Tonsillectomy has changed a great deal in the last twenty to thirty years. Most parents and even more of the grandparents who accompany children into my office have a story to relate about their experiences with a tonsillectomy. Some recall having the procedure done in a doctor's office or being put to sleep with a mask soaked in ether. Others remember the extreme nausea that sometimes followed ether anesthesia or perhaps staying in the hospital for three or four days afterwards. And everyone has heard of someone who almost hemorrhaged to death after having a tonsillectomy. Nowadays, the operation is recommended much less frequently and usually only after multiple courses of antibiotics. The surgery is done in an operating room and the anesthesia administered by an anesthesiologist. And perhaps most surprisingly to many people, adults and even most children are sent home after the procedure is over.

Most of these changes are indicative of advances in medical knowledge and improvements in surgical technique. The tonsils have a role in the development of the body's immune system. Their importance decreases with age but they are no longer removed for trivial reasons. Improved methods of anesthesia have tremendously increased the safety of the procedure and the risk of a healthy patient undergoing anesthesia is less than the car trip to the hospital! The actual removal of the tonsils is often performed with an electric knife, thus reducing blood loss and minimizing subsequent nausea. Typically, only a few ounces of blood is lost during a routine tonsillectomy. The throat will always be sore after a tonsillectomy but these improvements lessen post-operative problems and usually allow discharge later the same day. Bleeding, if any, occurs in 2-3% of all tonsillectomies and usually presents 5-7 days later. It is usually mild and easily controlled. Contrary to popular opinion, adults are not more likely to have problems with bleeding than children.

When should I or my children consider a tonsillectomy? A tonsillectomy should be considered if a person has multiple attacks of tonsillitis despite antibiotic treatment. Chronic sore throats can sometimes be improved by tonsillectomy. Enlarged tonsils may produce symptoms of snoring, difficulty in swallowing and even difficulty breathing, especially at night. However, enlarged tonsils without associated systems or infection do not need to be removed. Abscessed tonsils always need prompt evaluation and treatment. Other occasional indications for tonsillectomy include chronic lymph node infections in the neck and poor weight gain in a young child or infant. Enlarged tonsils with accompanying partial blockage of breathing has also been shown to inhibit the proper growth and development of the jaws and tonsillectomy is often recommended prior to putting braces on the teeth.

Despite the many changes described above, tonsillectomy is still one of the most commonly performed surgical procedures. If you have any of these symptoms, check with your family physician. He or she will examine your throat and almost certainly prescribe an antibiotic or other medication. If necessary, he or she will refer you to an ear, nose and throat specialist (otolaryngologist). Many other problems can masquerade as a sore throat and the otolaryngologist will perform a complete examination of the nose, throat, sinuses and voice box and determine the cause of the problem. If the tonsils seem to be producing the symptoms, removal may be recommended. Above all, avoid falling into the many misconceptions and old wives' tales that surround this procedure. Tonsillectomy is certainly not done with the same frequency as in past generations, but in properly selected patients. the results can be very dramatic.