The tonsils are two oval-shaped pads of lymphoid tissue located at the back of the throat. They function as part of the immune system, trapping germs, like bacteria and viruses, that enter through the mouth and nose. These organs contain white blood cells that produce antibodies to fight off pathogens. When the tonsils become a source of chronic illness or a physical obstruction, surgical removal, known as a tonsillectomy, may be necessary.
Primary Medical Conditions Requiring Removal
Tonsillectomy is typically based on two main problems: chronic infection and airway obstruction. Tonsil infections, or tonsillitis, can be caused by viruses or bacteria, often Group A beta-hemolytic streptococcus (strep throat). Removal is considered when these infections become recurrent or chronic, severely impacting quality of life.
Recurrent tonsillitis can lead to symptoms such as persistent sore throat, difficulty swallowing, and fever. In more severe cases, a peritonsillar abscess may form, which is a collection of pus behind the tonsil that can cause intense pain and bulging. While an abscess is often treated with drainage and antibiotics, a history of recurring abscesses can be a strong reason for removal.
The second major indication for tonsillectomy is when the tonsils are abnormally large, a condition known as hypertrophy, which can physically block the airway. This enlargement often leads to loud, chronic snoring and difficulty breathing, particularly during sleep. The most serious consequence of this obstruction is Obstructive Sleep Apnea (OSA), where the tonsils cause breathing to repeatedly stop and start throughout the night.
OSA can lead to fragmented sleep, resulting in daytime sleepiness, behavioral issues, and difficulty concentrating. In children, OSA is a common reason for tonsillectomy, often resulting in improved quality of life and better sleep patterns.
Determining the Necessity of Surgery
A physician determines the necessity of a tonsillectomy by carefully evaluating the frequency and severity of the patient’s symptoms. For recurrent throat infections, specific guidelines, sometimes referred to as the Paradise criteria, are used to standardize the decision. These criteria suggest that tonsillectomy may be appropriate if a patient has had at least seven documented infections in the past year.
Alternatively, the guidelines may be met with at least five episodes per year for two consecutive years, or three episodes per year for three consecutive years. Each episode must be documented in the medical record and include clinical signs such as a temperature above 101°F, swollen neck glands, pus on the tonsils, or a positive strep test. These frequency thresholds help distinguish a chronic problem from occasional sore throats.
For suspected airway obstruction, the evaluation begins with a physical examination to visually assess the size of the tonsils. If the tonsils appear significantly enlarged, especially if they nearly touch each other, they are likely contributing to breathing issues. A physician may also recommend a sleep study, or polysomnography, to accurately diagnose and measure the severity of Obstructive Sleep Apnea.
The Tonsillectomy Procedure and Recovery
The tonsillectomy is performed under general anesthesia, ensuring the patient is completely asleep and comfortable throughout the procedure. The surgeon removes the tonsils completely, often using techniques like electrocautery, which uses heat to remove the tissue and control bleeding, or coblation, which uses radiofrequency energy and a saline solution. The procedure itself is relatively quick, typically taking less than an hour.
After the surgery, recovery requires a healing period that usually lasts between 10 to 14 days, with adults often experiencing a more difficult recovery than children. Pain management is a primary focus, and prescribed medications are used to control the discomfort, which can sometimes include referred pain to the ears. Patients are often advised to avoid non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen immediately after surgery, as they can interfere with blood clotting.
Maintaining hydration is important for a successful recovery, and patients are encouraged to drink plenty of fluids and consume soft, cool foods like ice cream, applesauce, and broth. A white or yellowish coating will form where the tonsils were removed, which is a normal sign of healing and will gradually disappear. Strenuous activity, such as heavy lifting or exercise, should be avoided for up to two weeks to prevent complications like post-operative bleeding.