How will I know if I need a tonsillectomy?Ear, Nose & Throat
Thank you for your question. Tonsils are two oval-shaped soft tissue sitting at the back of your throat (see picture below).
They are part of your immune system. Their role in your body's immunity against infection is negligible as other immune organs such as your lymphatic system, liver and spleen are the main players in your immune system.
I shall answer both your questions as follows:
a) How do I know if I need to remove my tonsils?
I often tell my patients that the tonsils are very much like the appendix. If they do not give you any problems, you leave them alone.
It doesn't mean that if your grandmother had her tonsils removed, you are more likely to or need to have your tonsils removed.
However, in some patients, the tonsils can be problematic. I do recommend tonsillectomy (surgical removal of tonsils under general anaesthesia) in these conditions:
1. Frequent or recurrent tonsillitis - If you get frequent tonsil infections (usually painful sore throat, fever and painful swallowing requiring oral antibiotics) resulting in hospitalisation, significant time off work or significant impairment in quality of life, you may consider having your tonsils removed. Most ENT surgeons would recommend tonsillectomy if you have significant acute tonsillitis more than 3 times a year.
2. Snoring or obstructive sleep apnoea (OSA) - If your tonsils are very big such that they cause snoring or OSA (a condition in which a person "chokes or stop breathing momentarily" during sleep), your ENT Specialist may recommend removal of your tonsils to create more space in your upper airway.
3. Suspected cancer - If there is a suspicious growth on your tonsil or if one of your tonsil is way bigger than the other (asymmetrically enlarged tonsil), you may need a tonsillectomy to rule out cancer.
4. Other problems with your tonsils – Sometimes a tonsil is removed because a fish bone is stuck and buried within it or as part of surgical access to other areas in the throat and neck region.
b) Are there any adverse effects if I have them removed?
As mentioned above, the tonsils play a very small role in the immune system of your body. There are numerous studies that have shown that removal of the tonsils does not decrease your immunity or make you more prone to infections.
However, like all surgeries, there are potential risks involved in the removal of tonsils. The most common complication of tonsillectomy is bleeding (~5-10%).
The majority of bleeding can be stopped in the clinic. Occasionally, the bleeding may require surgical intervention.
Rarer complications from tonsillectomy include infection and injuries to the lips, teeth or gums during surgery (during retraction of the tongue and mouth to expose the tonsils). The operation is done through the mouth and there will be no external cuts on the neck.
Hope this helps, and all the best!
Tonsillectomy is probably the commonest surgery performed by the ENT Surgeon. There are various indications for tonsillectomy.
The commonest would be recurrent tonsillitis.
- Severe throat pain, with high fever
- Difficulty eating
This requires a course of antibiotics up to 2 weeks per episode.
Individuals with recurrent tonsillitis can have such infections as frequent as once per month. There are various recommendations on how frequent the infection should be before we recommend the surgery.
However, you can imagine that it really depends on the individual's lifestyle and work commitments.
Some guidelines recommend infections of more than 6 time a year before we consider surgery.
For some, having a 2 week disruption even 3 - 4 times a year is too disruptive to their work/ studies and they may consider the surgery.
Other indications for performing tonsillectomy are as follows:
1) As part of the surgery to increase airway for treating sleep apnoea.
2) When there are reasons to suspect cancer (eg, enlarged tonsil of only one side, non healing ulcer on tonsil) and tissue is required for confirmation.
3) Repeated Quinsy (a more severe form of infection compared to tonsillitis where pus develops and patient can be in danger of airway obstruction due to the pus and swelling. In this case, the threshold to recommend surgery is lower than for tonsillitis).
4) Tonsoliths (bacteria and food debris trapped in tonsils) causing bad breath.
Tonsillectomy is indicated in several scenarios, including
1. Enlarged tonsils with obstructed airways
2. Sleep disorders like obstructive sleep apnoea deemed secondary to enlarged tonsils
3. One-sided tonsillar enlargement where there is a concern of cancer
4. Other less absolute indications, including recurrent tonsillitis (≥3 to 5 times a year) or resulting complications like peritonsillar abscesses
There is no real issue with removing them (ie you can live without them), but surgery entails some risks that will be explained to you by your surgeon if you are to undergo the procedure.
Hope this helps.