It has been one of the most frequently planned surgical procedures for about 100 years – the removal of the palatine tonsils (also: tonsillectomy). In the sixties, it was almost routinely used to prevent secondary diseases. Today, the function of the tonsils in the body’s defense system is valued more highly and it is known that healthy tonsils should not be removed. Which tasks the tonsils have, which diseases of the tonsils there are and when the tonsils should actually be removed, you can read here.
Defense function of the tonsils
The tonsils have a “good image” today. They are considered “guardians” against viral and bacterial attacks, especially in children. The palatine tonsil belongs to the so-called lymphatic pharyngeal ring, which is formed by lymphatic tissue collections in different regions of the pharynx. This ring is part of the immune system and has an important defense function against invading germs. Thus, healthy tonsils act as biological filtering organs and can intercept germs that have entered the bloodstream and lymphatic system. Research shows that tonsillectomy too early can impair the performance of a child’s immune system for years to come.
Tonsillectomy: When is surgery necessary?
Because of this important function, surgery to remove the tonsils is now used only for well-defined disease states, namely:
- Recurrent acute tonsillitis (more than three times a year).
- Tonsillitis that does not heal despite the administration of antibiotics or when an abscess (accumulation of pus) is formed.
- Existing chronic tonsillitis
- Enlarged palatine tonsils that interfere with breathing
In children, the palatine tonsils are usually removed only from the age of six. Important: In the case of chronically inflamed tonsils or inflammation with abscess formation, the tonsils must also be removed in infancy. A tonsillectomy due to constant inflammation or a chronic disease leads almost immediately to an improvement or healing of the existing clinical picture. Especially in childhood, the susceptibility to infections that existed until then decreases significantly. Experience also shows that children whose physical development was impaired by constant infections make very rapid progress after surgery.
What are the clinical pictures?
Acute inflammation of the palatine tonsils (angina tonsillaris) occurs when viruses or bacteria enter the throat. Especially children between five and eleven years are affected by the so-called “angina“. There are severe swallowing difficulties and high fever; the general condition is severely restricted. If it is a viral infection, the inflammation and pain when swallowing usually subside after one to three days without special therapy. In the case of a bacterial infection, bacteria from the streptococcus group are usually responsible. The tonsils are swollen (“thick”) with inflammation, bright red, and have white to yellowish coatings that are stripe-like, dot-like, or smeary. A typical accompanying symptom is unpleasant bad breath. The infection with bacteria can become really dangerous if an abscess forms on the inflamed tonsils, i.e. a collection of pus. The pus must be surgically removed as soon as possible. In the same session, the tonsils are usually removed. Accompanying antibiotics are given to the patients.
Chronic tonsillitis
Chronic tonsillitis occurs when there is a permanent buildup of bacteria and dead cellular debris on the depressions of the tonsil surface that perpetuate the inflammation. This results in fissuring of the surface and scarring of the tissue. Many sufferers do not even notice the infection because they have no symptoms. Some experience mild swallowing difficulties or an unpleasant taste and bad breath. When pressure is applied, pus wells up from the small dimples on the surface of the tonsils. Antibiotics now no longer reach the tonsil tissue. In addition, the bacterial colonization can act as a stray focus: Bacteria and messenger substances enter the blood from there, can be carried to other organs and cause infections. If chronic tonsillitis is carried over, kidney and heart valves are threatened and rheumatic fever can occur.
Tonsil surgery: what are the complications?
The operation is a short procedure, usually performed under general anesthesia. In the process, the doctor separates the two palatine tonsils at the so-called tonsillar pole. The procedure is performed as an inpatient because there is a risk of postoperative bleeding. These occur most frequently on the day of the operation and the first day after. But there is also a risk on the fifth and sixth day, when the whitish wound coatings detach from the tonsil beds. Because these bleeds can be massive and life-threatening, they require immediate medical intervention. Therefore, patients usually remain in the hospital for six to seven days for observation. In a small percentage of cases, side cord angina, inflammation of the side wall of the throat, is more common after surgery. Importantly, there is no fear of a weakening of the body’s immune defenses in adults, as sufficient lymphoid tissue remains in the pharynx even after surgery.
Are there alternatives to surgery?
There is no alternative to surgery for palatine tonsil enlargement or for chronic palatine tonsillitis. In the case of an abscess, a reaper opening may be made instead of removal to allow the pus to drain. But even then, tonsils should be removed at intervals of a few weeks.
