In the 1960s and early 1970s, it was practically a rite of passage: School-age children in the U.S. routinely had their tonsils removed through a surgical procedure called a tonsillectomy.
The culprit: tonsillitis, an inflammation of the tonsils that commonly occurs during a child’s early school years, ages 4-8, says Amelia F. Drake, MD, a pediatric otolaryngologist (ear, nose and throat doctor) and a professor in the UNC School of Medicine.
The tonsillectomy experience for children was so common in the U.S. then that a famous cartoon monkey’s book nodded to it. In Curious George Goes to the Hospital, George swallows a jigsaw puzzle piece and must have a small operation to remove it. The monkey is given ice cream after his surgery—just like many children who had tonsillectomies. (A common complaint after the surgery is a severe sore throat, making it hard to eat. The chill of ice cream or a popsicle can provide relief.)
But not every case of tonsillitis justifies surgery. And though tonsillectomies have been done less frequently since the 1960s, they are still considered one of the most common major surgical procedures for children. Here, Dr. Drake explains the procedure—and when you or your child might need it.
What Is a Tonsillectomy?
During a tonsillectomy, surgeons remove two round lumps in the back of the throat known as the palatine tonsils. In some cases, surgeons also remove the adenoids, a patch of tissue behind the nose that’s not visible without special instruments.
Tonsils and adenoids help trap bacteria and viruses that people breathe in, helping prevent throat and lung infections. Luckily, they are not the body’s only defense against infection, as sometimes the tonsils can become more hurtful than helpful.
“They came about to protect you, but sometimes they get overwhelmed by infection and need to come out,” Dr. Drake says.
A tonsillectomy is performed under general anesthesia. During surgery, the physician uses a scalpel to remove the tonsils. The operation is generally done on an outpatient basis, meaning the patient can go home on the day of the surgery.
Today, about 289,000 tonsillectomies are performed every year in the U.S., compared with 1.4 million in 1959. The procedure started to wane in the 1970s, as doctors became concerned that the surgery wasn’t always necessary and that the risks outweighed the benefits in some cases. (Although rare, some people experience post-surgical complications such as bleeding.)
Should You or Your Child Have His or Her Tonsils Out?
In general, otolaryngologists perform tonsillectomies when people experience recurrent sore throats accompanied by fever or when they have trouble breathing while sleeping. (Inflamed tonsils and adenoids can block the airway.)
For children in particular, tonsillectomies can be beneficial in the long run. The procedure prevents recurring tonsillitis as children reach their teen and adult years, and adults endure a longer recovery time—nearly twice as long as that of children—because more extensive healing is required.
Dr. Drake says an otolaryngologist is likely to recommend the surgery if someone experiences:
- Enlarged tonsils that cause upper airway obstruction, severe difficulty swallowing, sleep disorders or cardiopulmonary complications
- A bacterial infection that usually begins as a complication of untreated strep throat or tonsillitis—it may appear as a pus-filled pocket near a tonsil—that does not respond to medical intervention
- Tonsillitis accompanied by febrile convulsions, or seizures that may stem from a spike in body temperature
An otolaryngologist may also consider surgery if someone experiences:
- Six or more tonsil infections per year, as documented by a doctor
- Persistent foul taste or breath from chronic tonsillitis
- Chronic or recurrent tonsillitis that does not respond to antibiotics
Dr. Drake estimates that most children need a week to 10 days to recover, and adults often need at least two weeks.
Patients will need to get plenty of rest for the first few days after the procedure and avoid strenuous activities for two weeks. A severe sore throat is also common after a tonsillectomy, so, like Curious George, cue the ice cream.
If you or your child experiences frequent bouts of tonsillitis, talk to your doctor or make an appointment with an ENT specialist or a pediatric ENT specialist near you.