Tonsils are small, oval-shaped pads of tissue located at the back of the throat, one on each side. These lymphatic tissues serve as part of the body’s immune system, helping to filter out germs that enter through the mouth and nose. A tonsillectomy is the surgical procedure performed to remove these tonsils. This operation remains one of the most frequently performed surgical procedures, particularly among children and teenagers.
Current Tonsillectomy Rates
Across the globe, the prevalence of tonsillectomy varies considerably. In the United States, more than 500,000 tonsillectomies are performed each year. In England, during the 2019/2020 period, approximately 10,500 tonsillectomies were conducted on children under 17 for recurrent tonsillitis, and 7,300 procedures for adults. Another 9,500 tonsillectomies were performed on children for sleep-disordered breathing.
Overall, the United Kingdom saw about 37,000 tonsillectomies performed in 2016 and 2017. International comparisons highlight significant differences. For instance, in 1998, pediatric tonsillectomy rates ranged widely, from 19 procedures per 10,000 children in Canada to 118 per 10,000 in Northern Ireland. In Australia, the hospitalization rate for tonsillectomy among individuals aged 17 and under was 750 per 100,000 people in 2017 and 2018.
Historical Shifts in Procedure Numbers
The frequency of tonsillectomies has undergone substantial changes over the past century. Between 1915 and the 1960s, tonsillectomy was the most commonly performed surgical procedure in the United States. This era reflected a medical belief that tonsils were “portals of infection” that could lead to systemic diseases.
However, a notable decline in procedure numbers began after 1945. This trend accelerated in the 1950s and 1960s, partly influenced by a suspected connection between tonsillectomy and bulbar poliomyelitis during polio epidemics. Rates have decreased by as much as 50% in Western countries in recent decades. In the UK, the number of tonsillectomies performed has halved over the last two decades. Specifically, in England, the rate dropped from 1.01 per 1,000 population in 2003-2004 to 0.87 per 1,000 in 2012-2013, representing a 6.8% reduction in operations despite an overall population increase.
Who Undergoes Tonsil Removal
Tonsillectomy is most frequently performed in pediatric populations. A UK study from 2003-2012 showed 62% of tonsillectomies were performed on children, and 38% on adults.
In Scotland, recent data indicate that young children (0-4 years) are making up an increasing proportion of tonsillectomy patients. Children under the age of 9 now account for over 75% of all tonsillectomy procedures in that region. In Australia, the median age for patients undergoing tonsillectomy in 2017-2018 was 5 years. Historically, children aged 5 to 9 years were the demographic most likely to receive tonsil removal surgery.
Key Influences on Tonsillectomy Trends
Several factors have shaped the trends and current rates of tonsillectomies. Historically, the high number of procedures was driven by the “focal theory of infection,” which suggested localized tonsil infections could spread and cause diseases elsewhere.
Scientific understanding evolved, leading to a re-evaluation of this theory. The decline in tonsillectomy rates is largely attributable to advancements in medical knowledge and treatment approaches. The widespread availability of antibiotics significantly reduced the need for surgery to manage recurrent tonsil infections. A deeper understanding of the tonsils’ role in the immune system contributed to a more conservative approach to their removal.
Evolving medical guidelines and diagnostic criteria have also influenced current practice. Modern indications for tonsillectomy primarily focus on recurrent severe tonsillitis, often defined by specific criteria. There has also been a shift in primary indications for tonsillectomy in children, moving from recurrent infections to addressing obstructive sleep apnea.