Tonsil and adenoid surgery for children and adults: a complete guide to making the right decision

Last Update: 26/11/2025

Tonsil and adenoid surgery is one of the most common ENT procedures, especially in children who suffer from repeated throat infections, snoring, or breathing problems during sleep. When parents hear the doctor say, “We may need to consider removing the tonsils and adenoids,” it is normal to feel worried and to ask:
Is this really necessary? Is it safe? Are we making the right decision?

This article is designed to be the bridge between everything you have already learned about tonsillitis, enlarged adenoids and their treatments, and the final step of deciding whether tonsil and adenoid surgery is the right option for your child or for you. Our goal is not to push you towards surgery, but to help you understand when medical treatment is enough and when surgery genuinely improves breathing, sleep and quality of life.

 

If your child or a family member has repeated throat infections, loud snoring or difficulty breathing through the nose, you can book an appointment with our ENT consultants at Magrabi Hospitals for a detailed evaluation before deciding on surgery:Book your appointment now

 

What is tonsil and adenoid surgery and why are they sometimes done together?
 

The tonsils are two small glands at the back of the throat, and the adenoids are a patch of tissue high behind the nose. In early childhood they help the immune system recognise germs, but in some children (and some adults) they become more harmful than helpful:

• The tonsils may become infected again and again, causing pain, fever and difficulty swallowing.
• The adenoids may grow too large and cause nasal blockage, snoring, mouth breathing or ear problems.
   

Tonsil and adenoid surgery is a procedure in which an ENT surgeon removes:
 

• The tonsils only (tonsillectomy), or
• The adenoids only (adenoidectomy), or
• Both together in one session (tonsil and adenoid surgery).
   

This combined operation is often recommended in children who have both problems at the same time: repeated tonsillitis plus enlarged adenoids that affect breathing and sleep. This article will help you understand when we can continue with medicines and observation, and when it becomes reasonable to think about surgery.

 

When is medicine enough and when does tonsil and adenoid surgery become necessary?

 

The decision to perform tonsil and adenoid surgery is not based on a single infection or one bad night of snoring. It is based on a pattern of symptoms over time and their impact on daily life.

Situations where watchful waiting and medical treatment are usually enough

Your ENT doctor may prefer to continue with medical treatment and monitoring if:

1- Tonsil infections are mild and infrequent:
 

• Only a few episodes per year.
• Symptoms respond quickly to medicines.
• No repeated absence from school or work.
   

2- Adenoid enlargement is mild:
 

• Occasional nasal blockage only.
• Mild or intermittent snoring.
• No repeated middle ear infections or hearing problems.
   

3- Daily life is not significantly affected:
 

• Sleep is acceptable without frequent waking.
• Appetite and growth are within normal limits.
• Concentration and energy during the day are good.
   

In these situations, the safest plan is often: treat infections when they occur, follow up regularly with the ENT specialist, and avoid rushing into surgery.

Signs that make surgery more likely

Your doctor may start to think more seriously about tonsil and adenoid surgery when one or more of the following are present:
 

1- Frequent tonsil infections:
 

• Many episodes within a year, with high fever and severe throat pain.
• Each episode causes obvious fatigue and repeated absence from school or work.
   

2- Significant adenoid enlargement:
 

• Persistent nasal blockage and difficulty breathing through the nose.
• Loud, continuous snoring and frequent mouth breathing.
• Repeated middle ear infections or hearing loss in the child.
   

3- Clear impact on quality of life:
 

• Poor or disturbed sleep, frequent awakening at night.
• Poor appetite or lack of expected weight gain.
• Decline in school performance or daytime attention due to lack of sleep.
   

4- Possible sleep apnoea (stopping breathing during sleep):
 

• Pauses in breathing at night noticed by parents.
• Excessive sweating or restless, uncomfortable sleep.
   

In these cases, the decision is based on the accumulation of symptoms and their daily impact, not on a single infection. This is when your ENT doctor will discuss whether tonsil and adenoid surgery is now the safest and most effective option in the long term.
 

When do we remove the tonsils only, the adenoids only, or both together?
 

Not every patient needs both tonsils and adenoids removed. Sometimes the main problem is the tonsils alone, sometimes only the adenoids, and in many children it is a combination of both. Understanding this helps explain why the doctor may recommend one operation rather than another.
 

When is tonsil surgery alone enough?
 

We usually think about tonsillectomy alone when the main problem is in the throat, without significant nasal or adenoid symptoms, such as:
 

1- Repeated tonsillitis without nasal problems:
 

• Several attacks of tonsillitis every year with fever and pain.
• No persistent nasal blockage or snoring from enlarged adenoids.
   

2- Problems specific to the tonsils:
 

• Abscess around one tonsil (peritonsillar abscess).
• Unusual enlargement of one tonsil or repeated bleeding from the tonsils that needs assessment.
   

In such situations, removing the tonsils alone is usually enough, as removing adenoids that are not causing symptoms adds no benefit.
 

When is adenoid surgery alone enough?
 

Here, the main problem is enlarged adenoids behind the nose, while the tonsils are normal-sized and not frequently infected:
 

1- Adenoid enlargement causing breathing and ear problems:
 

• Persistent nasal blockage and mouth breathing.
• Loud snoring during sleep.
• Repeated middle ear infections or fluid behind the eardrum, sometimes with hearing loss.
   

2- Tonsils are normal:
 

• No frequent tonsil infections.
• No major throat pain or swallowing problems linked to the tonsils.
   

In these cases, adenoidectomy alone is often enough to improve nasal breathing, reduce snoring and decrease ear problems, without needing tonsil surgery.
 

When is tonsil and adenoid surgery together recommended?
 

This is the most common scenario in children, especially when both the tonsils and adenoids are causing significant problems:
 

1- A child with clear adenoid enlargement:
 

• Long-standing nasal blockage.
• Loud snoring and mouth breathing.
• Possibly repeated ear infections or hearing problems.
   

2- Plus frequent tonsil problems:
 

• Repeated episodes of tonsillitis.
• Enlarged tonsils that affect swallowing or breathing at night.
• Impact on sleep, appetite or daytime activity.
   

In such children, your ENT doctor may recommend tonsil and adenoid surgery in one session because:
 

• There is one general anaesthetic instead of two separate operations.
• There is one recovery period, not two.
• Both sources of the problem (tonsils and adenoids) are treated at the same time, giving a better chance to improve breathing and sleep.
   

The final decision is based on a full ENT assessment of the nose, throat, ears, pattern of sleep and number of infections, followed by an open discussion with the family. This section is really the “bridge” between the adenoid and tonsil topics: it explains when dealing with one area is enough, and when combined tonsil and adenoid surgery offers the most complete solution.

 

How do ENT doctors at Magrabi evaluate the case before recommending surgery?
 

Before Magrabi ENT consultants recommend tonsil and adenoid surgery, they perform a detailed assessment. The aim is always to answer one key question:

Can we still safely continue with medical treatment and observation, or has surgery become the option that will genuinely improve health and quality of life?

Medical history and physical examination

The assessment starts with a detailed conversation and careful examination. Our doctors focus on:
 

1- Medical history:
 

• Number of tonsillitis episodes per year.
• Severity of each episode: fever, throat pain, difficulty swallowing, days off school or work.
• How long symptoms last and how they affect sleep, appetite and daily activity.
• How well the child or adult responds to medicines now compared with before.
   

2- Physical examination:
 

• Examination of the throat to assess tonsil size and signs of frequent inflammation.
• Examination of the nose and adenoid area for signs of blockage or mouth breathing.
• Assessment of the ears and hearing, especially in children with repeated ear infections.
   

This helps the doctor decide whether the main problem is in the tonsils, the adenoids, or both.
 

Supportive tests when needed
 

In many cases, history and examination are enough. Sometimes additional tests are useful, for example:
 

1- X-ray or nasal endoscopy:
 

• To assess adenoid size and how much they block the airway behind the nose.
   

2- Sleep studies (polysomnography):
 

• When there are signs of sleep apnoea, such as pauses in breathing, very loud snoring or daytime sleepiness.
• These tests show how the tonsils and adenoids affect oxygen levels and sleep quality.
   

These investigations are not required for every patient, but can be helpful in borderline or complex cases.
 

Discussing options with the family or patient
 

1- After gathering all information, Magrabi ENT doctors sit with the parents or patient to explain clearly:
 

• The current situation and how severe the problem is.
• The benefits and limitations of continuing with medical treatment and observation.
• The expected benefits and possible risks of tonsil and/or adenoid surgery.
   

2- The decision is always shared:
 

• We encourage families to ask all their questions.
• We may direct them to more detailed articles about tonsil surgery and adenoid surgery separately for those who want to understand each procedure in depth.
   

What happens during tonsil and adenoid surgery?
 

When Magrabi ENT doctors recommend tonsil and adenoid surgery, they explain the steps clearly so parents and patients know what will happen in the operating room and afterwards.
 

Type of anaesthesia and duration
 

• Tonsil and adenoid surgery is performed under general anaesthesia.
• The patient is fully asleep and feels no pain during the procedure.
• A specialist anaesthetist monitors breathing, heart rate and blood pressure throughout the surgery.
• The actual operating time is usually short. The total time your child spends in the operating area includes preparation, surgery and the recovery period in the recovery room.
   

The steps of tonsil and adenoid surgery in simple terms
 

Inside the operating room:

The surgeon works through the mouth and nose. There are no cuts on the skin of the neck or face.
 

1- Adenoid removal (adenoidectomy):
 

• The adenoids are reached behind the nose using special instruments through the mouth or nose.
• The enlarged tissue that is blocking the airway or affecting the ears is removed.
   

2- Tonsil removal (tonsillectomy, when needed):
 

• The tonsils on both sides of the throat are removed using modern techniques designed to reduce bleeding and pain as much as possible.
• At the end, the surgeon checks carefully for bleeding and ensures the area is safe before the patient is transferred to the recovery room.
   

All of this is done following strict safety protocols in a hospital environment experienced in ENT surgery for children and adults.
 

How long do patients stay in hospital after surgery?
 

How long a child or adult stays in hospital depends on age and overall health:

1- In many cases:
 

• Surgery is done as a day-case procedure, and the patient can go home a few hours after full recovery from anaesthesia.
   

2- In some situations:
 

• Very young children, patients with chronic illnesses, or those who need closer monitoring may stay one night for observation.
   

3- Before going home, the medical team explains:
 

• How to give pain relief medicines.
• What to eat and drink in the first days.
• Which warning signs to watch for.
   

Complications of tonsil and adenoid surgery in children
 

Although tonsil and adenoid surgery in children is considered safe when performed in a specialised centre, parents should be aware of possible complications, even if they are uncommon:

1- Throat and ear pain:
 

• Throat pain is expected in the first days after surgery.
• Pain may also be felt in the ears because of shared nerves—this does not mean there is an ear infection.
   

2- Difficulty swallowing and poor appetite:
 

• Children may refuse solid food at first and prefer cool liquids and soft foods.
• This usually improves gradually as healing progresses and pain is controlled.
   

3- Mild bleeding:
 

• Small streaks of blood in saliva or after coughing may occur in the first day.
• Any heavy or continuous bleeding is an emergency and needs urgent medical attention.
   

4- Mild fever:
 

• A small rise in temperature can happen after surgery and usually responds well to fever-reducing medicines.
• Persistent high fever must be reported to the doctor.
   

5- Dehydration or infection:
 

• Not drinking enough fluids can cause dehydration. Parents are encouraged to offer fluids regularly.
• Post-operative infection is rare but possible and is treated promptly if it occurs.
   

If you would like to know more about the ENT services and surgical techniques available at Magrabi, you can visit:
Magrabi ENT Department – Saudi Arabia

Recovery after tonsil and adenoid surgery: first days and the following two weeks
 

Recovery after tonsil and adenoid surgery usually has a few difficult days at the beginning, followed by gradual improvement over one to two weeks. Knowing what to expect makes the process less stressful for everyone.
 

1- Pain after surgery and how to manage it
 

• Throat pain is normal and may radiate to the ears.
• Pain is usually worst in the first few days and may peak around days 3–5.
   

To manage pain, doctors usually recommend:
 

2- Regular pain relief:
 

• Give pain medicines exactly as prescribed, without waiting until the pain is very severe.
• Do not give any additional medicines without medical advice.
   

3- Cool or lukewarm fluids:
 

• Help soothe the throat and make swallowing easier.
   

4- Gentle swallowing:
 

• Although swallowing can be uncomfortable, regular small sips can help the healing process.
   

If pain is severe and does not improve with medicines, or is associated with bleeding, you should contact your doctor immediately.
 

Eating and drinking after surgery
 

Good hydration and nutrition are essential for healing:

1- In the first days:
 

• Focus on cool fluids such as water, non-acidic juices and milk (if tolerated).
• Offer soft foods: yoghurt, mashed potatoes, pureed vegetables, soft soups, ice cream or jelly (if approved by the doctor).
   

2- Avoid for a while:
 

• Hard or crunchy foods (chips, nuts, crusty bread).
• Very hot or spicy foods.
• Fizzy or acidic drinks that can irritate the throat.
   

3- As recovery progresses:
 

• Gradually return to a normal diet based on what the child or adult can comfortably swallow.
• Ensure plenty of fluids to prevent dehydration.
   

Activity and return to school or work
 

1- First days:
 

• Rest at home is recommended, with light movement around the house.
• Avoid rough play, running and any strenuous activity.
   

2- During the first two weeks:
 

• No contact sports, heavy lifting or swimming unless the doctor approves.
   

3- Returning to school or work:
 

• Depends on age, type of work and speed of recovery.
• Many children can return to school once pain is manageable, eating and drinking are better and sleep has improved.
   

What to expect after tonsil and adenoid surgery in children
 

Post tonsil and adenoid surgery in children has some specific points for parents to watch:
 

1- Behaviour and mood:
 

• Children may be clingier, irritable or tearful in the first days.
• This usually improves as pain decreases and sleep normalises.
   

2- Sleep:
 

• Snoring and mouth breathing may persist for a short period while swelling goes down.
• Over time, parents often notice much quieter, more restful sleep.
   

3- Bad breath:
 

• Temporary bad breath is common while the throat heals.
• Encouraging fluids and gentle oral hygiene helps.
   

4- Home monitoring:
 

• Keep track of how much the child drinks and how often they urinate (to detect dehydration).
• Watch for any bleeding, bloody vomit, persistent high fever or extreme lethargy, and seek medical care if these occur.
   

With good pain control, proper fluids and food, and careful observation, most children recover well and gain significant long-term benefit from the operation.

 

When should you contact a doctor urgently after tonsil and adenoid surgery?
 

Most children and adults pass through tonsil and adenoid surgery without serious problems. However, it is crucial to recognise warning signs that need urgent medical assessment:

1- Significant bleeding from the mouth or nose:
 

• Bright red blood coming from the mouth or nose.
• Vomiting blood or spitting clots.
   

2- Breathing difficulties:
 

• Fast, laboured breathing.
• Noisy breathing or any signs of airway obstruction.
   

3- High fever not responding to medicines:
 

• Persistent high temperature despite proper doses of fever medication.
   

4- Signs of dehydration:
 

• Refusal to drink for many hours.
• Dry mouth, reduced tears, or very little urine.
• Unusual sleepiness or extreme tiredness.
   

5- Severe pain not controlled by prescribed medicines.
 

In any of these situations, you should contact your doctor immediately or go to the nearest emergency department.
 

Frequently asked questions about tonsil and adenoid surgery
 

When does my child need tonsil and adenoid surgery together?
 

Combined tonsil and adenoid surgery is usually considered when:

• Enlarged adenoids cause nasal blockage and snoring and
• The child also has repeated tonsil infections or enlarged tonsils that disturb sleep, appetite or growth.
   

Treating both problems in one operation often gives better overall improvement.
 

Is tonsil and adenoid surgery painful for my child?
 

Yes, some pain is expected, especially in the throat and sometimes in the ears, but it is temporary and manageable:

• Doctors prescribe appropriate pain relief for the child’s age and weight.
• Pain usually improves gradually over 1–2 weeks.
   

What is the right age for tonsil and adenoid surgery?
 

There is no single “perfect age”. The decision depends on:

• How severe and frequent the symptoms are.
• How much they affect sleep, breathing, growth and daily life.
   

If the problem is clearly affecting a child’s health or development, ENT specialists may recommend surgery even in younger ages.
 

Can tonsil or adenoid problems return after surgery?
 

• Throat infections can still occur after tonsil removal, but they are usually milder and less frequent.
• Adenoids rarely grow back. If some tissue does regrow, it usually does not cause the same degree of blockage.
   

Is tonsil and adenoid surgery safe for adults too?
 

Yes. Although most operations are done in children, adults may also need surgery for:

• Repeated tonsillitis.
• Sleep apnoea due to enlarged tonsils or adenoids.
   

Recovery in adults can be slower and more painful than in children, so careful adherence to post-operative instructions is especially important.
 

How can I prepare for the decision about tonsil and adenoid surgery for my child or myself?
 

You can prepare for an informed decision by:

1- Tracking symptoms:
 

• Number of tonsillitis episodes per year.
• Snoring, pauses in breathing during sleep, mouth breathing.
   

2- Noting daily impact:
 

• Sleep quality, appetite, weight gain and school performance.
   

3- Collecting medical information:

• Other illnesses, regular medicines and any previous reaction to anaesthesia.
   

4- Preparing questions for your doctor:
 

• Are there non-surgical options left to try?
• What benefit is expected from surgery?
• What are the risks and how are they minimised?
• How long will recovery take?
   

5- Choosing an experienced centre:
 

• Surgery should be performed by qualified ENT specialists in a hospital with strong experience in paediatric and adult ENT surgery.
   

 

Conclusion
 

Tonsil and adenoid surgery is not a decision made after a single infection. It is the result of careful evaluation of symptoms, their frequency and how much they affect breathing, sleep, growth and daily life.

In many children and adults, medical treatment and observation are enough. In others, surgery becomes the option that truly relieves daily suffering and restores normal breathing and restful sleep.

If you feel that tonsil or adenoid problems are starting to affect your child’s comfort or your own quality of life, the best next step is to discuss the situation calmly with an ENT consultant. Together, you can decide whether it is time for surgery or whether continued observation is still safe.

 

You do not have to make this decision alone.
You can book a consultation with Magrabi ENT consultants to review your or your child’s case in detail and to decide, together, whether tonsil and adenoid surgery is the right step now:Book your appointment now

 

Medical references
 

• Saudi Ministry of Health – trusted health information and guidance on children’s illnesses and respiratory conditions.
• Saudi Food & Drug Authority (SFDA) – information about the safe use of medicines, painkillers and antibiotics for children and adults.
• American Academy of Otolaryngology – Head and Neck Surgery (ENTHealth) – educational resources about ENT diseases and surgery (in English).
   

 

Medical review
 

This article has been medically reviewed by:

Dr Hesham Abdul Aziz
ENT Specialist – Magrabi Hospitals

 

Medical disclaimer
 

The information in this article is for general education only and does not replace a consultation with an ENT specialist or any other qualified doctor.

If you or your child have worrying symptoms, or if you are considering tonsil and adenoid surgery, please do not rely on this article alone. Always consult your doctor or visit the nearest medical centre for a personal assessment and a treatment plan tailored to your specific case.