy?

There are risks with any surgery, including infection and problems with anesthesia.

Sometimes children get dehydrated from not drinking enough when they go home, and may need to come back to the hospital for fluids.

Rarely, bleeding might happen during the surgery, right after it, or up to 2 weeks later. Call the doctor right away if your child coughs up, throws up, or spits out bright red blood or blood clots. Doctors might need to do another procedure to stop the bleeding.

How Can I Help My Child Feel Better?

Give your child pain medicine as directed by your health care provider.

Kids should rest at home for a few days following surgery and take it easy for a couple of weeks. They can return to school or childcare when they can eat normally, are sleeping well, and don’t need pain medicine.

Offer plenty to drink, and soft foods like pudding, soup, gelatin, or mashed potatoes until your child is ready for solid foods.

When Should I Call the Doctor?

Call the doctor if your child:

• gets a fever
• vomits after the first day or after taking medicine
• has a sore throat despite taking pain medicine
• isn’t drinking enough liquids

Call the doctor right away if your child vomits blood or something that looks like coffee grounds, or has trouble breathing.

What Else Should I Know?

After tonsillectomy, kids can still get colds, sore throats, and throat infections. They won’t get tonsillitis unless the tonsils grow back, which is uncommon.

Even though the tonsils are part of the immune system, removing them doesn’t affect the body’s ability to fight infections. The immune system has many other ways to fight germs.