Tonsillectomies are performed less frequently than in previous decades. Medical understanding and practices regarding tonsils and their removal have significantly changed. This shift reflects a deeper appreciation for the tonsils’ role in the body’s defenses and the evolution of treatment approaches for related health concerns.
Understanding Tonsils and Their Role
Tonsils are collections of lymphoid tissue at the back of the throat, visible as two rounded lumps. They are part of the immune system’s lymphatic system, helping the body fight infections. Tonsils act as a first line of defense, trapping bacteria and viruses entering through the mouth or nose.
These tissues contain immune cells that produce antibodies, which help neutralize pathogens. Tonsils are active in early childhood, aiding in the development of white blood cells like B and T cells. While they serve a significant purpose in developing immunity, their removal later in life does not compromise the immune system.
Evolution of Tonsillectomy Practices
In the early 20th century, tonsillectomies were among the most common surgical procedures, particularly in children. This widespread practice stemmed from a medical theory that tonsils were “portals of infection,” causing systemic diseases throughout the body. Many physicians believed it was best to remove them as a preventative measure, despite ambiguous supportive evidence.
A significant shift occurred with a greater understanding of the tonsils’ immune function. Doctors recognized these organs were not redundant but played an active role in the body’s defenses. The development of effective antibiotics also dramatically reduced the need for surgery for bacterial tonsillitis. Antibiotics offered a less invasive treatment for these infections.
The medical community gained a clearer understanding of tonsillectomy risks. Like any surgical procedure, it carries potential complications such as pain, bleeding, swelling of the tongue or soft palate that may affect breathing, and reactions to anesthesia. These recognized risks contributed to a more cautious approach, reserving the procedure for cases where benefits clearly outweighed potential harms. By the late 1970s, expert panels concluded there was insufficient evidence to support routine, preemptive tonsillectomies.
When Tonsillectomy is Still Recommended
While not as common as in the past, tonsillectomies are still performed for specific medical reasons. One primary indication is recurrent, severe tonsillitis that significantly impacts a person’s quality of life. This often involves frequent documented infections over a period of years, with each episode meeting specific criteria like fever, swollen neck glands, or pus on the tonsils.
Another common reason for tonsil removal is obstructive sleep apnea (OSA), especially in children, where enlarged tonsils block the airway during sleep. This can lead to loud snoring, gasping for air, and daytime sleepiness. Tonsillectomy can help reduce airway resistance and improve sleep quality in these cases. Other indications include a peritonsillar abscess, suspicion of malignancy, or tonsil stones causing persistent bad breath. The decision for surgery is always made after careful consideration of benefits versus risks, often involving consultation with an ear, nose, and throat specialist.