Children's ENT Throat & Voice

Tonsil Stone Removal vs Tonsillectomy: When to Opt for the Latter

February 3, 2020
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Tonsil stone removal refers to the specific act of removing tonsil stones, which are small calcified formations that can develop in the crevices of the tonsils. Tonsil stones themselves are not a reason for tonsillectomy unless they are causing significant problems or recurring infections.

On the other hand, tonsillectomy is a surgical procedure where the entire tonsils are removed from the back of the throat. This procedure is typically performed when the tonsils become chronically infected, enlarged, or cause other severe symptoms such as difficulty breathing or swallowing.

Tonsillectomy is one of the most common surgeries performed in children. However, some adults may also benefit from tonsillectomy. Dr Gan shares his opinion on when you should consider having your tonsils removed and the risks and concerns associated with the procedure.



What are tonsils?


Tonsils are two oval-shaped glands located at the back of your throat (left tonsil and right tonsil (Figure 1). They are part of your immune system that protects you against infection and illness.



Figure 1 – A picture of the back of the throat showing the location of the tonsils



What is Tonsillectomy?


Tonsillectomy is the surgical removal of the tonsils. The operation is done through the mouth under general anaesthesia (patient asleep) and there will be no external visible cuts in the neck region.



When (or Why) do I need a Tonsillectomy?


If you do not have problems with your tonsils, they should be left alone. However,  if your tonsils are problematic such as the conditions listed below, they should be removed.



1. Recurrent (frequent) tonsillitis (Figure 2a&b)– Tonsillitis is an infection of the tonsils. Patients with tonsillitis usually experience bad sore throat, painful swallowing and fever. During an active infection, the tonsils are swollen, inflamed and may have patches of pus. Your doctor will usually need to treat the tonsillitis with a course of oral antibiotics, pain relievers as well as gargle and lozenges. If you experience frequent or severe tonsillitis, your doctor may recommend a tonsillectomy.



Tonsil vs. Tonsillitis

Figure 2a- A comparison between normal and infected tonsils



Infected Tonsil

Figure 2b- White patches on a red and swollen tonsil, indicating a tonsil infection



2. Snoring and breathing problems – If your tonsils are big, they may block the upper airway, leading to breathing difficulties and snoring. It can also be a cause of obstructive sleep apnoea (OSA), a condition where a patient stops breathing for a short period during sleep.



3. Suspected cancer – If you have a growth on the tonsil or an abnormally enlarged tonsil (one tonsil much bigger than the other), the tonsils may have to be removed and tested for cancer.



4. Other problems with the tonsils – In some instances, the tonsils may be removed when there is an embedded foreign body (e.g. fish bone completely buried in the tonsil) or  to provide access for surgery in the mouth for other reasons.



Does removal of the tonsils weaken my immune system?


Tonsils play a very small role in your immune system. The lymphatic system, bone marrow, spleen and thymus are the key organs in your immune system. Removal of the tonsils will not make you more susceptible to infections. There are many studies that have shown that tonsillectomy is a safe procedure with no significant negative effects on the immune system.



What are the possible risks and complications from Tonsillectomy?


Tonsillectomy is, in general, a common and safe surgical procedure. However, as with all surgical procedures, there are some risks involved. The most common risk is bleeding (less than 5% chance). Most cases of bleeding after a tonsillectomy can be stopped in the clinic. In rare occasions, the bleeding may have to be stopped in the operating theatre setting. Rarer complications of tonsillectomy include infection, injuries to the lip, teeth, gums and tongue (during retraction of the mouth and tongue) as well as tongue numbness and altered or decreased taste (usually temporary).



What is the recovery like after tonsillectomy?


After removal of the tonsils, the surgical wound (area where the tonsils used to lie on) is exposed (no stitches placed). Hence, when you look at the back of your throat, you will see two large white patches (on the left and right side of your throat). Do not be alarmed as this is the normal appearance of a post-tonsillectomy wound. There will be pain during this period but your pain should be kept under control with painkillers, gargles and lozenges. The white patch (which look like large ulcers – Figure 3) will heal on its own and it usually take approximately 3-4 weeks for the wound to close completely.



Tonsils Removal

Figure 3 – The appearance of the throat a few days after removal of the tonsils. The white patches (indicated by blue arrows) are the surgical wounds (where the tonsils used to lie on). This appearance is temporary and the wound usually heals completely over 3-4 weeks.



Is there any restrictions after tonsillectomy?


You can resume most of your activities of daily living after tonsillectomy. However, to ensure that your recovery is smooth, you should take the following precautions:


Food – Certain food will make your recovery more unpleasant. Spicy food, acidic food and alcohol can cause more pain to the surgical wound. Hence, it would be best to avoid these foods till your surgical wound heals in about 3-4 weeks’ time.


Exercise – It is advisable not to perform any exercise for at least 2 weeks after the surgery. As the surgical wound is raw during this period, there is a risk of bleeding from increased blood circulation to the head and neck region from exercise. Likewise alcohol consumption may also have the same effect and should be avoided.



Tonsils Jokes



Best wishes,



Dr Gan Eng Cern
ENT Specialist Singapore

    When Should You See an ENT Specialist in Singapore?

    • Any ear, nose or throat symptoms that you are troubled with or concerned about
    • Persistent blocked nose with mouth breathing or snoring

    Dr Gan Eng Cern

    Dr Gan Eng Cern is a distinguished ENT doctor with fellowship training. In addition to his clinical practice as an ear, nose and throat specialist in Singapore, Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.


    • 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
    • 2016 – Best Educator Award (Eastern Health Alliance)
    • 2016 – “Wow” Award (Patient Compliment)
    • 2014 – Eastern Health Alliance Caring Award – Silver
    • 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
    • 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
    • 2007 – Singhealth Best Doctor Award


    • MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
    • MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
    • MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
    • FAMS – Fellow of the Academy of Medicine Singapore

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