From the Guidelines
Tonsillectomy is recommended for patients with recurrent tonsillitis, defined as at least 7 episodes in the past year, at least 5 episodes per year for 2 years, or at least 3 episodes per year for 3 years, with documentation of sore throat and at least one of the following: temperature ≥38.3°C, cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus 1.
Key Indications for Tonsillectomy
- Recurrent tonsillitis with frequent episodes, as defined above
- Chronic tonsillitis that doesn't respond to antibiotics
- Peritonsillar abscess that recurs despite treatment
- Tonsils so enlarged they cause breathing difficulties, sleep apnea, or swallowing problems
- Halitosis (bad breath) due to chronic tonsillitis or tonsil stones
- Suspected malignancy
Preoperative Evaluation
Before surgery, patients typically undergo a thorough evaluation including physical examination and medical history review 1.
Postoperative Care
Recovery takes about 10-14 days, during which patients should:
- Consume soft foods
- Stay hydrated
- Take prescribed pain medications, usually acetaminophen or ibuprofen, sometimes with stronger options like codeine for severe pain
- Avoid strenuous activities
Immune System Considerations
The tonsils play a role in the immune system, but their removal doesn't significantly compromise immunity because other lymphatic tissues continue to function 1.
Benefits and Risks
The benefits of eliminating chronic infections or airway obstruction generally outweigh the risks of surgery for patients meeting the criteria for tonsillectomy 1.
Modifying Factors
Clinicians should assess patients with recurrent throat infection who do not meet the initial criteria for tonsillectomy for modifying factors that may make tonsillectomy favorable, such as multiple antibiotic allergies, PFAPA, or history of peritonsillar abscess 1.
Sleep-Disordered Breathing
Tonsillectomy may be considered for patients with obstructive sleep-disordered breathing, and clinicians should ask caregivers about comorbid conditions that may improve after tonsillectomy, such as growth retardation, poor school performance, enuresis, asthma, and behavioral problems 1.
From the Research
Tonsillectomy Recommendations
Tonsillectomy is a surgical procedure that involves the removal of the tonsils, and it is often recommended for individuals who experience recurrent acute tonsillitis. The decision to undergo a tonsillectomy is typically made after considering the frequency and severity of tonsillitis episodes, as well as the impact of the condition on the individual's quality of life.
Indications for Tonsillectomy
The following are some indications for tonsillectomy:
- Recurrent acute tonsillitis, defined as seven or more episodes of tonsillitis in the past year, or five or more episodes per year for two consecutive years, or three or more episodes per year for three consecutive years 2
- Tonsillitis that is severe enough to cause significant morbidity, such as fever, sore throat, and difficulty swallowing 3, 4, 5
- Tonsillitis that is not responsive to non-surgical treatments, such as antibiotics and pain management 6, 2
Benefits of Tonsillectomy
The benefits of tonsillectomy include:
- Reduction in the frequency and severity of tonsillitis episodes 3, 4, 5
- Improvement in quality of life, including reduced pain and discomfort, and improved ability to swallow and speak 3, 5
- Reduction in the number of days missed from work or school due to tonsillitis 3, 4
Considerations for Tonsillectomy
The following are some considerations for tonsillectomy:
- The potential risks and complications of the procedure, such as bleeding, infection, and reactions to anesthesia 2
- The potential for spontaneous improvement in tonsillitis symptoms without surgery 2
- The importance of weighing the potential benefits of tonsillectomy against the potential risks and considering alternative treatment options 2