Tonsillitis Treatment & Tonsillectomy for Adults in Singapore

What is Tonsillitis?

Tonsillitis is inflammation of the palatine tonsils — the two oval lymphoid structures at the back of the throat. The tonsils are part of the immune system's first defence against inhaled and swallowed pathogens, and they are most active in childhood. By adulthood they have largely outlived their usefulness, which is why removing them in adults causes no immune harm.

Doctors describe tonsillitis in three patterns:

• Acute tonsillitis — a single episode lasting a few days to two weeks. Most commonly viral; about 15–30% are bacterial (Group A Streptococcus is the most important).
• Recurrent tonsillitis — repeated, well-defined episodes separated by symptom-free intervals. Recurrent disease meeting the Paradise criteria (see below) is the standard indication for tonsillectomy.
• Chronic tonsillitis — persistent low-grade infection or inflammation, often with halitosis, tonsil stones (tonsilloliths), and a near-constant scratchy throat. Symptoms drag on for months.

Symptoms of Tonsillitis

• Severe sore throat, often worse on swallowing
• Fever above 38°C, sometimes with chills
• Painful or difficult swallowing (odynophagia, dysphagia)
• Tender, enlarged lymph nodes in the front of the neck
• White or yellow patches (exudate) on swollen, red tonsils
• Bad breath (halitosis), often with white debris (tonsil stones)
• Muffled voice, sometimes called a "hot potato" voice
• In children — refusal to eat or drink, drooling, irritability
• Snoring or apnea events when tonsils become very large

What Causes Tonsillitis?

Tonsillitis is almost always infectious. The pathogen profile shapes treatment:

• Viruses — adenovirus, rhinovirus, influenza, parainfluenza, Epstein-Barr (glandular fever), and Coxsackie. Viral tonsillitis does not need antibiotics.
• Bacteria — Group A beta-haemolytic Streptococcus ("strep throat") is the most important. Untreated strep tonsillitis can lead to rheumatic fever and post-streptococcal glomerulonephritis, so confirmed cases are treated with a 10-day course of penicillin or, if allergic, a macrolide.
• Less common organisms — Fusobacterium (associated with peritonsillar abscess and Lemierre's syndrome), gonorrhoea, and other STIs in adults with relevant exposure history.

Risk factors include close contact with young children (parents, teachers, childcare workers), recent viral upper respiratory infection, smoking, and chronic mouth breathing.

How is Tonsillitis Diagnosed?

Diagnosis is largely clinical:

• History — frequency and duration of episodes, severity, time off work or school, antibiotic use
• Throat examination — assessing tonsil size (Brodsky grading 1–4), exudate, asymmetry, palatal swelling
• Cervical lymph node palpation — tender anterior cervical nodes are typical of bacterial tonsillitis
• Throat swab — for culture or rapid Streptococcus antigen test in suspected bacterial cases
• Blood tests — full blood count, monospot or EBV serology if glandular fever is suspected
• Flexible nasoendoscopy — to assess airway impact and exclude other pathology in atypical or persistent cases

Treatment Options for Tonsillitis in Singapore

Medical Treatment

• Supportive care — rest, generous oral fluids, paracetamol or ibuprofen for pain and fever, throat lozenges, saltwater gargles
• Antibiotics — only for confirmed or strongly suspected bacterial (Group A Strep) tonsillitis. A standard 10-day course of penicillin V or amoxicillin; macrolides such as azithromycin for penicillin-allergic patients
• Steroids — a short course of oral steroid is sometimes used for severe glandular fever-related tonsillar swelling
• Intravenous treatment — admission may be needed if you cannot swallow tablets or fluids

When Surgery is Indicated — the Paradise Criteria

Tonsillectomy is recommended for recurrent tonsillitis meeting the internationally accepted Paradise criteria, which require:

• ≥7 episodes of well-documented sore throat in the previous year, or
• ≥5 episodes per year for the previous 2 years, or
• ≥3 episodes per year for the previous 3 years

Each "episode" should have been associated with at least one of: temperature >38.3°C, cervical lymphadenopathy, tonsillar exudate, or a positive Strep test, and ideally documented at a doctor's visit at the time.

Other indications for tonsillectomy include:

• Previous peritonsillar abscess (quinsy) — surgery is recommended after one episode in adults
• Obstructive sleep apnea or significant snoring related to tonsillar enlargement
• Persistent halitosis or large symptomatic tonsil stones not controlled by gargling
• Suspected tonsil malignancy — particularly an asymmetrical, hard, or ulcerated tonsil
• Recurrent streptococcal carriage transmitting infection in the household

Tonsillectomy — What to Expect

• Day surgery under general anaesthesia — the procedure itself takes 30–45 minutes
• Surgical technique — Dr Pang offers both coblation (radiofrequency-assisted, lower thermal injury) and traditional cold steel dissection. Selection depends on the indication and patient anatomy.
• Recovery — most adults need 10–14 days off work; throat pain typically peaks at days 3–7, with referred pain to the ears. A structured pain protocol of regular paracetamol, an NSAID, and an opioid for breakthrough pain is provided.
• Diet — counter-intuitively, normal-textured food is encouraged from day 1 to keep the throat muscles moving. Aggressive hydration is critical.
• Risks — primary bleeding (within 24 hours, <1%) and secondary bleeding (typically days 5–10 when the scab separates, 2–4%). Adults have a slightly higher bleeding risk than children. Any post-operative bleeding requires immediate A&E review.
• Activity — no strenuous exercise, swimming, or air travel for 2–3 weeks
• Cost — typically $7,000–$12,000 at Mt Elizabeth Hospital depending on ward class and technique. Medisave-claimable up to the relevant surgical limit, and most integrated shield plans cover the procedure substantially. Our team will provide a written estimate and assist with insurance pre-authorisation.

Why Choose Dr Pang for Tonsillitis Treatment?

• Senior ENT specialist with over 20 years of practice across the United Kingdom, United States, and Singapore
• Former Senior Consultant and Clinical Director at the National University Hospital Department of Otolaryngology
• Experienced in both adult and adolescent tonsillectomy using coblation and cold steel techniques
• Structured perioperative pain management protocol for adult patients — pain after adult tonsillectomy is significant and we plan for it carefully
• Direct admitting privileges at Mt Elizabeth Hospital with same-week surgical scheduling for selected cases
• Convenient Mt Elizabeth Medical Centre location off Orchard Road

Frequently Asked Questions