What are the tonsils?
The tonsils are a group of lymphatic tissues / structures / organs that are in the back of the throat. They form a kind of ring around that is thought of as a monitoring station for the items we eat & and drink and the air we breathe. Most of the time, we refer to the “palatine tonsils” when we say the word “tonsils”, with there being one right and one left. The adenoid or “adenoids”, a kind of unnecessary plural, cannot be seen by opening the mouth: they are above the “punching bag”, aka uvula, located where the nose meets the throat. To be thorough, the other large tonsil is on the bottom of the throat, where the tongue meets the throat. These are rarely problematic from an infection perspective.
When are tonsils removed?
There is only one time where a doctor might “mandate” tonsillectomy, and that is in a child who has sleep apnea. Once a parent or guardian’s report was sufficient, but now we use “polysomnography” or a sleep study to determine whether a patient has this. Many tell me that back in the day, if one child in a family had to get tonsillectomy, the others came and had theirs too. This is one end of a pendulum swing and it would be fair to think that we are on the other side of that swing now. To have tonsillectomy for infection, one needs many antibiotic-treated and/or culture-proven infections to be a candidate, according to guidelines.
How about in adults?
For adults, it would be quite difficult to have the tonsils removed, due to the intense and sometimes long lasting pain. Tonsillectomy is almost always “elective” for adults, meaning an option insofar as it is rarely necessary. Of course, if they need to be biopsied for suspicion of other pathology, this is different. Also, most tonsil problems “burn out” and go away. In fact, it is not uncommon for the otolaryngologist to not see the tonsils of senior citizens since they have shrunken.
What about the immune system if the tonsils are removed?
The current opinion is that the tonsils and adenoids are, after all, important to the immune system. Only a decade ago, the thought was that they were not and that there were no repercussions. A new study looked at the long-term health risks associated with removing tonsils and adenoids in children, and found that these procedures were associated with increased long-term risk of respiratory, infectious, and allergic disease.
Please call or email Dr Kortbus at hudsonENT for an expert analysis of these important issues!