Short answer
For adults, tonsillectomy is mainly considered for frequent, disabling tonsillitis, repeated throat abscesses (quinsy), tonsils large enough to block the airway, or a suspected tumour. A large UK trial found it roughly halved sore-throat days over two years compared with painkillers and antibiotics as needed. Recovery usually means about 10 to 14 days of throat pain and time off work, and bleeding afterwards is the most serious risk. Whether it is worthwhile depends mainly on how often and how severely tonsillitis is affecting your life.
Key points
- UK guidance uses the number of tonsillitis episodes per year to decide when surgery may be offered.
- The operation takes about 30 minutes under general anaesthetic, usually as a day case.
- Throat pain lasts about 10 to 14 days and is often worst on days three to six.
- Up to 1 in 5 adults return to hospital with bleeding; about 1 in 100 need a second operation.
- Coughing or spitting fresh blood after surgery needs immediate medical advice.
Why adults have tonsillectomy
The tonsils are usually removed only when they cause frequent, disabling tonsillitis despite treatment, are large enough to block the airway, have caused repeated quinsy (an abscess beside the tonsil), or if a tumour is suspected. Waiting to see how things develop is also a reasonable choice.3
For recurrent tonsillitis, UK national guidance described alongside the NATTINA trial supports offering surgery after seven episodes in one year, five a year for two years, or three a year for three years.1 When large tonsils contribute to sleep apnoea, removing them is one recognised option, covered on our page about snoring and sleep apnoea treatments.
Does it work for recurrent tonsillitis in adults?
Until recently the evidence in adults was thin. A 2014 Cochrane review found only two small adult trials, with 156 participants followed for about six months. Surgery was associated with about 10 fewer sore-throat days, but the result for the number of episodes was inconclusive, and the reviewers judged the evidence too low in quality to draw firm conclusions.4
The NATTINA trial, published in The Lancet in 2023, was much larger. It randomised 453 UK adults with recurrent acute tonsillitis to immediate tonsillectomy or conservative management (painkillers and antibiotics when needed) and followed them for two years.2
| Immediate tonsillectomy | Conservative management | |
|---|---|---|
| People randomised | 233 | 220 |
| Median sore-throat days over 24 months | 23 | 30 |
| Rate of sore-throat days | About half as many with surgery (incidence rate ratio 0.53), counting post-operative pain | |
| Main harm | Bleeding: 54 episodes in 44 participants (19%) | Not applicable |
The authors concluded that immediate tonsillectomy was clinically effective and cost-effective for adults meeting the criteria.12 The evidence that surgery reduces sore-throat days in this group is now Moderate: it comes mainly from one large trial, which was open-label, meaning participants knew which treatment they had.2
What the operation involves
Tonsillectomy is done through the mouth under general anaesthetic and takes about 30 minutes. Most people go home the same day after a period of observation, once they are eating, drinking and feeling well enough.3
Recovery
Throat pain lasts about 10 to 14 days and is often worst between days three and six.3 Regular paracetamol or ibuprofen, taken about half an hour before meals for at least the first week, is usually advised; aspirin is avoided because it may increase bleeding.3
- Eating: eating normally helps healing and can ease pain; drink plenty and choose bland foods.3
- Work: plan for 10 to 14 days off.3
- Infection: avoid crowds, smoky places and people with colds, and wash your hands often. Smoking slows healing and raises the risk of bleeding.3
- Expected changes: a white-looking throat and sore ears are normal while healing; ear pain comes from shared nerves rather than an ear infection.3
The main risk: bleeding
Bleeding is the most serious possible complication. One NHS trust tells adults that up to 20 in 100 may return to hospital because of bleeding and about 1 in 100 need a second operation. Bleeding can occur up to two weeks after surgery, most often between days five and ten.3 In the NATTINA trial, bleeding affected 19% of participants after surgery and was the most common adverse event.2
When to seek medical advice
If you spit or cough up fresh blood after a tonsillectomy, seek medical advice immediately, even if it stops, because a small bleed can come before a larger one. Contact the ward or your GP, or go to A&E; call 999 if bleeding is heavy.3
Contact your GP or the hospital if you develop a fever or a bad smell from the throat, which may mean infection.3
Common questions
How long will it hurt?
Usually about 10 to 14 days, with pain often peaking between days three and six.13
When can I go back to work?
Most adults are advised to plan for 10 to 14 days off work.3
Is it safe to fly soon after a tonsillectomy?
Bleeding can happen for up to two weeks, so being far from medical help during that period is worth discussing with your surgeon before you book travel.3 See how soon you can fly after surgery.
Can I choose to wait instead?
Yes; a wait-and-see approach is a recognised option, and you can change your mind or ask for a second opinion.3
Bottom line
For adults with frequent, severe tonsillitis, good-quality UK trial evidence now shows that tonsillectomy reduces sore-throat days over two years. That benefit comes at the cost of a painful fortnight and a real risk of bleeding, so the decision rests on how much tonsillitis is affecting your life.
Related reading
- Ear, nose and throat overview
- What are the treatment options for snoring and sleep apnoea?
- How soon can you fly after surgery?
- How long should you stay abroad after surgery?
Sources
- Newcastle University Press Office. Press release on the NATTINA adult tonsillectomy trial, 17 May 2023. https://www.ncl.ac.uk/press/articles/archive/2023/05/tonsillectomy. Accessed 5 November 2026.
- Wilson JA, O’Hara J, Fouweather T, et al. Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial. The Lancet; 2023;401(10393):2051–2059. https://discovery.dundee.ac.uk/en/publications/conservative-management-versus-tonsillectomy-in-adults-with-recur/. Accessed 5 November 2026.
- Royal Berkshire NHS Foundation Trust, ENT Department. Adult tonsil surgery: patient information. 2026. https://royalberkshire.nhs.uk/media/fkmosacf/adult-tonsil-surgery_aug26.pdf. Accessed 5 November 2026.
- Burton MJ, Glasziou PP, Chong LY, Venekamp RP. Surgical removal of the tonsils (tonsillectomy) for chronic or recurrent acute tonsillitis. Cochrane Database of Systematic Reviews; 2014, Issue 11: CD001802. https://www.cochrane.org/evidence/CD001802. Accessed 5 November 2026.
Article history
- — First published.