Tonsillectomy and Adenoidectomy
What are tonsillectomy and adenoidectomy?
Tonsils are small lumps on either side of the back of your throat.
Adenoids are small lumps at the back of your nose.
They both help fight off infection, but sometimes they get too large and cause problems with breathing and sleeping.
Having them surgically removed with tonsillectomy and/or adenoidectomy can solve the issue.
Both procedures are done under a general anaesthetic (you will be asleep) and the tonsils and adenoids are removed through your mouth.1, 2
Tonsillectomy and adenoidectomy are most often done for children.
Tonsillectomy and adenoidectomy are performed by an Ear, nose and throat (ENT) specialist.
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Public and private hospital options
It’s important to understand how getting your procedure in a public or private hospital differs.
| Question | Public system (Without health insurance) | Private system (With health insurance) |
|---|---|---|
| Will I avoid public hospital waiting lists? |
No. |
Yes. |
| Will I be able to choose my hospital? |
No. |
Yes. |
| Will I be able to choose my doctor or surgeon? |
No. |
Yes. |
| Will I have out-of-pocket costs? |
No. |
Yes. |
What’s covered in a public hospital?
In a public hospital, tonsillectomy or adenoidectomy is covered by Medicare for eligible residents.
Once you are discharged from hospital, you may still need to pay out-of-pocket for things like medicines and health services (like physiotherapy or occupational therapy).
What’s covered in a private hospital?
In a private hospital, private health insurance can cover some costs of tonsillectomy or adenoidectomy.
You may have an out-of-pocket cost if you use private hospital cover when you get treatment. You can minimise some of these costs by choosing a hospital and specialist that have agreements with your health insurer.
If you have an excess on your cover, you will have to pay for that out of pocket.
What is hospital excess?
Hospital excess is the amount of money you contribute upfront (out of your own pocket) before you can claim a benefit on hospital treatment. With HBF hospital cover, you choose an excess option when you first get hospital cover, but you can change your excess at any time.
With HBF, you only pay hospital excess once per person, per calendar year (to a maximum of twice on a family policy) when you’re admitted to hospital.
Are you an HBF member? You can check your excess in myHBF or the HBF App. This is the set amount you’ll pay when you’re admitted.
What is an out-of-pocket cost?
A hospital out-of-pocket cost is the portion of a hospital bill that you pay from your own pocket for which you won’t be reimbursed – by either health insurance or Medicare.
How to find health cover for tonsillectomy or adenoidectomy
If you want private health insurance cover for tonsillectomy or adenoidectomy, look for HBF hospital cover (not extras cover) that includes a category called ‘Tonsils, adenoids and grommets’.
You need to hold hospital cover that includes ‘Tonsils, adenoids and grommets’ for two months before you can claim for tonsillectomy or adenoidectomy (or 12 months if you need a tonsillectomy or adenoidectomy due to a pre-existing condition).
Ask your GP for an open referral
Your GP is the one who’ll most likely refer you to a specialist – but you may want the option to choose your own specialist.
Asking for an open referral can let you:
- Choose your own specialist.
- Find a specialist with good availability who can perform treatment at the hospital you prefer.
- Find a specialist that you trust to perform your surgery.
- Find a specialist with minimum out-of-pocket expenses for you.
Find an surgeon with minimum out-of-pocket costs
To find Ear, nose and throat (ENT) who have an agreement with HBF, just search for ‘ENT’ in our find a provider tool.
- Look for the “Full Cover” tick mark or “Access Gap Cover” tick mark.
- These specialists will help minimise your out-of-pocket cost.
If you’ve already started working with a specialist
If you’ve already got a specialist, ask them these questions:
- Do you have a Full Cover or No Gap agreement with HBF?
If they don’t, you may need to consider if their fees work with your budget. - What hospital(s) do you operate in?
You can then check if the hospital has a Full Cover or No Gap agreement with HBF.
Signs you may need a tonsillectomy or adenoidectomy
Tonsillectomy may be recommended if the tonsils cause:3
- Frequent or repeated inflammation or infection such as tonsillitis.
- Breathing problems or sleep disorders.
Adenoidectomy may be recommended if the adenoids cause:2
- Repeated ear infections, glue ear or sinusitis.
- A very blocked nose.
- Disturbed breathing, leading to bad sleep, snoring or sleep apnoea.
If both the tonsils and adenoids are causing problems, they can be removed at the same time through adeno-tonsillectomy.1
Alternatives to tonsillectomy and adenoidectomy
If the tonsils are causing problems, the only alternative is to wait and hope that the problem gets better.1
If the adenoids are causing problems, your doctor can use nasal sprays to improve a blocked nose. Aside from that, the only option is to also wait and see if it gets better.1
Adenoidectomy recovery
Most people leave hospital the same day following surgery, but some may stay overnight. Full recovery only requires a few of days of rest.2
- You may have a sore throat for a day or two.
- You can return to normal activity after a day or two.
- You may have a blocked nose, a smelly nose, or blood-stained discharge for up to a couple of weeks.
- See your doctor if you experience fever, fresh bleeding, vomiting, severe pain or you can’t eat or drink.
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Further reading
1 Health Direct - Adeno-tonsillectomy (2023)
2 Health Direct - Adenoidectomy (2023)
3 Health Direct - Tonsillectomy (2023)