“Never in the history of medicine have so many physicians owed so much economic security to a single operation as tonsillectomy.” (Lyman Richards, Quoted in The New York Times,1953)
Tonsils, located at the back of one’s throat and adenoids, present high up behind the nose are part of the immune system and help protect the body from infection by trapping germs coming in through the mouth and nose. They are collections of tissue producing cells that attack the invading microorganisms and counteract their toxins by forming antibodies. They swell up temporarily whenever there is active infection.
Though tonsils were removed frequently in earlier times the present scenario has changed because doctors believe that the positive role of tonsils in helping the owner for a lifetime cannot be ruled out (even though there is no proven evidence as of now). We also know that speech is the miracle brought about by the various oro-pharyngeal tissues modulating the laryngeal jet of air and therefore contributory role of these tissues to good voice cannot be ignored.
As of now the operation is beneficial when done for few specific indications, namely, repeated attacks of tonsillitis (The American Academy of Otolaryngology defines repeated infections in children as seven episodes in one year, or five episodes in each of two years, or three episodes in each of three years) and evidence of chronic infection (unresponsive even after the bugs are identified and treated with a full course of medication ). A certain bacteria called “streptococcus” if housed long enough in this tissue may affect many organs of the body and sometimes the ENT surgeon might consider removing the tonsils. Bleeding and malignancy can occur in the tonsils even in adults necessitating tonsillectomy. Please remember that the surgery is never done during active infection and is not an emergency. Complications are not threatening except for bleeding. However it should be emphasised that having the tonsil removed doesn’t mean that you will never get a sore throat again!
With adenoids the situation is knotty. Swollen adenoids are quite annoying as they cause mouth breathing (leading to foul breath), nasal congestion (affecting speech) and snoring, can be severe enough to stop spontaneous breathing (called obstructive sleep apnoea) as well as recurrent ear and sinus infections. More serious long-term effects, typically secondary to obstructive sleep apnoea, include behavioural and learning difficulties, poor attention span, hyperactivity, and very rarely, a drop in a child’s intelligence quotient. In later years, there can elevated blood pressure and heart problems. It also contributes to stunted growth. Therefore with considerably swollen adenoids, an adenoidectomy (with tonsillectomy in cases of coexisting tonsillar hypertrophy) is the typical management strategy for patients. However, potential complications (bleeding, damage to bones of the face and neck although rare) and the absence of a complete resolution of symptoms have prompted the investigation of non-surgical alternatives especially in children.