Impacts nearly one million a year

It is estimated that around a million patients have a Tonsillectomy or Adenoidectomy or both (T and A) in this country each year. Obviously this procedure has a large impact on the health of many of our children, as well as on our health care budget.

The question of tonsils and whether patients should keep them or lose them has divided physicians for years. Needless to say many articles have been written on the subject and a number of serious studies have been performed to try and determine who, if anyone, should get their tonsils out. The adenoids are closely related to the tonsils and their importance in causing disease has also been carefully studied.

It is well known that the tonsils and adenoids are closely related to ear disease in children with recurrent tonsillitis and ear infections. Research performed in the 60’s and 70’s showed that some children carry large numbers of disease causing bacteria in their throat. It was found that performing a Tonsillectomy and adenoidectomy reduced the number of dangerous bacteria in these children. The most obvious change in throat bacteria was a reduction in the number of children who carried Strep. It is important to remember, however, that viruses are felt to be as important in recurrent tonsillitis as bacteria and these were also reduced following tonsillectomy.

The immunological systems of children with recurrent tonsil disease have been shown to maintain higher than normal levels of antibodies. Following removal of the tonsils and adenoids these antibody levels return to normal

Adenoids are known to cause other problems besides recurrent infections. They are located behind the nose, “above and behind” the soft palate. If they are enlarged they can block the nasal airway and prevent the child from breathing through his nose. Unfortunately, this “mouth breathing” has been associated with abnormal jaw growth. These children frequently require braces and palate expanders to correct this problem. Modern orthodontists are aware of this problem and refer these children for improvement of nasal breathing before applying the mouth appliance.

Adenoids are located next to the tube which lets air behind the eardrum (the Eustachian tube). If they block this tube, the child will have trouble with fluid behind the ear, and possibly ear infections. This is an important problem because the eardrum is like a bass drum in that if you fill it with fluid it will not work. Children with this problem have a hearing loss which can affect their language development. Fortunately it is easily treatable.

The operation “Tonsillectomy and Adenoidectomy” has been a subject of controversy for years. The frequency of this operation has varied with the fashion of the times. I think that medical treatment should be directed by knowledge and common sense, not by fashion.

Obviously if a patient is not having trouble with his tonsils, they should be left alone. If a patient does have problems with recurrent episodes of tonsillitis (more than three or four a year), or complications of enlarged adenoids (including ear disease or nasal obstruction) then that patient needs treatment.