Tonsillectomy Risks, Benefits and Alternative Options

Once a more common surgical procedure, tonsillectomy is now reserved only for certain situations.

About Tonsillitis and Tonsil Stones

Tonsils reside in the back of the throat as “gland-like structures”. They contain lymphocytes, which help fight infection. The role of tonsils in the immune system is that they act like a net that traps viruses and bacteria. When they do their job correctly, they can help keep the body healthy. When they do not, they can develop tonsil stones (tonsilloliths) or they can become inflamed, which is called tonsillitis. Tonsil stones form when debris hardens and calcifies, getting trapped in the tonsils. They are more likely in people who have repeated tonsillitis. Tonsil stones may or may not have symptoms, but generally, they can cause white debris, sore throat, bad breath, ear pain, tonsil swelling, and difficulty swallowing. Many times, tonsil stones can be removed at home with swabs or salt water gargles. Sometimes antibiotics are necessary, but they have side effects and can lead to resistant bacteria.

Tonsillectomy and Other Surgical Options

Rarely, surgery (without general anesthesia) would be needed to remove the tonsil stones. There are times that tonsillectomy would be recommended, as tonsil stones tend to be more common in people with repeated bouts of tonsillitis.¹ Tonsillectomy may accompany removal of the adenoids (adenoidectomy) as well. Adenoids are also part of the lymphatic system, and their swelling can cause ear infections.² Tonsillectomy and adenoidectomy are usually performed under general anesthesia and take several days of recovery time. The procedures may be outpatient or require an overnight hospital stay. The resulting sore throat can last several days, affecting the ability to eat, drink, and speak. There is a risk of post-surgicalbleeding. In general, tonsillectomies are performed when a patient has chronic tonsillitis or several bouts in one year, abscesses that won’t drain, foul odor in the mouth that doesn’t improve with antibiotics, or if a person has sleep apnea.³ Recurrent strep throat is another reason a tonsillectomy may be recommended. One variation on traditional tonsillectomy is intracapsular tonsillectomy, where a small layer of tonsil is left behind to “protect the underlying throat muscles”. The recovery is faster and the risk of bleeding is lessened, but there is still a 1% chance that the tonsils can “re-enlarge or become infected”.⁴ After tonsillectomy, cases of strep may disappear, but there is always a chance that these types of infections could return.⁵ During recovery, pain medication may be needed. Fluids should also be increased. There are risks of dehydration, fever, and difficulty breathing.⁶

Alternative Options

Instead of traditional tonsillectomy procedures where tonsils are removed, somnoplasty is an alternative. In somnoplasty, the enlarged tonsils are shrunk with electrodes, which are inserted into the tonsils. The energy wave “burns away the tonsil tissues” under local anesthesia. There are fewer side effects, such as bleeding, although the patient may have trouble swallowing after the procedure, for about two weeks.⁷ Somnoplasty is generally performed for adult patients with sleep apnea. Children would likely require a general anesthetic because, during somnoplasty, a patient would have to comply with a “needle pressed down their throat”. There isn’t enough information about whether or not somnoplasty can help with infected tonsils.⁸ Repeated infections can lead to the overuse of antibiotics, which may make the bacteria resistant. There are more natural options that can help patients cope with repeated infections, such as “cleansing the lymphatic system” via hydrotherapy, massage, diet, and herbs. Homeopathic kits could also help some patients.⁹