Treating tonsillitis: is surgery necessary?

Written by: Mr Prince Modayil
Published: | Updated: 03/05/2019
Edited by: Lisa Heffernan

Tonsillitis is an inflammatory condition of the tonsils. The tonsils are located at the back of the throat and are made of lymphoid tissues. They provide some immunity for new-born babies for the first 12 months, after which they serve no function.

Tonsillitis is generally caused by a viral infection, but sometimes it can be caused by a bacterial infection. It is more common in children, but teenagers and adults can also get it.

We interviewed otolaryngologist Mr Prince Modayil to talk about tonsillitis and when surgery is necessary.

What symptoms come with tonsillitis?

The tonsils will look red and swollen. Usually symptoms can last for 3-4 days and can also include the following:

  • Fever and flu-like symptoms
  • Sore throat
  • Difficulty swallowing
  • Nausea
  • Tiredness
  • Swollen glands in the neck
  • White spots on the tonsils
  • Bad breath

How is tonsillitis diagnosed?

Tonsillitis can be diagnosed by clinical examination and with a throat swab. A blood test may also be carried out to check for the presence of glandular fever. This is a viral infection which can cause extreme tiredness, swollen tonsils and a thick white coating that covers the throat.

How is tonsillitis treated?

Antibiotics may be required if the condition lasts for more than 4 days and the tonsils remain swollen with white spots.

The following steps are essential for full recovery:

  • Drinking plenty of water to stay hydrated
  • Taking paracetamol or ibuprofen
  • Gargling warm, salty water
  • Using sprays or lozenges
  • Plenty of rest

Sometimes, due to a very bad tonsil infection, quinsy can occur. This is a tonsil abscess that causes difficulty breathing and being able to speak, voice changes and trismus (difficulty opening the mouth).

If a person develops quinsy, the abscess will have to be drained under local anaesthetic or antibiotics will be administered intravenously in the hospital.

When does tonsillitis require surgery?

A tonsillectomy to remove the tonsils will be considered if; the patient suffers from tonsillitis 7 times in one year, 5 times a year for 2 consecutive years, 3 times a year for 3 consecutive years or if they suffer from quinsy twice.

A tonsillectomy involves the total removal of the tonsils, under general anaesthetic. The operation only takes about 30 minutes and can be done as a day case procedure in most cases.

Expect to take 10 to 14 days off work or school following the operation and the throat will be sore for about ten days, following the procedure. There is a risk of bleeding after surgery (5-6 %). 1 in every 100 adults and children will require a second operation to stop the bleeding.

For more details on surgery please visit

What about coblation tonsillotomy for tonsillitis?

A coblation tonsillotomy is performed in children/adults with very large tonsils that are causing obstructive sleep apnoea. A coblation tonsillotomy involves reducing the size of the tonsils, to allow more space for the child to breathe. However, this is not the preferred method of treatment for adults and children with tonsillitis. It is preferable to remove the tonsils altogether, to avoid further infection and complications in the future.

Learn more about tonsillectomy and coblation

By Mr Prince Modayil
Otolaryngology / ENT

Mr Prince Modayil is one of London's leading ENT specialists, treating both children and adults, and with a special interest in children's ear, nose and throat disorders.  He has vast experience in treating a wide range of ENT problems in adults and has a special interest in nose and sinus disorders. He treats glue eartongue tiesleep apnoeasore throattonsillitis, tonsilloliths, nasal deviation, nasal polyps, sinusitis, deafness, ear problems, voice problemsMr Modayil completed his specialist training at various tertiary hospitals in London and Manchester. He underwent fellowship training in children's ENT surgery at Evelina London Children's Hospital & Rhinology fellowship at St George's University Hospital

Mr Modayil is an Honorary Senior Lecturer at St George's Medical School and conducts paediatric clinical governance meetings at St George's University Hospital. As a regular speaker at national and international speakers, Mr Modayil is recognised among peers for his commitment to spreading best practice in ENT surgery and promoting the latest effective techniques. Among patients Mr Modayil is highly rated for his caring and considerate manner, and the reassurance he provides to parents at all stages of their child's treatment.

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