Tonsillectomy: When is it Necessary?

Many older adults today have had a tonsillectomy (surgical removal of the tonsils at the back of the throat). The frequency of tonsillectomy procedures peaked in popularity from the late 1950s through the 1970s as a treatment for children with frequent or recurring sore throats (tonsiliitis). Since the heyday of tonsillectomy in the 70s, the tonsillectomy rate has declined by about 75%, from about 1 million per year to just around 250,000. The reason for this decline is a growing skepticism on the part of both doctors and parents that the procedure has benefit for most people in helping control infections. Even a major research study in 2004 showed that many, if not most, tonsillectomies, might not be necessary at all.

The operation itself is a fairly simple procedure with relatively few risks of serious consequences. Still, infection, bleeding, and complications from the anesthetic drugs are a potential risk of any surgical operation. Most children who have a tonsillectomy will need to miss at least a week of school, and there is usually some degree of discomfort in the days following the procedure.

While doctors may still debate the necessity for tonsillectomy and its effectiveness as a treatment, there are certain circumstances for which the tonsillectomy is definitely recommended, including:

• Sleep apnea, a condition in which breathing is temporarily interrupted at night. Sleep apnea can be caused by markedly enlarged tonsils and is usually accompanied by heavy snoring
• Any degree of airway obstruction or swallowing problems caused by enlarged tonsils
• An abscess around the tonsils (peritonsillar abscess) that has not been cured by drainage and medical management
• Tonsil infection that results in febrile seizures
• Tonsil stones that cause bad breath
• Any suspicion of cancer (very rare) in the area or another need for a biopsy to establish a diagnosis

In other situations, such as a high frequency of throat infections (more than 5-6 sore throat infections per year) or very severe infections, a tonsillectomy may be considered. The type and severity of infections as well as their response to antibiotics is taken into consideration when deciding whether a tonsillectomy might be appropriate for an individual patient.