Adenoid and tonsil surgery is used in children and adults to treat breathing difficulty, snoring, recurrent tonsillitis and ear problems caused by enlarged adenoids and tonsils. It is a short procedure performed under general anaesthesia.

On what criteria is tonsil surgery decided in a child?

Today the most common reason for tonsil surgery in children is in fact not infection but airway obstruction — in children with snoring, pauses in breathing during sleep, restless sleep and constant mouth breathing, enlarged tonsils and adenoids are the primary reason for surgery. Accompanying findings such as slowed growth, bed-wetting or a drop in school performance also support the decision.

For surgery because of recurrent infection, clinical guidelines set a clear, widely accepted threshold (the Paradise criteria): at least 7 episodes in the past year, at least 5 episodes in each of the past 2 years, or at least 3 documented episodes in each of the past 3 years. Each episode must be documented with findings such as fever, swollen neck glands, exudate on the tonsils or a positive strep test. Below this frequency, guidelines recommend watchful waiting rather than surgery — because in moderately affected children the benefit of surgery does not outweigh the surgical risk.

In some special situations surgery can be considered with fewer episodes: severe allergy to more than one antibiotic, PFAPA syndrome (periodic fever episodes) or a previous peritonsillar abscess. Rarely, if asymmetric or rapid growth is noticed in one tonsil, that also needs separate assessment.

In the end the decision is made together with the family, according to the child’s own picture (frequency of infection, obstruction, or both).

At what age is adenoid surgery done?

Adenoid surgery can be done from the age of 2, but ideally I prefer age 4 and above — at that age the process is easier to manage both surgically and in terms of the child’s general development.

How are pain and eating managed after surgery?

After adenoid surgery there is almost no pain. For pain after tonsil surgery, ordinary pain-relief syrups are usually enough and no additional strong painkiller is needed.

For eating, I give my patients a specific post-tonsillectomy diet — a plan that starts with soft, cold, non-spicy and non-acidic foods and returns gradually to normal eating as healing progresses. This both reduces pain and supports comfortable healing of the surgical area. (You can find the full day-by-day plan on the Post-Tonsillectomy Diet page.)

Does removing the tonsils weaken immunity?

No. Research shows that tonsil and adenoid surgery does not adversely affect the basic working of the immune system (cellular and antibody-based immunity) — the operation does not “weaken” the child’s overall immune capacity. The tonsils are not the only, or an indispensable, part of the immune system; many other tissues and mechanisms in the body perform this role.

The literature does note that the tonsils and adenoids also act as a local defence and filter in the upper airway, so a slight increase in the frequency of some infections in this region may be seen after surgery. But this does not outweigh the main purpose of the operation — preventing recurrent severe infection or obstruction — and we weigh this balance together when making the decision.