Tonsils are lymphoid tissues at the back of the throat, part of the immune system. They trap pathogens and produce antibodies. Immune function declines after puberty.
Common Tonsil Issues
Tonsils can become inflamed and infected, causing common issues. Acute tonsillitis, a sudden inflammation, often causes sore throat, fever, and difficulty swallowing. Typically viral (up to 70% of cases), bacterial infections like Group A Streptococcus are also common.
Chronic tonsillitis occurs when inflammation persists over two weeks, causing persistent sore throat, swollen lymph nodes, and bad breath. A severe complication is a peritonsillar abscess, a pus-filled pocket near a tonsil, often resulting from tonsillitis spreading to surrounding tissues, causing severe pain and difficulty opening the mouth.
Specific Signs for Removal
Tonsillectomy is considered when tonsil issues significantly impact health and quality of life. Recurrent infections are a primary indicator, guided by criteria.
Tonsillectomy may be recommended for: seven or more documented tonsillitis episodes in a single year; five or more per year for two consecutive years; or three or more per year for three consecutive years. Each episode involves sore throat, fever above 38.3°C, enlarged neck lymph nodes, or pus on tonsils.
Chronic sore throats and persistent tonsillitis, even without acute infections, also warrant consideration. This includes ongoing inflammation causing discomfort and interfering with daily life. Enlarged tonsils can lead to sleep-disordered breathing, manifesting as snoring, pauses in breathing (obstructive sleep apnea), and restless sleep. In children, this commonly causes obstructive sleep apnea, leading to daytime sleepiness, behavioral issues, and poor school performance.
Difficulty swallowing (dysphagia) occurs when enlarged tonsils obstruct the throat, making eating and drinking challenging. Repeated or severe peritonsillar abscesses are reasons for tonsillectomy. While a single abscess is often drained, recurrent ones indicate a persistent problem benefiting from surgical intervention.
The Medical Assessment
When tonsil problems arise, a healthcare professional conducts a thorough medical assessment. The process begins with a consultation where the doctor gathers a detailed symptom history (frequency, severity, and daily impact), covering sore throat frequency, difficulty swallowing or breathing, and sleep disturbance.
A physical examination of the throat, ears, and nose follows. The doctor inspects tonsils for inflammation, redness, swelling, or white/yellow patches indicating infection. The neck is palpated for swollen lymph nodes.
Diagnostic tests identify the cause of infection. A rapid strep test detects Group A Streptococcus bacteria. If negative but bacterial infection is suspected, a throat culture may be sent for definitive results, typically taking a day or two. This comprehensive evaluation, combining symptom history, physical findings, and test results, informs the decision regarding tonsillectomy.
Alternatives to Surgery
Before tonsillectomy, non-surgical approaches are explored for less severe or infrequent tonsil issues. Watchful waiting is common, particularly for children, as tonsils naturally shrink with age, involving monitoring symptoms without immediate surgery.
Antibiotics are prescribed for bacterial tonsil infections to eliminate bacteria and alleviate symptoms. However, they are ineffective against viral tonsillitis, which accounts for many cases. Over-the-counter pain relievers like acetaminophen or ibuprofen manage discomfort and fever from tonsil inflammation.
For mild sleep-disordered breathing not severe enough for surgery, lifestyle adjustments or other medical interventions are considered. These include addressing allergies or maintaining a healthy weight, which can help reduce tonsil size and improve breathing. While surgery is an option for persistent problems, these alternatives manage symptoms and may avoid tonsillectomy.