The tonsils are two oval-shaped pads of lymphatic tissue located at the back of the throat. They are part of the immune system, acting as an initial line of defense against inhaled or ingested pathogens like bacteria and viruses. Tonsillectomy is the surgical procedure involving the complete removal of these palatine tonsils. Although the tonsils serve an immune function, the body’s ability to fight infection remains robust after their removal. Tonsillectomy is performed when the tonsils become a source of frequent or persistent health problems.
Recurrent and Chronic Infection
One of the most frequent reasons for tonsillectomy in adults and older children is to resolve chronic or recurring tonsillitis. This condition involves inflammation and infection, often presenting with a severe sore throat, fever, and difficulty swallowing. Surgery is considered only after a patient experiences a specific pattern of documented infections over an extended period.
A common guideline for considering tonsillectomy involves meeting a frequency threshold. This includes having at least seven documented infections within the past year. Alternatively, the criteria may be met by having five or more infections per year for two consecutive years, or three or more infections annually for three consecutive years.
The persistent nature of these infections severely impacts quality of life, leading to missed school or workdays. Chronic inflammation can also cause persistent bad breath or a foul taste in the mouth that does not resolve with conservative treatments. In some cases, the bacteria causing the infection may become resistant to standard antibiotic treatments.
Removing the tonsils eliminates the primary site where these frequent infections originate, offering a definitive solution when long-term antibiotic courses have failed. Tonsillectomy is also a consideration for individuals who are chronic carriers of bacteria like Group A Streptococcus, meaning they harbor the bacteria without showing symptoms but can still spread it.
Airway Obstruction and Sleep Issues
For younger children, the most common reason for tonsillectomy is the physical size of the tonsils blocking the upper airway, known as tonsillar hypertrophy. This condition leads to significant breathing difficulties, especially during sleep, as the enlarged tonsils crowd the space at the back of the throat.
This physical obstruction results in loud snoring, labored breathing, and pauses in breathing called obstructive sleep apnea (OSA). Repeated drops in blood oxygen levels and fragmented sleep due to OSA can have serious long-term consequences. Untreated sleep disruption often manifests as behavioral issues, poor school performance, and growth delays.
The continuous nighttime effort to breathe places stress on the cardiovascular system. Severe, untreated OSA due to enlarged tonsils can increase the risk of heart and blood vessel problems over time. Tonsillectomy is a first-line treatment to open the airway and resolve these sleep-disordered breathing issues.
Acute and Rare Medical Necessity
While infection and obstruction are the most common reasons for removal, several less frequent but urgent medical situations require tonsillectomy. One condition is a peritonsillar abscess, a collection of pus that forms behind the tonsil.
Although a peritonsillar abscess is usually treated initially with drainage and antibiotics, tonsillectomy may be necessary if the abscess is recurrent or difficult to drain due to its location. The procedure may be performed immediately or delayed until the acute infection subsides.
A rare but definitive indication for tonsillectomy is the suspicion of malignancy in the tonsil tissue. This suspicion is often raised when one tonsil is noticeably larger than the other, known as asymmetric tonsil enlargement. Individuals suffering from severe tonsil stones (tonsilloliths) that cause chronic pain or extreme bad breath unresponsive to non-surgical treatments may also be candidates.
The Medical Decision Process
The decision to proceed with a tonsillectomy requires a thorough evaluation by a specialist, typically an Otolaryngologist. During the consultation, the specialist reviews the patient’s medical history, focusing on documented frequency and severity of past infections.
The physical examination includes a visual assessment to grade the size of the tonsils, which helps determine the degree of potential airway obstruction. For sleep-related breathing issues, especially in younger children, a sleep study may be ordered to objectively measure the severity of the disruption.
Before scheduling surgery, the medical team ensures that non-surgical alternatives have been appropriately attempted. For recurrent infections, this means confirming that adequate antibiotic treatment courses have failed.
In cases of mild sleep-disordered breathing, watchful waiting or a trial of medical management, such as a short course of steroids, may be recommended to see if symptoms resolve. Tonsillectomy is generally reserved for when conservative approaches have failed to alleviate symptoms or when the condition poses a significant health risk.