Tonsillectomy: When Should It Be Done?

By Dr. Katerina Panagiotidi, MD, PhDc – ENT Surgeon

What is a Tonsillectomy?

A tonsillectomy is a surgical procedure to remove the palatine tonsils located in the throat, performed by an ENT surgeon. 

The tonsils are lymphatic tissue—part of our immune system—but after the age of five, they no longer serve a significant function. In some cases, they become enlarged and cause breathing or swallowing difficulties, especially in children.

Recurrent tonsil infections can lead to hypertrophy (enlargement), and when bacteria are not eliminated effectively, chronic or recurrent tonsillitis may occur. Tonsil issues can affect individuals of all ages.

When Should I Have My Tonsils Removed—and at What Age?

The indications for tonsillectomy are divided into absolute and relative categories. It’s a common misconception that if tonsil removal isn’t done in childhood, it cannot be performed later in life. In fact, age is not a limiting factor as long as the patient is older than 5 years, the point at which tonsils no longer significantly support immune function.

Absolute Indications for Tonsillectomy

Obstructive causes:

• Enlarged tonsils obstructing the airway

• Obstructive sleep apnoea, loud snoring, frequent night awakenings

• Chronic mouth breathing

• Poor academic or work performance, constant fatigue, daytime sleepiness

• Speech disorders caused by enlarged tonsils

• Difficulty swallowing (dysphagia)

• Delayed physical growth and weight gain in children

• Abnormal jaw or facial development due to tonsil size

Inflammatory causes:

• Frequent severe infections requiring repeated antibiotic use

• Recurring episodes of tonsillitis, defined by:

  • Severe sore throat with fever over 38.3°C

  • Enlarged neck lymph nodes (>2 cm)

  • White patches on tonsils

  • Positive throat culture for Streptococcus

Other causes:

• History of peritonsillar or parapharyngeal abscess

• Frequent bleeding from the tonsils

• Suspicion of malignancy in the tonsils

Relative Indications for Tonsillectomy

• Compromised health due to respiratory, cardiovascular, or systemic conditions

• PFAPA syndrome

• Very severe episodes of tonsillitis

• Allergic reactions to antibiotics

• Persistent bad breath causing social or personal issues

Do you think you might have one or more of the above indications?
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