By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

INFECTED TONSILS CAN STOP FIGHTING DISEASE, PROMOTE IT INSTEAD

QUESTION: The doctor says my child needs to have his tonsils out. I didn’t think that was done anymore. Can’t we just wait and see if he will outgrow his frequent strep throats? If we have the tonsils out, will they grow back? And does it mean he won’t get sick anymore?

ANSWER: Tonsillectomy, having the tonsils surgically removed, used to be one of the most common childhood surgeries in the United States. It is still done, but much less often. Let me review a little of the history of this procedure.

Records show that tonsillectomies were performed by ancient physicians before 100 AD. This was done without anesthesia and was very painful. With the development of effective anesthesia, the number of tonsillectomies performed each year began to increase in the late 1800s. The popularity of this procedure really soared in the first half of the 20th Century as surgical and anesthesia procedures evolved and improved. But then a few decades ago, the guidelines were made more stringent, and the numbers began to drop. We went from several million of this procedure still being performed each year in the 1970s to about 600,000 by the late 1990s. The result of this change is good for the patient in that it means many fewer unnecessary tonsillectomies are performed today than in the past.

When you say tonsillectomy, I’m assuming that you are referring to the tonsils in the throat. For the record, we have three sets of tonsils -- the lingual tonsils, which are comprised of lymphoid tissue on the back of the tongue; the pharyngeal tonsils, which are located behind the nose and the roof of the mouth and are also called the adenoids; and the palatine tonsils, which are the ones in the throat.

Tonsils produce lymphocytes, special immune system cells that help your body fight disease. When the tonsils are healthy, they perform this task admirably. If the tonsils become chronically diseased, however, they don’t produce as many of these good “fighter cells” that help promote healing; instead, become a seed bed for infection.

As in the past, chronic infection is still often a good reason for having a tonsillectomy. Airway obstruction is another reason to take the tonsils out. If a person is having three or more tonsil infections per year, that can be an indication for tonsillectomy, especially if he or she is becoming more resistant to antibiotic treatment.

Some children will build up their immune systems and overcome these chronic infections. But in many other cases, the child is better off having the tonsils out. For instance, some studies have shown that kids with chronic tonsillitis who have a tonsillectomy have about two fewer sore throat infections per year than kids who don’t have the tonsillectomy. These kids miss less school and report a better quality of life. Also, children with sleep apnea and airway obstruction due to their tonsils often find this operation brings complete relief.

With modern surgical techniques, it’s very uncommon for tonsils to grow back. This did happen with certain older techniques that left the base of the tonsil intact.

If you are not sure what you should do, return to the specialist with a list of questions. Then, if you are still not satisfied, get a second opinion. Your primary care physician can be a good resource for you in making this tough call.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.