Tonsillectomy is a surgical procedure that has evolved over recent years, and its now undertaken using the most up-to-date methods that reduce risks such as pain and bleeding. Here to tell us more about the modern tonsillectomy procedure, what’s involved and whether adults can undergo the procedure, is award-winning consultant ENT surgeon in London/Essex, Mr Anurag Jain.
What’s the latest method of tonsillectomy?
The most recent and widely adopted method is coblation tonsillectomy (controlled ablation using radiofrequency plasma).
- It uses lower temperatures (40–70°C) compared to traditional electrocautery, which reduces thermal injury.
The increased trend is toward intracapsular tonsillectomy (partial removal, leaving the capsule intact) in children, as it reduces pain and bleeding risk.
What’s involved, and what technology is used?
Coblation tonsillectomy: Uses radiofrequency energy in a saline medium to dissolve tissue with minimal heat spread.
General anaesthesia is required. Procedure time is usually 20–40 minutes.
Is a modern tonsillectomy safe?
Yes, but with caveats:
- Common risks: Pain, bleeding (primary <24h, secondary 5–10 days), infection, dehydration.
- Safety improvements: Coblation and intracapsular techniques reduce bleeding and recovery time compared to “cold steel” dissection.
- Mortality is extremely rare (<1 in 40,000).
- Risk of regrowth of tonsils (around 2% risk) requiring revision procedure.
Overall, modern tonsillectomy is considered safe in experienced hands.
Mr Jain has completed a year’s Paediatric ENT fellowship at Evelina’s Children Hospital, St Thomas’ Hospital, London, from where the largest series of coblation intracapsular tonsillotomy was published, and he is an expert in performing these procedures.
What are the reasons someone might have a tonsillectomy?
Main indications:
- Recurrent tonsilitis (usually ≥7 episodes/year, or ≥5 per year for 2 years, or ≥3 per year for 3 years).
- Obstructive sleep apnoea (OSA) due to enlarged tonsils.
- Peritonsillar abscess (quinsy) – recurrent or non-resolving.
- Suspicion of malignancy (rare).
- Dysphagia, halitosis, or speech problems caused by tonsillar hypertrophy.
What age is best for a tonsillectomy? Can adults have them?
- Children (age 3–12): Most common group. Surgery is often easier, and recovery tends to be quicker.
- Adults: They can have a tonsillectomy, but recovery is usually more painful and bleeding risk is slightly higher. It’s still effective and safe when indicated.
There isn’t a single “best age,” but surgery is usually avoided under 3 years unless there’s severe sleep apnoea.
Is there an alternative to tonsillectomy?
Yes, depending on the problem:
- Watchful waiting for mild/reducing tonsilitis.
- Antibiotics/medical management (though overuse is discouraged).
- Tonsillotomy (partial removal, often with coblation or microdebrider) – increasingly popular for children with OSA.
- Continuous Positive Airway Pressure (CPAP) – for adults with OSA if surgery is not suitable.
The latest tonsillectomy methods (especially coblation and intracapsular approaches) are safer, less painful, and quicker to recover from compared to older techniques. Surgery is reserved for clear medical reasons, and while children benefit the most, adults can safely undergo it too.
