When it comes to tonsils, it's important to distinguish between the two types. When people talk about tonsillitis, they usually mean the palatine tonsils. However, there are also pharyngeal tonsils – these are often mistakenly called "polyps" in common parlance. Nasal polyps, however, are benign growths of the nasal mucosa that usually only occur in adults. In cases of recurrent or severe tonsillitis, a tonsillectomy in adults may be recommended by an ENT specialist to prevent further complications and improve quality of life.

When is a tonsillectomy an option?

If tonsillitis occurs repeatedly or if enlarged tonsils cause serious health problems, they can be removed using appropriate surgical treatment methods.

Enlarged tonsils

Many children have enlarged tonsils. The causes are unclear. Typical symptoms include snoring, labored breathing, sleep apnea, difficulty swallowing, and frequent colds. Respiratory infections and middle ear infections may also occur more frequently. Enlarged tonsils do not always cause health problems. They can also shrink on their own over time. Parents are advised to monitor the development of the symptoms in consultation with an ear, nose, and throat (ENT) specialist. 

Tonsillitis

This refers to an inflammation of the palatine tonsils, also known as tonsillitis. It is a viral or bacterial inflammation of the tonsils. It primarily affects children and adolescents, but tonsillitis can occur at any age. Severely swollen tonsils cause difficulty swallowing. Other symptoms include a sore throat, fever, and fatigue. Tonsillitis is treated with pain relievers and fever reducers. Bacterial infections are treated with antibiotics.

Criteria for tonsillectomy

• According to current guidelines, removal of the palatine tonsils is a possible option.

• in children whose enlarged tonsils cause discomfort,

• in children who have had three to five bacterial tonsillitis episodes in twelve months and who experience further episodes in the next six months,

• in adults who have had three to five episodes of bacterial tonsillitis with severe symptoms over a twelve-month period, which were treated with antibiotics, and in whom further episodes occur,

• in the case of at least or more than six bacterial tonsillitis infections.

Partial or complete removal of the palatine tonsils

During a tonsillotomy, an ear, nose, and throat (ENT) specialist surgically reduces the size of the palatine tonsils using various surgical instruments (laser, monopolar needle, ultrasonic scalpel, scissors, or radiofrequency ablation). Unlike a complete tonsillectomy (removal of the tonsils), this procedure preserves some of the tissue. This allows the tonsils to continue performing their function in the body's immune system. The procedure is associated with less pain, swallowing, and sleep disturbances during the first two weeks. The surgery is performed under general anesthesia on an outpatient or inpatient basis in a hospital.

During a tonsillectomy, the palatine tonsils are completely removed. Various surgical instruments are used in this procedure as well. Because the risk of postoperative bleeding is higher than with a tonsillotomy, a tonsillectomy is performed under general anesthesia in an inpatient setting.

When is a tonsillectomy not necessary?

In cases of enlarged tonsils that cause no or only minor discomfort, as well as in cases of occasional tonsillitis (i.e., fewer than three inflammations in twelve months), partial or complete removal of the tonsils is usually not necessary.

Tonsillectomy / (Partial) Removal of the Palatine Tonsils

There are two types of tonsil surgery: Firstly, the palatine tonsils can be completely removed (tonsillectomy), a procedure primarily used in young children with chronic tonsillitis, as well as in older children, adolescents, and adults. Secondly, there is the option of partial removal of the palatine tonsils (tonsillotomy), which is often appropriate for children under 6 years of age. 

Complete removal of the palatine tonsils (tonsillectomy)

During a tonsillectomy, the two palatine tonsils are removed from their bed using surgical instruments. The operation is usually performed on an outpatient or inpatient basis under brief general anesthesia . A tonsillectomy is a routine procedure in the field of otolaryngology and one of the most frequently performed surgical operations overall.

A relatively common complication (1-6%) is postoperative bleeding, which can occur either on the day of surgery, the day after, or about a week later when the scab falls off. To specifically avoid postoperative bleeding, cold drinks and soft foods are recommended in the days following the operation. Physical exertion and hot baths or showers are prohibited for at least two weeks. Postoperative bleeding requires immediate medical attention!

Unlike children, who cope remarkably well with tonsil surgery, adults often find a tonsillectomy very painful and sometimes suffer from severe pain for 2 to 4 weeks.

Partial removal of the palatine tonsils (tonsillotomy)

Besides complete removal of the palatine tonsils, there is also the option of partial removal, a procedure known as tonsillotomy. This operation is primarily performed on children between the ages of 3 and 6 when the tonsils, due to their abnormal size, cause breathing and swallowing difficulties, but are not a source of chronic inflammation. During a tonsillotomy, a portion of the palatine tonsils is removed on an outpatient basis (e.g., using a laser or radiofrequency).

• Besides the advantage of preserving the tonsils' important immune function, especially for children, this method is also characterized by significantly less pain and bleeding. In cases of chronic tonsillitis, tonsillotomy is generally not advisable, as a chronically inflamed organ would remain in the body.

• Those with statutory health insurance should clarify the cost coverage for a tonsillotomy in advance with the surgeon and their health insurance company.

• Tonsillectomy and tonsillotomy: removal or partial removal of the palatine tonsils

Repeated inflammation of the palatine tonsils

Repeated inflammation of the palatine tonsils (tonsillitis) or enlarged tonsils are the most common reasons for tonsil surgery. The current standard surgical treatment for tonsillitis is tonsillectomy, in which the palatine tonsils are completely removed. In contrast, tonsillotomy involves the partial removal of the palatine tonsils. This procedure is primarily considered for children with enlarged tonsils. Decisions regarding these procedures should always be made in consultation with an experienced ear nose and throat specialist, who can evaluate the patient’s condition and recommend the most appropriate surgical approach.