I am once again dealing with this dreaded annoying infection. I have had re-occuring tonsilitis since I was a child. Several years ago, I was so fed up, I asked my doctor to remove my tonsils. He indicated that this was no longer an "elective" type surgery and the tonsils are more valuable than once thought.
I would like to have them removed. Is this a stupid decision? Should I just continue to look around until I find a DR that will do this?
Thank You,
Answer ------------------------
As is true for any medical intervention, a recommendation requires a consideration of the likelihood of direct benefit versus the potential for adverse consequence or complication. Even in an adult, there is occasionally sufficient potential benefit versus risk to warrant consideration of tonsillectomy. Exact criteria for adult tonsillectomy have yet to be defined by outcomes research analyses, but most consider 4-6 episodes of bacterial tonsillitis in a year to be appropriate criteria at present. Occasionally a lesser degree of frequency might be considered appropriate if there is a history of severe infection such as abscess.
Episodic sore throats, even if relatively frequent, do not necessarily justify a tonsillectomy if bacterial infection or focal chronic inflammation of the tonsils is not demonstrated. Often such sore throats have no relation to the tonsils but are associated with other causes including sinus or nasal disease, allergy, reflux of stomach acid, etc.
It is true that the tonsils are active immunologic organs however, they are generally considered secondary in importance to the balance of the immune system. Furthermore the period of greatest activity is felt to be between the ages of 4 - 10. There is also very little evidence of measurable nor certainly of clinically significant decline in immune function following the removal of tonsils. One might consider the tonsils as a sort of filter. Occasionally the filter fails to function properly and becomes colonized with the very organisms it is intended to help eradicate. While the tonsils involvement in immune function is relatively small, it nevertheless needs to be taken into account. The main risks to consider, however, would be those relative to the actual surgical procedure and recovery period. Primarily these risks include those associated with a general anesthetic as well as the risk of bleeding. Bleeding can occur as late as 7 - 10 days following tonsillectomy. The reported risks of anesthetic complication or of significant bleeding vary in the medical literature, but in general are felt to be very low. Nevertheless, these risks must be considered and placed in appropriate context with the degree of problems that the tonsils cause for an individual.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
Click here to review
previous Ear, Nose and Throat Clinic consultations