A common question I am asked is; Doctor why do I need to have my tonsils removed? Or, why does our pediatrician say my son or daughter should have their tonsils removed? The answer is always complex and includes many different factors all of which play an important role in the answer.
The tonsil is lymphoid tissue that helps in the development of the body’s immune antibody development. In most people as they age the function and the size of the tonsils will decrease. In some people the tonsils continue to enlarge and they can become continually infected or harbor subclinical bacterial contamination. Sometimes if they continue to enlarge they can produce difficulty with speech, swallowing and breathing. Large tonsils can be a precursor to obstructive sleep apnea (OSA).
Tonsillectomy In Adults
Adults, for this discussion someone 25 years of age or older, often times have their tonsils removed for reasons of repetitive strep throat infections, obstructive symptoms, snoring, swallowing problems, bad breath, or possibly even a severe tonsil infection called a peritonsil abscess. Sometimes adults who have suffered repetitive viral pharyngeal infections will develop chronic pain in their throat which is improved with a tonsillectomy.
Tonsillectomy in infants and children under the age of 4
A tonsillectomy in an infant or child under the age of 4 is uncommon and requires a special evaluation by the pediatrician and otolaryngologist. Often times other physicians are involved in the decision to perform a tonsillectomy in a child this young. These may include a pediatric: neurologist, pulmonologist and infectious disease expert.
Tonsillectomy in children over the age of 4
Children over the age of 4 most commonly have their tonsils removed because of repetitive throat infections most often from the bacteria streptococcus. This is commonly referred to as strep throat. Strep throat is most often associated with a very sore throat, malodorous breath, a high fever, and difficulty with drinking and eating. Strep throat is most often diagnosed with a rapid strep test, or a throat culture. It is almost always treated with antibiotics and can be very contagious affecting other family members.
Other reasons children over the age of 4 have their tonsils removed can include heavy snoring with obstructive type symptoms. Sometimes these children will have a sleep study that documents obstructive breathing patterns during sleep. If children have had multiple treatments with various antibiotics there is a concern that they may develop bacteria that are resistant to antibiotics. More and more antibiotic resistant infection mount a serious health challenge to clinicians and patients.
Having tonsils removed is done through a surgical procedure called a tonsillectomy. It is often accompanied by removal of the adenoid tissue. The adenoid is lymph tissue in the back of the nose. Surgical removal of the tonsil and adenoid is always done with general anesthesia. Surgery takes about 30 minutes and is most often done as an outpatient. Both adults and children over the age of 4 can usually go home the same day as surgery.
Recovery after a Tonsillectomy
The recovery after surgery takes about seven to ten days. Younger children will recuperate quicker than an adult. Physical activity and travel is strictly limited after surgery. Most surgeons recommend 2 weeks of no travel and restricted activity.
Diet after a tonsillectomy is predominantly hydration drinks and cool soft foods. Hot food and hard chewy food or spicy food is to be avoided. A liquid narcotic pain medicine is prescribed after surgery and most patients will use a narcotic medication for about 10 days, although younger children do recuperate quicker. Adults are recommended to not drive while taking prescription pain medicine and to avoid important business and personal decision making situations.
Once completely recovered from surgery patients are most often free from future bacterial infections of the pharynx. The tonsil and adenoid do not grow back, although some people may develop some lymphoid tissue in the same location as the tonsils and adenoid.