When to remove tonsils?

You Might Need a Tonsillectomy Now

Problems with antibiotics: In cases where an infection in the tonsils does not respond to antibiotics or for people with allergies to antibiotics, a tonsillectomy may be the best treatment option.

Enlarged tonsils: Enlarged tonsils can lead to trouble swallowing or to obstructive sleep apnea, a condition that involves difficulty breathing during sleep. In these cases, taking the tonsils out can help treat the condition by removing the obstruction.

“Enlarged tonsils are a more common cause of sleep apnea in children,” Lintzenich said. “Tonsillectomy is also more likely to completely cure sleep apnea among children than adults.”

Abnormal growths: “Cancer of the tonsils is on the rise, in part due to its association with the human papillomavirus virus,” said Lintzenich. HPV can cause cancers in the back of the throat, particularly at the base of the tongue and the tonsils. “To rule out cancer is an indication for tonsillectomy,” she said. “It’s rare, but recommended whenever we have concerns about a mass in the tonsils or chronic pain on one side, trouble swallowing, or asymmetry. We don’t take a biopsy of the tonsils. If we are worried, it’s a good reason to take them out.”

When to See Your Doctor

Because sore throats are not uncommon, it may be difficult to know when to make an appointment. But, if you notice some of the following symptoms, call your doctor:

  • Pain on one side of the throat
  • Painful or difficult swallowing
  • A hoarse voice
  • Fever
  • Enlarged or swollen lymph nodes, or glands, in the neck
  • A white or yellow coating on the tonsils
  • Severe or recurring sore throat

Tonsillectomy: What to Expect

A tonsillectomy is performed under general anesthesia. Doctors can use one of several techniques for removing the tonsils, depending on their preference, noted Lintzenich. The entire procedure takes about an hour.

Although rare, the risks from a tonsillectomy include possible bleeding and infection. The procedure itself is no different for adults than for children, but adults typically experience more discomfort after the surgery.

“There is no question that this is an extremely painful procedure for adults,” Lintzenich said. “It’s also painful for kids — they are just very resilient. Generally, patients need to miss work or school for at least two weeks, and they are not back to normal for about a month. This isn’t something to be taken lightly.”

Lintzenich added that over-the-counter pain medications and avoiding acidic foods could help ease the pain after a tonsillectomy, but “mostly it just takes time.”

Tonsils, those two clusters of tissue in the back of the throat and their counterparts, the adenoids, are located just behind the nose. Their purpose is to help filter out harmful bacteria and viruses that are breathed in, protecting the body from infection. (Although adenoids typically shrink by age 7, and are virtually nonexistent by the teen years). But for some children, they are more trouble than they’re worth.

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So when do they need to go?

Pediatric otolaryngologist Rachel Georgopoulos, MD, says the most common reasons for removal — a tonsillectomy and/or adenoidectomy — are recurring throat infections and airway obstruction. (While doctors do these procedures mostly on children, some adults also opt for them as well, she says.) Here’s what often happens:

1. They are affecting your child’s sleep.

Some children have larger tonsils and adenoids than others, and they sometimes interfere with breathing. This is a problem particularly at night because the body is in a reclined position. It can cause a serious health condition known as sleep apnea — short periods of time when breathing stops during sleep.

If a child has severe sleep apnea, Dr. Georgopoulos says she will also perform an endoscopy prior to the tonsillectomy/adrenalectomy to do a thorough evaluation of the child’s airway while they are sleeping.

“Symptoms of sleep apnea in children can include snoring at least four nights out of seven, pauses in breathing followed by a ‘catch-up’ breath, restless sleep, sweating, tiredness and even bed wetting,” says Dr. Georgopoulos.

The effects of poor sleep also carry over into the waking hours. Children may show restless or erratic behavior, irritability and poor coping skills. “Removing tonsils and adenoids to help correct airway obstruction is so effective that many patients no longer experience sleep apnea,” she says.

“For children 3 and older, the surgeon usually removes both tonsils and adenoids. On occasion we will address tonsils in children younger than 2, and we will do what is called an intracapsular tonsillectomy, which is partial removal of the tonsil tissues,” she says.

2. They are causing recurring throat infections.

Recurring throat infections mean defenses can’t keep up. Tonsils help keep bacteria and viruses out but, because they are one of the body’s first lines of defense, they are sometimes overwhelmed and infected themselves.

If your child has frequent throat infections (like strep throat) that include a fever and swollen lymph nodes lasting for three or four days, talk with your doctor about whether a tonsillectomy and adenoidectomy would help.

“Frequent” means:

  • Six to seven episodes per year.
  • At least five episodes per year in each of the preceding two years.
  • More than three episodes per year in each of the preceding three years.

How does surgery help?

Surgery to remove tonsils and/or adenoids is usually well-tolerated, with most children going home a few hours later. Tylenol® or ibuprofen help manage pain, and patients usually recover in seven to 10 days, says Dr. Georgopoulos.

She adds that surgery sometimes also helps with:

  • Nasal obstructions that cause a narrow palate.
  • Swallowing issues.
  • Tonsil stones (calcified material in the tonsils).
  • Peritonsillar abscess (when infection spreads beyond tonsils).

The good news is that surgeries to remove tonsils and adenoids are among the most common outpatient pediatric surgeries — and most children recover quickly.

Study: Tonsil and adenoid removal associated with respiratory diseases, allergies and infections

19 June 2018

HEALTH:

Health data from more than one million Danish children serves as foundation for University of Copenhagen study reporting considerably higher risks for certain respiratory diseases, among other things, as a result of tonsil removal.

Tonsils and adenoids serve a role in the human immune system and contribute to white blood cell production. They also monitor what passes through the throat and appear to ‘train’ the immune system of children.

In a comprehensive study, evolutionary biologists from the University of Copenhagen’s Department of Biology, the University of Melbourne and Yale have demonstrated that people who had their tonsils and adenoids removed during childhood, were subject to an increased risk of developing respiratory diseases, allergies and infectious diseases later on in life.

The researchers analyzed health data from nearly 1.2 million Danish children born between 1979 and 1999, from the age of 10 and up to 30-years-old.

Of the 1.2 million children, more than 60,000 had their tonsils, adenoids, or both removed before the age of 9. The researchers discovered a significantly increased risk of being afflicted by diseases including asthma, pneumonia, chronic obstructive pulmonary disease and other respiratory infections, compared with the group whose tonsils were not removed.

“In particular, we found a significant link between having had tonsils or adenoids removed and upper respiratory tract disease later on in life,” says Professor Jacobus Boomsma of the University of Copenhagen’s Department of Biology.

Tonsils are not there by chance
Tonsils and adenoids serve a role in the human immune system and contribute to white blood cell production. They also monitor what passes through the throat and appear to ‘train’ the immune system of children.

“Our research always begins with evolutionary assumptions – in this case, that the immune organs surrounding our airways are not coincidental, but there due to some sort of useful biological adaptation. As such, it is reasonable to ask if removing them provokes any long-term consequences,” states Boomsma

Furthermore, the study suggests an increased risk of pneumonia and asthma later in life as a result of tonsil and adenoid removal, as well as a far higher incidence of nose and eye allergies.

“The extensive dataset from Denmark provides us with unique opportunities to look at broader contexts, as we are able to consider a range of other health factors and socio-economic differences among families, which results in more accurate results,” adds Boomsma.

Operations offer mixed long-term results
Researchers were careful to study whether tonsillectomies and adenoidectomies had any real impact on the ailments that they were intended to remedy. The results were mixed.

“According to our study, adenoid removal reduces the risk of sleep disorders and throat inflammation to a slight degree, but increases the risk of middle ear infections. Therefore, the long-term benefits remain unclear,” explains Boomsma.

The article emphasizes that the potential long-term effects of tonsil and adenoid removal have not been documented until now, and that this study ought to catalyze renewed discussion in cases where non-surgical treatments are an option for young people suffering from breathing, sinusitis and otitis media problems.

Researchers point out that while there may be medical grounds for performing tonsillectomies and/or adenoidectomies, the study’s conclusions are clear and should be considered within the context of thorough individual assessments.

“We believe that our results are solid, not least because we have been able to clean our data by accounting for 18 other factors that might come into play. We would have liked to correct for smoking, but the health register lacked this information. Other Nordic countries have collected similar datasets for their populations for over roughly thirty years, so corresponding analyses would be of great interest,” suggests Boomsma.

Surgical removal of the tonsils (tonsillectomy) for chronic or recurrent acute tonsillitis

Review question

This review compared the clinical effectiveness and safety of surgery (removal of the tonsils – tonsillectomy, or adenotonsillectomy – removal of the tonsils and adenoid tissues) against non-surgical management in adults and children with frequent or chronic tonsillitis.

Background

Surgical removal of the tonsils is a commonly performed operation in patients with chronic or recurrent infections of the tonsils (tonsillitis) or the other tissues at the back of the throat (pharyngitis). Sometimes, the adenoid tissues are also removed during the surgery. However, opinions vary greatly about whether or not the benefits of these operations outweigh the risks.

Study characteristics

This review included evidence available up to 30 June 2014. Seven trials with low to moderate risk of bias were included: five in children (987 participants) and two in adults (156 participants). An eighth trial in 40 adults was at high risk of bias and did not provide any data for analysis.

Although some studies in children followed participants for two or three years, reliable information is only available for up to about one year after surgery due to the high number of participants missing follow-up after the first year. Some studies had recruited children who were more severely affected by tonsillitis than other studies (for example, they had tonsillitis more often and with more severe symptoms). Therefore, we grouped the children into ‘severely affected’ and ‘less severely affected’ subgroups.

Two studies in adults had a short duration of follow-up (five to six months following surgery).

Key results

We found that in general children affected by recurrent acute tonsillitis may have a small benefit from adeno-/tonsillectomy: this procedure will avoid 0.6 episodes of any type of sore throat in the first year after surgery compared to non-surgical treatment. The children who had surgery had three episodes of sore throat on average compared to 3.6 episodes experienced by the other children. One of the three episodes is the episode of pain caused by surgery.

When it comes to avoiding bad sore throats, children who have more severe or frequent tonsillitis may benefit more from surgery compared to less severely affected children. In less severely affected children the potential benefits of adeno-/tonsillectomy are more uncertain. There are no good quality data for the effects of surgery in the second or later years after surgery.

We did not find enough evidence to draw firm conclusions on the effectiveness of tonsillectomy in adults with chronic/recurrent acute tonsillitis. Evidence is only available for the short term and is of low quality. The data are also difficult to interpret as the studies do not take into account the days of pain that always follow the operation. Based on the two small trials, tonsillectomy seems to result in fewer days of sore throat in the first six months after surgery.

Two of the studies in children said that they could not find a difference in quality of life outcomes and one study could not find a difference in the amount of painkiller that children took to help with their sore throats.

Bleeding immediately after tonsillectomy or in the two weeks following surgery is an important complication. The studies did not provide good information to allow us to assess accurately the risk of these complications.

Quality of the evidence

We judged the quality of the evidence to be moderate for the data on children (this means that further research is likely to have an important impact on how confident we are in the results and may change those results). Quality is affected by a large number of children who are ‘lost to follow-up’ after the first year of the study. In addition, some children who are assigned to the ‘no surgery’ group end up having surgery.

The quality of evidence for tonsillectomy in adults in adults is low.

As always, any potential benefits of surgery should be carefully weighed against the possible harms as the procedure is associated with a small but significant degree of morbidity in the form of bleeding (either during or after the surgery). In addition, even with good pain relief medication, the surgery is particularly uncomfortable for adults.

When do adults need their tonsils removed

Posted November 28, 2017 by Christina M. Emanuel, M.D.

Even though it’s not as common as it once was, tonsillectomies are still mostly done on children. But, sometimes adults need to have their tonsils removed too. Here are a few things that may lead to a tonsillectomy as an adult.

Sore Throat

One of the most common reasons for a visit to your primary care doctor is a sore throat. The most likely reason your doctor may refer you for tonsillectomy are very frequent sore throats or a chronic infection in your tonsils. If you have infrequent, uncomplicated infections, your doctor will probably just treat you as needed.

Abscess On Your Tonsils

If you experience severe pain, fever, significant bulging around your tonsil, pain when you open your mouth or you notice your uvula is shifted to one side, you may have an abscess on your tonsils and should seek medical attention immediately. While it is typically treated with antibiotics and drainage, 10 to 15 percent of the time the abscess returns, prompting some clinicians to recommend tonsillectomy early in the course of treatment rather than waiting for it to come back.

Sleep Apnea

If your tonsils are enlarged, they may actually obstruct your airway when you lie down and cause you to completely stop breathing in your sleep, a condition called sleep apnea. You may wake up in the middle of the night gasping for breath. Chances are, if you have sleep apnea, you may have been told that you snore loudly as well, though loud snoring does not necessarily mean you have sleep apnea. Not all sleep apnea is caused by enlarged tonsils, but if your doctor suspects this is the problem, he or she may recommend tonsillectomy.

One Big Tonsil

If one of your tonsils is much larger than the other, your doctor may recommend tonsillectomy as a precaution to rule out a serious underlying cause. Surgery is typically recommended only if you have other related symptoms. If you don’t have other “red flag” problems, such as difficulty swallowing, persistent pain, swelling of the glands in your neck, or one tonsil that keeps getting larger and larger over time, it is extremely unlikely that the difference in size of your tonsils is important. Most of the time, having one enlarged tonsil is simply due to a minor issue.

If you’re concerned about your tonsils, but need a primary care physician, visit summahealth.org to find one.

Christina M. Emanuel, M.D.
Family Medicine
Summa Health

Tonsillitis in Adults

Risk Factors for Tonsillitis in Adults

The major risk factors for tonsillitis in adults are:

  • Still having your tonsils: While many older adults may have had their tonsils removed when they were children—when surgery was a more routine approach to dealing with tonsillitis—a growing number of adults born in the 70s and later still have their tonsils, putting them at risk for getting tonsillitis
  • Living or working in close proximity to children: Parents, grandparents, teachers—anyone in frequent contact with children, in whom tonsillitis is most common—are at increased risk of getting tonsillitis themselves
  • Age: The elderly are more susceptible to infection due to a weakened immune system

Symptoms of Tonsillitis

While each person may have slightly different symptoms, these are the most common symptoms of tonsillitis:

  • Swollen, red tonsils; they also may look yellow, gray, or white, or have white spots/patches
  • Blisters or painful sores on the throat
  • Sore throat that happens suddenly
  • Pain when swallowing or difficult to swallow
  • Snoring
  • Foul breath
  • Headache
  • Loss of appetite
  • Tiredness
  • Chills
  • Fever
  • Swollen and tender lymph nodes in the neck or jaw area

You may not have any symptoms but still have the strep bacteria, which you can spread to another person.

If tonsillitis is left untreated, a complication can develop called a peritonsillar abscess. This is an area around the tonsils that’s filled with bacteria, and it can cause these symptoms:

  • Severe throat pain
  • Muffled voice
  • Drooling
  • Difficulty opening mouth

How Tonsillitis in Adults Is Diagnosed

Your healthcare provider will ask about your health history and do a physical exam. To guide treatment, your provider may rub a sterile swab over the back of the throat and tonsils to get a sample of the secretions and perform:

  • Rapid strep test: This test can detect strep bacteria in minutes
  • Throat culture and sensitivity: The sample is cultured in a lab for the presence of bacteria; it helps the provider choose the best antibiotic to treat it, but can take 48 to 72 hours to get the results

How Tonsillitis Is Treated

Treatment for tonsillitis depends on what caused it, how severe it is, and your general health. Treatment options may include:

  • Medications: Tonsillitis caused by a virus is treated differently from tonsillitis caused by bacteria.Tonsillitis caused by bacteria is treated with antibiotic medicine. A mild case of tonsillitis doesn’t necessarily require treatment if a virus, such as a cold, causes it. Some cases of tonsillitis caused by a virus may be treated with antiviral medicine.
  • Surgery: While surgery used to be a fairly common approach to dealing with tonsillitis, today, tonsillectomies are not performed unless the condition is chronic and recurring. If a person experiences tonsillitis seven times within a single year or 3 episodes per year for 3 consecutive years, a doctor would probably consider surgery. A tonsillectomy might also be recommended if the tonsils are causing issues such as sleep apnea difficulty breathing or swallowing, or a difficult-to-treat abscess
  • Self care/home care: To make yourself comfortable and ease the discomfort of a sore throat, be sure to:

– Drink plenty of fluids
– Rest
– Gargle with warm salt water several times a day
– Use throat lozenges
– Avoid smoke
– Use over-the-counter pain relievers such as acetaminophen and ibuprofen

Contact Us

To learn more about the services available in the Division of Otolaryngology—Head and Neck Surgery or to schedule an appointment, please call 856.342.3113.

Tonsillitis normally goes after a few days. Treatment can ease the symptoms until the infection goes. See a doctor if the symptoms are severe or don’t get better quickly.

What are tonsils?

Tonsils are made of soft gland tissue and they are part of the body’s defence against infections (the immune system). You have two tonsils, one on either side at the back of the mouth. The picture below shows large tonsils that are not infected (no redness or pus).

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What are the symptoms of tonsillitis?

A sore throat is the most common of all tonsillitis symptoms. You may also have a cough, high temperature (fever), headache, feel sick (nausea), feel tired, find swallowing painful, and have swollen neck glands. The tonsils may swell and become red. Pus may appear as white spots on the tonsils. Symptoms typically get worse over 2-3 days and then gradually go, usually within a week. The picture below shows inflamed tonsils.

Glandular fever (infectious mononucleosis) is caused by a virus (the Epstein-Barr virus). It tends to cause a severe bout of tonsillitis as well as other symptoms. See separate leaflet called Glandular Fever (Infectious Mononucleosis) for more details.

Is tonsillitis infectious?

Infectious means you can pass the infection to someone else. The infection may spread by close physical contact with other people, or by droplets in the air, caused by sneezing or coughing.

As with coughs, colds, flu and other similar infections, there is a chance that you can pass on the virus or bacterium that has caused tonsillitis.

When should you contact a doctor?

See a doctor if symptoms of a sore throat cause severe symptoms, or if they do not ease within 3-4 days. In particular, you should seek urgent medical attention if you develop:

  • Difficulty in breathing.
  • Difficulty swallowing saliva.
  • Difficulty opening your mouth.
  • Severe pain.
  • A persistent high temperature.
  • A severe illness, especially when symptoms are mainly on one side of the throat.

What are the treatments?

Mild tonsillitis often doesn’t need any treatment. However, it is important to drink plenty of water. Paracetamol or ibuprofen will help to ease pain, headache and high temperature. Gargles, lozenges and sprays may help to soothe a sore throat but they do not shorten the illness.

Most throat and tonsil infections are caused by viruses but some are caused by bacteria. Antibiotics kill bacteria but do not kill viruses. Even if tonsillitis is caused by a bacterium, treatment with an antibiotic does not make much difference in most cases.

If you have repeated bouts of tonsillitis you may consider having your tonsils removed (tonsillectomy).

Having no treatment at all is one option. Many tonsil infections are mild and soon get better on their own.

Treatment options include.

  • Have plenty to drink. It is tempting not to drink very much if it is painful to swallow. You may become mildly lacking in fluid in the body (mildly dehydrated) if you don’t drink much, particularly if you also have a high temperature (fever). Some lack of fluid in the body can make headaches and tiredness much worse.
  • Paracetamol or ibuprofen eases pain, headache and fever. To keep symptoms to a minimum it is best to take a dose at regular intervals as recommended on the packet of medication rather than now and then. For example, take paracetamol four times a day until symptoms ease. Although either paracetamol or ibuprofen will usually help, there is some evidence to suggest that ibuprofen may be more effective than paracetamol at easing symptoms in adults. Paracetamol is usually the preferred first-line option for children, but ibuprofen can be used as an alternative. Note: some people with certain conditions may not be able to take ibuprofen. So, always read the packet label.
  • Other gargles, lozenges and sprays that you can buy at pharmacies may help to soothe a sore throat. However, they do not shorten the illness.

Do I need an antibiotic for tonsillitis?

Usually not. Most throat and tonsil infections are caused by germs called viruses, although some are caused by germs called bacteria. Without tests, it is usually not possible to tell if it is a viral or bacterial infection. Antibiotics kill bacteria, but do not kill viruses.

Even if a bacterium is the cause of a tonsil or throat infection, an antibiotic does not make much difference in most cases. Your body defences (immune system) usually clear these infections within a few days whether caused by a virus or a bacterium. Also, antibiotics can sometimes cause side-effects such as diarrhoea, rash and stomach upsets.

So, most doctors do not prescribe antibiotics for most cases of tonsillitis or sore throat.

An antibiotic may be advised in certain situations. For example:

  • If the infection is severe.
  • If it is not easing after a few days.
  • If your immune system is not working properly (for example, if you have had your spleen removed, if you are taking chemotherapy, etc).

What about having my tonsils taken out?

If you have repeated (recurring) tonsillitis you may wonder about having your tonsils removed. Guidelines suggest it may be an option to have your tonsils removed (tonsillectomy) if you:

  • Have had seven or more episodes of tonsillitis in the preceding year; or
  • Five or more such episodes in each of the preceding two years; or
  • Three or more such episodes in each of the preceding three years.
  • And …
  • The bouts of tonsillitis affect normal functioning. For example, they are severe enough to make you need time off from work or from school.

The adenoids may also be removed at the same time. The adenoids are also part of the body’s defence against infections (the immune system). Adenoids hang from the upper part of the back of the nasal cavity. See separate leaflet called Tonsils and Adenoids for more details.

Although full-blown episodes of tonsillitis are prevented after tonsillectomy, other throat infections are not prevented. However, the overall number and severity of throat infections may be reduced. Also, the risk of developing quinsy is reduced. Many people say they generally feel better in themselves after having their tonsils removed if they previously had frequent episodes of tonsillitis.

Tonsillectomy is usually a straightforward minor operation. But, as with all operations, there is a risk. For example, there is a small risk of life-threatening severe bleeding from the throat during or just after the operation.

What is the outlook?

In nearly all cases, a tonsillitis or sore throat clears away without leaving any problems. However, occasionally tonsillitis may progress to cause a complication. Also, a sore throat or tonsillitis is sometimes due to an unusual, but more serious, illness.

Sometimes the infection can spread from the tonsils to other nearby tissues. For example, to cause an ear infection, sinus infection or chest infection.

What is quinsy?

Quinsy is also known as peritonsillar abscess. Quinsy is an uncommon condition where a collection of pus (abscess) develops next to a tonsil. This is caused by a bacterial infection.

  • It usually develops just on one side. It may follow a tonsillitis or develop without tonsillitis.
  • The tonsil on the affected side may be swollen or look normal, but is pushed towards the middle by the abscess next to the tonsil. Quinsy is very painful and can make you feel very unwell.
  • It is treated with antibiotics, but also the pus often needs to be drained with a small operation.

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