The tonsils are small masses of lymphatic tissue at the back of the throat, serving as an initial defense against inhaled or ingested germs. They trap viruses and bacteria entering through the mouth and nose, containing immune cells designed to fight infection. When this defense is overwhelmed, the tonsils become infected and inflamed, a condition known as tonsillitis. A tonsillectomy, the surgical removal of the tonsils, is considered when symptoms are severe, frequent, or lead to structural problems that impair quality of life.
Acute Symptoms of Tonsillitis
An acute episode of tonsillitis, often caused by bacterial infections like Streptococcus (strep throat) or various viruses, creates a profoundly uncomfortable feeling in the throat. The primary sensation is a severe sore throat, often described as a raw or burning pain that makes swallowing liquids and solids extremely difficult. This intense discomfort when swallowing is medically termed odynophagia.
The pain frequently radiates upward, causing an earache on the same side, a phenomenon known as referred pain. The tonsils appear visibly red and swollen, often covered with white or yellowish patches, pus streaks, or a coating of exudate. The immune response also causes the lymph nodes in the neck to swell and become tender, feeling like firm, painful lumps beneath the jawline.
A high fever often accompanies these symptoms, sometimes exceeding 101°F, alongside general malaise and fatigue. The swelling can also affect the voice, making it sound muffled or thick due to physical obstruction. The combination of pain, fever, and difficulty swallowing can interfere significantly with eating, drinking, and overall daily function.
Persistent Conditions That Indicate Removal
Beyond acute infections, persistent structural or chronic issues can indicate the need for tonsil removal. One common problem is tonsillar hypertrophy, the physical enlargement of the tonsils that obstructs the airway. This structural issue is felt most prominently during sleep, manifesting as habitual snoring, mouth breathing, and pauses in breathing (obstructive sleep apnea).
Chronically enlarged tonsils can interfere with swallowing, leading to difficulty with certain foods or a persistent feeling of something caught in the throat. Another condition is the formation of tonsil stones (tonsilloliths), which are small, calcified deposits that form in the tonsillar crypts. These stones often cause chronic bad breath (halitosis) and a lingering feeling of irritation.
A more immediate and severe complication is a peritonsillar abscess, a collection of pus that develops next to the tonsil, typically on one side. This feels like an extreme, one-sided throat pain that makes opening the mouth difficult, a condition called trismus, due to muscle spasm. The abscess can also result in a distinctive “hot potato” voice and cause the uvula to be visibly pushed away from the affected side.
Objective Medical Criteria for Tonsillectomy
A physician translates the subjective feelings of pain and obstruction into objective standards to determine if a tonsillectomy is warranted. For recurrent infections, the most widely used guideline is the frequency criteria, sometimes referred to as the “7-5-3 rule.” This standard suggests surgery if a patient has experienced seven or more documented episodes of tonsillitis in the past year, five or more per year for the past two years, or three or more per year for the past three years.
For an episode to be counted, it must be severe and documented by a doctor, including features like a temperature above 101°F, swollen neck lymph nodes, pus on the tonsils, or a positive test for Group A streptococcus. The documentation must also confirm that the infections are severe enough to interfere with normal activities, such as school attendance or work.
When breathing difficulty is the primary concern, such as with obstructive sleep apnea, the decision hinges on the objective size of the tonsils and confirmation of the breathing disorder. Tonsil size is graded on a scale. For definitive confirmation of airway obstruction, a sleep study (polysomnography) may be performed, which measures breathing pauses and oxygen levels to provide a quantifiable assessment of severity.