When should tonsils be removed?

The tonsils and adenoids are tissue at the back of the mouth and nose that fight infections. If they become infected, they become large and painful, and removal may be suggested. There are benefits but also risks that have to be considered before undergoing tonsillectomy or adenoidectomy. Expert consultant ENT and thyroid surgeon, Mr Julian Hamman looks at when this surgery is advisable and when it should be avoided.

Does removing the tonsils and adenoids affect the immune system?

Patients often ask whether tonsil or adenoid removal will affect their overall health. There are many misconceptions about what the tonsils and adenoids do, particularly in their role in the immune system. Indeed, both the tonsils and adenoids are made of lymphoid tissue which supports the immune system and fights infection.

Tonsils and adenoids, however, only help with the development of the immune system up until about two years of age. After this, the surgical removal of the tonsils or adenoids will not impact the immune system, as more than enough lymphoid tissue remains to fight against infection.

What factors need to be considered before removal?

Tonsil or adenoid removal is a surgery that requires much consideration before being performed. In the majority of cases, there are many factors to consider. Guidelines have been written, but they are only guidelines, not strict rules. Factors that will influence the decision include:

• severe and frequent tonsilitis
• difficulties breathing at night
• snoring
• allergies to antibiotics
• other health problems

If someone is suffering from one or more of these, it is likely tonsillectomy or adenoidectomy will be considered appropriate.

What are the different types of tonsil and adenoid problems?

There are two types of tonsil and adenoid problems that may require the removal of the tissues, which are obstructive and infective.

Infective problems occur as a result of an infection, these include:

• recurring tonsilitis
• quinsy (abscesses forming beside the tonsil)
• tonsillar asymmetry (one tonsil is larger in size because of past infection)
• recurring middle ear infections
• tonsillolths (tonsil stones)
• halitosis (bad breath)

Obstructive problems are caused by the size of the tonsils or adenoids, such as:

• obstructive sleep apnoea (OSA)
• nasal obstruction
• dysphagia (swallowing problems)

When should tonsils and adenoids be removed?  

Considering removal of tonsils and adenoids depends on whether the problems are classed as infective or obstructive.

Removal as a treatment for infective problems largely depends on how frequently infection occurs.  Tonsilitis might be considered if it happens 7 times in one year, 5 times a year for two years, or three times a year for three or more years. Even then, the situation is more likely to be monitored and treated with antibiotics, as most people will ‘grow out’ of tonsilitis as they get older. If someone has two or more quinsies (abscesses), it’s likely they will get more so removal may be considered. If one tonsil is larger than the other, for an unknown reason, it may be removed for analysis and to rule out tonsil cancer, which is very rare.

If removal is being considered to treat obstructive problems, it is only in cases when the tonsils and adenoids are so large it causes breathing problems during sleeping or a blocked nose that affects the sound of the voice and smell. It is very important that other causes are ruled out and that they are certainly caused by the size of these glands.

Who is not a suitable candidate for tonsil or adenoid removal surgery?

Certain people are more at risk of complications following the removal of the tonsils or adenoids. This includes people with:

• bleeding disorders, due to the associated risk of bleeding post-operation.
• palate or upper airway development problems, as the tonsils work as a swallowing mechanism for these people.
• problems of the throat’s muscles or nerves
• current tonsil infections

Since there is a higher risk of dangerous complications, it’s best that tonsillectomy or adenoidectomy procedures are avoided.

If you are interested in booking a consultation with Mr Julian Hamann to find out more about tonsillectomy, adenoidectomy, or other treatment options, you can do so via his Top Doctors profile.