When it comes to the role tonsils play in health and well-being, there's a lot of controversy. Tonsils (the lymph tissue at the back of the mouth) and their close cousins, the adenoids (the lymph tissue at the top of your throat by the back of the nose) can act as a reservoir where bacteria grow and thrive.
"Historically, doctors removed tonsils for a variety of reasons: the tonsils are too big, the tonsils are causing people to get sick too often, or because they were there," says Alvin Ko, M.D., an otolaryngology (ENT) specialist at Henry Ford Health. But with the increased availability of antibiotics, less invasive treatments and knowledge of potential complications, the tide has shifted away from surgery, which is generally done now mainly for children with recurrent strep throat (when the infection keeps coming back or happens often) or sleep apnea.
Tonsils and Adenoids: The Basics
The American Academy of Otolaryngology calls tonsils and adenoids the "first line of defense as part of the immune system." To better understand how they work — and when they should be removed — we asked Dr. Ko to explain the basics of kids' most frequently removed tissues.
Q: What do the tonsils and adenoids do?
A: The tonsils are two lymph nodes on each side of the back of your throat. They act as a defense mechanism against infection by trapping bacteria and viruses. They also produce proteins called antibodies to help kill those germs, preventing throat and lung infections. Your adenoids are made of the same lymphoid tissue as your tonsils, but they sit at the top of your throat where it meets the back of your nose. The adenoids filter out germs and bacteria attaching to the back of your throat.
Q: What are some reasons kids get their tonsils removed?
A: The tonsils and adenoids can act as reservoirs where bacteria can grow and thrive. Historically, most children had their tonsils and adenoids removed. Today's doctors are more selective, and patients must meet certain criteria before they undergo a tonsillectomy and/or adenoidectomy, such as:
- Recurrent strep throat
- Recurrent ear infections (adenoid removal only, usually when putting in ear tubes)
- Sleep apnea
Sore throats, ear infections and sleep-disordered breathing aren't just problematic for the kids they affect. Families have to manage the burden, too. Parents have to watch their children suffer and take time away from work to shuttle them to the doctor. Children miss out on school and sporting activities. Plus, recurrent infections of any type can lead to other problems, such as heart, joint, neurological and kidney problems. All of those factors nudge parents — and doctors — toward tonsil removal.
Q: Why is the rate of tonsillectomies declining?
A: As with all things in healthcare, removing tissue comes with a certain degree of risk. Patients may experience negative reactions to anesthesia or postoperative complications. In the 1970s and 1980s, tonsillectomies declined 50 to 75 percent in part because access to a wider variety of antibiotics could be used to treat health conditions that were traditionally the reason for tonsil removal.
Q: How might removing the tonsils and adenoids affect health down the line?
A: It's not entirely clear. One recent study suggest tonsil and adenoid removal may be linked to an increased risk of allergies, respiratory illness and infectious diseases later in life. That elevated risk could relate to the fact that patients had an underlying condition that called for tonsil removal, not because of the tonsillectomy itself. Multiple other studies showed no meaningful impact on patients’ immune system.
To Remove Or Not To Remove
Unfortunately, there are no hard and fast rules about tonsil and adenoid removal. Doctors have to assess patients on a case-by-case basis and determine whether the benefits of the procedure outweigh the risks — both in the short term and down the line.
"With a condition like sleep apnea, removing the tonsils produces a 79 percent cure rate," says Dr. Ko. "The reduction in sore throats isn't as clear cut. A child might experience fewer sore throats for a year or two, but studies say the benefits may not last beyond that. Many patients I’ve seen years later, however, mention they definitely noticed a positive difference."
Before you agree to have your child's tonsils removed, make sure you understand the reason for the procedure. If your doctor doesn't offer a clear explanation why the procedure is necessary, consider visiting another physician for a second opinion.
To find a doctor at Henry Ford, visit henryford.com or call 1-800-HENRYFORD (436-7936).
Dr. Alvin Ko is an otolaryngologist (ear, nose and throat specialist) who sees patients of all ages at Henry Ford Hospital in Detroit, Henry Ford West Bloomfield Hospital and Henry Ford Medical Center - Lakeside in Clinton Township.
