Tonsils serve as sort of a filter in your body. Chances are many of you have had them removed, but two recent studies differ on when and if that’s necessary.
Dr. Teresa Chan-Leveno is chief of otolaryngology at Parkland Hospital System and an assistant professor in the Department of Otolaryngology-Head and Neck Surgery at UT Southwestern Medical Center.
Purpose of tonsils: “Tonsils are sort of walnut-sized lymphoid tissue in the back of your throat. They’re part of a ring of tissue called Waldeyer’s ring, which helps to be a first pass at things and foreign substances coming in your body. They start the immune process. Sometimes if there’s something that comes, they’re the first site that sees them.”
Reasons past and present for removing tonsils: “Historically, it was for infections or tonsillitis or acute pharyngitis. Nowadays, the more common reason for removal is sleep disordered breathing or sleep apnea. We size the tonsils, sizes one through four, and four is sort of “kissing tonsils.” So, if you have something big enough in the back of your throat, two golf ball-sized things, they may lead to obstruction when you fall asleep at night and all your tissues collapse in your deep stage of sleep.”
Current research on when to remove tonsils: “Twenty or 30 years ago, the definition of seven infections per year, or five infections for two years back to back, or three infections for three years back to back became sort of the standard. And I think that’s pretty well recognized. Antibiotics has changed how often we're doing tonsillectomy for infection, and awareness of sleep-related problems has changed how often we’re doing tonsillectomy for sleep-disordered breathing. In children, we typically go straightforward to tonsillectomy and adenoidectomy rather than them doing nightly therapy with a CPAP mask and things like that because it’s often curative in kids.”
Is it OK for adults to sill have their tonsils? “If they’re not causing any problems, they can stay where they are. Our tonsils are more active when we’re age 3 to 10, and then they sort of phase out a little bit, and they might involute over time. You may not even notice you have tonsils anymore because they’re quite small.”
Reasons for adults to have tonsils removed: “Sleep-disordered breathing and tonsillitis are the biggest reasons. But adults can also have other problems: asymmetric tonsils (one tonsil’s bigger than the other), a malignancy such as a lymphoma or a squamous cell cancer. A different kind of infection like a peritonsillar abscess. Adults who didn’t get their tonsils out as children, even though it was recommended, might go on to decide as adults that they did want to get their tonsils out.”
Concerns about tonsillectomy for a child: “The concerns are the same as for an adult. The risks are bleeding, infection, voice change, nasal reflex and injury to the lips, teeth and tongue.”
When tonsillitis occurs, remove tonsils immediately or wait? “A one-time episode of tonsillitis, I wouldn’t go to surgery. The indications are seven infections in one year, and so you’re really are amounting a number of infections before taking them out. Also (when referred to a surgeon), good documentation is important to corroborate symptoms and make sure what has been called a tonsillitis is in fact a tonsillitis. Not every sore throat is a tonsillitis. It can be from viruses, from post nasal drip, from reflux. If we have recurring infectious tonsillitis, taking your tonsils out will probably be helpful. If we have sore throat related to those other reasons, we may still ongoing sore throats after removing the tonsils. We need to figure that out before going to surgery.”
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