If you’re over fifty, chances are excellent you no longer own your tonsils. If you’re 30 to 50, there’s a great chance that you should have had your tonsils removed but never had it done.
Here’s the deal. Back in the day, tonsillectomies paid the bills for primary care doctors all across the USA. Parents would bring their children in with their first bout of tonsillitis and be told, “Sorry, but they need to come out.” In the 1940s (and earlier), many of these cases were done awake, in the office or at the patient’s home. In his autobiography Boy, Roald Dahl told the appalling and hilarious story of his own dining room tonsillectomy. I’ve heard many similar stories from my older patients.
Sometime in the late 60s, the pendulum swung way over. I think the US government had something to do with this, but honestly, I’m not sure on the details of the history. Wikipedia isn’t much help*, stating only:
There has been a significant reduction in the number of tonsillectomies in the United States from several millions in the 1970s to approximately 600,000 in the late 1990s. This has been due in part to more stringent guidelines for tonsillectomy and adenoidectomy . . .
Nowadays, we remove tonsils for a few reasons:
And that’s about it. Big tonsils alone is not a good reason for tonsillectomy. They have to be causing major tsuris.
Why not do more tonsillectomies? It’s a painful operation, even in children, and especially in adults. It’s not without risk. Post-op bleeding can occur even weeks after surgery — that’s the main worry. Deaths are rare, but not unheard of.
Why not do fewer? Cuz when you need it, you really need it. I feel terrible when I meet someone in her twenties or thirties who has been getting sick six or seven times per year since childhood, all because “I was told they don’t do that operation any more.” Grrr.
Does tonsillectomy weaken the immune system? After all, the tonsils are part of the immune system. Think of them as big fat lymph nodes in plain sight. Yet, if anything, removing chronically infected tonsils strengthens the immune system.
Bill Cosby, back in the old days when he did stand-up, had a great routine about his tonsillectomy (this is on his Wonderfulness album). At one point, young Bill asks the doctor why he needs to have his tonsils removed. The doctor tells him, “Tonsils are like soldiers. They’re there to fight for you in time of war.” Dramatic pause. “Son, your tonsils have joined the other side.”
That skit also featured Cosby singing, “ICE CREAM. I’M GONNA HAVE ICE CREAM!” But young Bill discovers that the idea of ice cream doesn’t match up to the reality of ice cream when it hits a freshly operated throat. Poor kid.
Yup, it’s tonsil day today in the OR. Any questions?
*But I am listed as an external source. Is that cool, or what?