Tonsillectomy in Singapore

What Is a Tonsillectomy?

The palatine tonsils are part of the immune system. They help trap germs entering through the mouth and nose. In some, the tonsils become a repeated source of infection, blockage, bad breath, tonsil stones or other conditions. When these symptoms are persistent or severe, removing the tonsils may be recommended.

A tonsillectomy is a routine head and neck surgery to remove the palatine tonsils, two soft lymphoid tissue pads at the back of the throat. This tonsil removal procedure is one of the most common operations in ear, nose and throat care.

Tonsil removal surgery is performed through the mouth without external cuts on the neck or face. The surgeon removes the tonsil tissue from both sides of the throat and controls bleeding during the operation. In selected cases, the adenoids may also be removed at the same time. Adenoids are similar immune tissue located at the back of the nose, which are more commonly enlarged in children.

Tonsillectomies are commonly performed under general anaesthesia, meaning the patient is asleep and does not feel pain during the procedure. It may be performed as a day-surgery outpatient procedure, with or without an overnight stay, depending on the age, sleep apnea risk, medical conditions, bleeding risk, and the surgeon’s advice.

What Conditions Does Tonsillectomy Treat

Tonsillectomy treats tonsil problems that are recurrent, long-lasting, obstructive, suspicious or unlikely to improve with medical treatment alone.

Recurrent Tonsillitis

Recurrent tonsillitis, or frequent tonsillitis, is a pattern of repeated episodes of tonsillitis. Tonsillitis is an inflammation or infection of the tonsils. It can cause sore throats, fevers, swollen tonsils, pus on the tonsils, painful swallowing and enlarged neck glands. The 7-5-3 rule is often used as a guide for whether a tonsillectomy is needed:

• At least seven infections in the past year.
• At least five infections a year in two consecutive years.
• At least three infections a year for three consecutive years.

Chronic Tonsillitis

Chronic tonsillitis is an ongoing inflammation that does not fully resolve between episodes. This is different from recurrent tonsillitis, where infections come and go as separate episodes. In chronic tonsillitis, patients may have persistent throat discomforts, enlarged or inflamed tonsils, bad breath, tender neck glands or a constant feeling of irritation at the back of their throats.

Recurrent Tonsil Stones

Tonsil stones are small, hardened deposits that form in the crevices of the tonsils. They are made from trapped food particles, mucus, bacteria and dead cells. Tonsil stones may cause bad breath, throat irritations, a feeling of something stuck in the throat, coughing, ear discomforts or repeated white or yellow lumps from the tonsils.

Deep Tonsil Crypts

Tonsil crypts are small folds or pockets on the surface of the tonsils. Some people have deeper tonsil crypts that more easily trap debris and bacteria. This can lead to recurrent tonsil stones, bad breath, throat irritations or repeated low-grade inflammations. Tonsillectomy is not usually recommended simply because tonsil crypts are present. It may be considered when the crypts are clearly linked to persistent symptoms that do not improve with conservative care.

Peritonsillar Abscess (Quinsy)

A peritonsillar abscess is a pocket of pus that forms beside the tonsil after a severe bout of tonsillitis. It can cause severe one-sided throat pain, fever, a muffled voice, drooling, difficulty swallowing, difficulty opening the mouth and swelling around the tonsil. Treatment usually starts with antibiotics and abscess drainage.

Bleeding from the Tonsils

Bleeding from the tonsils is uncommon and should be assessed carefully. It may occur after an infection, trauma, severe inflammation, or, rarely, due to an abnormal growth.

Enlarged Tonsils

Enlarged tonsils, also called tonsillar hypertrophy, can narrow the throat and affect breathing, swallowing or sleep. Some naturally have large tonsils, but others develop enlargement after repeated infections or chronic inflammations.

Obstructive Sleep Apnea and Sleep-Disordered Breathing

Obstructive sleep apnea can occur when enlarged tonsils block the airway during sleep. In children and adults, this may cause loud snoring, restless sleep, mouth breathing, breathing pauses, daytime tiredness, poor concentration, or behavioural changes in children. In these cases, the aim of bilateral tonsillectomy is to improve breathing during sleep, not just to reduce the tonsillitis.

The pros and cons of a tonsillectomy and other treatments should be discussed carefully. Benefits may include fewer throat infections, fewer courses of antibiotics, better sleep, improved breathing and a better quality of life. The main drawbacks are pain during recovery, time away from work or school, bleeding risks and the usual risks of anaesthesia.

When to See an ENT Specialist for Tonsil Removal

You should see an ear, nose and throat (ENT) specialist if your tonsil symptoms are frequent, severe, affect sleep, or do not improve with the usual medical care.

Arrange an ENT review if you or your child has:

• Repeated episodes of tonsillitis
• Frequent sore throats with fevers
• Pus on swollen tonsils
• Difficulty swallowing
• Enlarged tonsils
• Loud snoring
• Breathing pauses during sleep
• Recurrent tonsil stones
• Persistent, severe bad breath despite good oral hygiene

A prompt assessment is also important if one tonsil is much larger than the other, there is bleeding from the tonsil, a neck lump, unexplained weight loss, persistent ear pains, voice changes, or difficulty opening the mouth. These symptoms do not always mean something serious, but they should be checked.

How to Prepare for a Tonsillectomy

Preparation for a tonsillectomy includes a medical review, medication planning, fasting instructions and arranging safe transport home.

• Before surgery, Dr Barrie Tan and the healthcare team will review the history of recurrent throat infections in the past year, sleep symptoms, medical conditions, medication use, allergies, family history of bleeding disorders, and any personal or family history of anaesthetic problems.
• Blood tests may be needed in selected patients undergoing a tonsillectomy.
• If surgery is being considered for obstructive sleep apnea or sleep-disordered breathing problems, a sleep study may be recommended.
• Patients should inform the clinic about all medicines and supplements. Aspirin, blood thinners, anti-inflammatory medicines and some supplements may need to be stopped or adjusted before a tonsillectomy surgery, but only with medical advice.
• Smoking and alcohol should be avoided before and after surgery because they can irritate the throat and slow the healing process.
• Fasting instructions will be given before general anaesthesia.
• Patients should arrange for a responsible adult to take them home after day surgery, or be available after discharge if an overnight stay is advised.
• It is sensible to plan for 10 to 14 days of recovery. Adults may need longer than children.

Tonsillectomy Surgical Procedure

What Happens During Surgery

During a tonsillectomy, the surgeon removes the tonsils through the mouth and seals the bleeding areas:

1. The patient is given general anaesthesia and monitored throughout the operation.
2. The mouth is gently held open with a specialised instrument.
3. The surgeon identifies both tonsils at the back of the throat.
4. The tonsils are removed using surgical instruments, heat energy, coblation, cautery, ultrasound, or other accepted techniques, with care taken to avoid blood vessels, including the branches of the external carotid artery and the lingual artery.
5. The dissection follows the tonsillar capsule plane.
6. Bleeding points are sealed or cauterised during the operation.
7. The throat is checked carefully, with attention to the glossopharyngeal nerve, before the patient wakes from anaesthesia.
8. The removed tissue may be sent for laboratory testing, especially in adults with unilateral enlargement, an unusual appearance, or any suspected disease.

What Methods Are Used

The technique used for a tonsillectomy depends on the patient’s anatomy, the reason for surgery and the surgeon’s preference.

Common methods include:

• Cold dissection: The tonsils are removed using surgical instruments with little or no heat. This may reduce heat-related tissue injury.
• Electrocautery: Heat is used to remove the tonsils and seal the bleeding sites simultaneously.
• Coblation: Radiofrequency energy and saline are used to remove all or part of the tonsils while producing less heat than a traditional cautery.
• Microdebrider: A powered rotating instrument removes part of the tonsil tissue. This is usually used for a partial tonsillectomy in selected cases.

Partial tonsillectomy may be considered for some patients, especially when the aim is to reduce airway obstruction while reducing postoperative pain. A full tonsillectomy is usually preferred when recurrent infection, tonsil stones, bleeding, or suspicious tonsillar changes are the main concern.

How long does a tonsillectomy take?

The operation itself often takes about 20 to 30 minutes, although the total time in the operating theatre and recovery area is longer. It may take more time if adenoid surgery or another procedure is performed on the same day.

Recovery and Outlook after  a Tonsillectomy

What to Expect After Surgery

After a tonsillectomy, throat pain, tiredness, earache, bad breath and a white healing layer in the throat are expected during recovery.

• Patients are usually monitored for the first few hours after surgery, or longer if needed.
• The throat usually feels sore for one to two weeks, with sore throat and throat pain peaking around days five to seven as the healing process progresses.
• Earache and sore throat pain are common because throat pain can radiate to the ears. This does not usually mean there is an ear infection.

Bad breath and a lingering sore throat are common during healing. A white or grey membrane on each side of the throat is also normal and usually clears after about two weeks. A mild fever in the first couple of days may occur, but persistent fever or poor fluid intake should be assessed.

It is important to drink plenty of fluids as dehydration can worsen pain and increase the risk of complications. Start with fluids and soft foods, then progress to a normal diet with solid foods as tolerated, gradually returning to a normal routine. Suitable options include water, porridge, yoghurt, soup, mashed potatoes, ice cream and soft-cooked foods. Avoid spicy, acidic, hot, hard, or crunchy foods for at least two weeks, as these can irritate the surgical area or increase the risk of bleeding.

Tonsillectomy Recovery Time

Tonsillectomy recovery time is usually 10 to 14 days. Some children recover sooner, while adults and severely affected children may take longer. Many patients need about two weeks away from work, school, exercise and travel. A first follow-up appointment may be arranged around two weeks after surgery to check healing.

Postoperative Care

Tonsillectomy post op care includes pain management by taking medication as prescribed, drinking enough fluids, resting, avoiding smoking and alcohol, and avoiding strenuous activity for about two weeks. Avoid aspirin unless specifically advised, as it can increase bleeding risk. Some painkillers can cause drowsiness, so patients should not drive, operate machinery or make important decisions while affected.

Risks and Possible Complications from a Tonsillectomy

Tonsillectomy complications, and postoperative complications generally, include bleeding, infection, dehydration, nausea, vomiting, pain, swelling and anaesthetic reactions.

• Bleeding after a tonsillectomy is the most important risk. A postoperative haemorrhage can occur 7 to 11 days after surgery, when the healing layer separates. Any fresh bleeding from the mouth or throat should be taken seriously, especially severe bleeding. Spit blood out gently rather than swallowing it. If bleeding continues, seek urgent medical care.
• Postoperative nausea and vomiting can occur after a tonsillectomy and anaesthesia. This may be managed with anti-nausea medication, fluids and careful pain control.
• Other possible risks include dehydration, infection, temporary changes in taste, injury to the lips, tongue or teeth, swelling of the tongue or soft palate, and a reaction to anaesthesia.
• Breathing difficulty is uncommon but may occur, especially shortly after surgery, in patients with airway swelling or sleep apnea.

Long-term side effects of a tonsillectomy are uncommon. Most patients who undergo a tonsillectomy continue to fight infections normally because the immune system has many other lymphoid tissues. Children who undergo tonsillectomies do well in the long term.

However, the surgical removal does not prevent every future sore throat, cold or throat infection. Recurrent throat infections may still occur due to viruses and other causes. Some patients may still develop throat irritations from reflux, allergies, viruses or other causes.

An urgent review is needed if there is bleeding, difficulty breathing, persistent fevers above 38°C, refusal or inability to drink, signs of dehydration, worsening pain not helped by medication, repeated vomiting, confusion or severe weakness.

How Barrie Tan ENT Healthcare Team Can Help

Barrie Tan ENT Head & Neck Surgery can help determine whether a tonsillectomy is appropriate and guide patients safely through treatment and recovery.

At Gleneagles Hospital in Singapore, Dr Barrie Tan, a senior otolaryngology head and neck surgeon, assesses children and adults with recurrent tonsillitis, enlarged tonsils, tonsil stones, quinsy, snoring, sleep symptoms, tonsil bleeding or suspicious changes. If you or your child is experiencing any of these conditions, schedule a consultation at Barrie Tan ENT Head & Neck Surgery today.

FAQs about Tonsillectomy

How much does a tonsillectomy cost?

The cost of a tonsillectomy in Singapore typically ranges from $4,000 to more than $15,000. This comprehensive cost includes initial specialist consultations, diagnostic scoping, surgeon fees, anaesthesia, and a private hospital stay or day-surgery facility. Insurance coverage also varies. A consultation is needed to assess the condition and provide a clear estimate.

Is a tonsillectomy serious surgery?

Tonsillectomy is a common ENT procedure, but it is still a surgical procedure performed under general anaesthesia and requires proper preparation and recovery. The main serious risk is bleeding during healing. Most patients recover well from the surgical procedure with good pain control, hydration and follow-up care.

What is the 7-5-3 rule for tonsillectomy?

This usually refers to the 7-5-3 rule, also known as the Paradise criteria. It means a tonsillectomy may be considered for recurrent tonsillitis if there have been seven episodes in one year, five episodes a year for two years, or three episodes a year for three years.

Why do doctors not like removing tonsils?

Doctors do not remove tonsils unnecessarily because many sore throats improve with time or medical care, and a tonsillectomy carries risks of pain and bleeding. Surgery is considered when the benefits, such as fewer infections or improved breathing, are likely to outweigh the risks.

What happens after the tonsils are removed?

After surgery, the throat is sore for one to two weeks. Earache, bad breath, neck muscle soreness, tiredness and white or grey healing patches in the throat are common. Patients need fluids, soft foods, pain medication, rest and avoidance of strenuous activity until the healing is complete.