Tonsil day

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:

  • Recurrent tonsillitis. We use strict numerical criteria on how many infections are too many. Yes, we get to use discretion — recurrent strep throat isn’t cool, nor are peritonsillar abscesses. But if someone comes in with only two bouts of tonsillitis per year for two years, they’re told to come back when things get more serious.
  • Chronic tonsillitis. Some folks are always conscious of their tonsils; and I think, perhaps on the boogerz blog, I’ve talked about tonsil stones. Nasty things.
  • Airway obstruction. In children, tonsillectomy/adenoidectomy is curative, with rare exception.
  • Suspicion for tonsil tumor. Rare, but this does come up from time to time.

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?

D.

*But I am listed as an external source. Is that cool, or what?

28 Comments

  1. Cap'n Dyke says:

    But th’nuns promised me all th’ice cream I could eat…

  2. Shelbi says:

    My tonsils are still present and accounted for, and doing whatever it is tonsils are supposed to do, I guess.

    I remember a couple of kids in school getting their tonsils out and talking about having a sore throat afterward, and I think my mom got hers out when she was a kid, but then she was a kid in the 50s and 60s, so she may or may not have needed it, right?

    I on the other hand, rather like my tonsils and they don’t bother me much [except when hay fever season rolls around, I do tend to get a couple of those nasty tonsil rocks, eewwwww! But I get rid of ’em, real quick-like.. sorry, I’m channeling a southern Missouri accent today].

  3. Walnut says:

    You can have all the ice cream you can eat, Cap’n. What they don’t tell you is that you won’t want to eat any.

    Shelbi — yeah, hard to say in that era whether it was necessary or not. She might remember enough of her history to reconstruct the decision — for curiosity’s sake only, since it doesn’t much matter now.

  4. Stamper in NV says:

    Did I ever tell you one of my tonsils grew back? To this day, I fear being “put under” (that’s why I’m dragging on the colonoscopy) because they used ether on me, and I can still remember what it felt like to have that cone put over my nose and mouth, and even though I was five when that happened, it’s still one of my strongest memories.

  5. Pat J says:

    I’ve still got my tonsils. No spleen, but tonsils.

    And that Bill Cosby bit (“ICE cream… We’re gonna eat ICE cream”) is one of the funniest things I’ve ever heard, to this day.

    (“When I get my ice cream, I’m not even gonna eat it. I’m gonna smear it all over my body…”)

  6. Walnut says:

    Yup, no matter what y’all might think of Cosby nowadays (and I understand he’s the object of some controversy), he was funny as hell in the 60s.

    Sis, I didn’t know one grew back! That’s all too common, because the docs back then used crappy techniques that left tonsil tissue behind. It’s like a weed in that respect.

  7. noxcat says:

    A friend of mine’s little brother lost his best friend to a botched tonsillectomy. I think they clipped an artery and didn’t catch it.

    I still have mine. As far as I know, I’ve only had tonsillitis once.

  8. Suisan says:

    Surprisingly healthy over here.

    Never had tonsilitis (that I know of), only had strep throat once, and still have the tonsils.

    But when I was a kid, I did do battle with impetigo for what seemed like a year around my lips, down my neck and into an armpit. Truly gross and caused a lot of teasing.

  9. Cap'n Dyke says:

    One o’mine grew back as well…

  10. Cap'n Dyke says:

    One o’mine grew back as well…but I got t’play ‘Hungry, Hungry Hippos’ all I wanted to.

  11. Walnut says:

    noxcat, it’s really rare to even have second hand knowledge of a death. I do, but that’s only because the last ENT in town lost a kid, sad to say.

    Suisan, there’s good medicine for impetigo these days, thank heavens!

    Cap’n, I keep trying to think of something rude to say about “Hungry Hungry Hippos”, and I’m failing miserably. Sorry.

  12. tambo says:

    I started getting chronic throat infections (strep throat with kissing tonsils, no less) when I was about 14. I’d take anti-biotics through the course, the infection would die off, then, a week or so after finishing the keflex, it’d come right back. In 1985, when I was 21, I finally convinced my GP to yank the damn things.

    Surgery sucked, as surgeries are prone to do, and I definitely didn’t want ice cream – Jello wasn’t too bad, though. I was back in college and eating crunchy things like chips and toast in 3 or 4 days. Both tonsils grew back but they’ve given me trouble free service ever since. My only regret is that I didn’t get to keep them. I thought they’d be a cool souvenier.

  13. fiveandfour says:

    No questions – just sayin’ I’m one of those between 30 and 50 who had mine out while a child. I remember beforehand one of the nurses trying to tell me one of the benefits of this surgery I was about to undergo was I’d get to have popsicles when it was all over. All I could think was, “But I don’t even like them that much!” I also remember afterwards that sensation in my throat of what I imagined was cauterized blood, which burned like hell, and that the last thing I wanted to do was swallow anything, much less a stupid popsicle.

    Funny how the whole experience is still so clear for me even though it happened when I was only 5 or 6 years old.

  14. Walnut says:

    Tam, you had an easy course. Some adults take 2 to 4 weeks to get back to solid food! Also, it’s amazing how many people want to keep their tonsils. Ugly buggers (the tonsils, that is).

    fiveandfour, yup, from my discussions with older patients it’s amazing how much this sticks with people.

  15. Erin O'Brien says:

    Listen Hoff:

    erf!

    Now come on over to my place and watch me try to say “neovaginoplasty” with my tonsils firmly in place. It’s more fun.

  16. Jim Donahue says:

    I still have ’em, though I’ve been threatened with having them out over the years.

  17. KariBelle says:

    I have a question. Why is this surgery so much tougher on adults than children? I had my tonsils removed when I was 7. I don’t remember everything about it but I think I was sore for about 3 or four days and then pretty much back to normal. My sister had hers removed at 18 and she was a frickin invalid for the better part of a week (of course she is a total drama queen.)

    I remember my parents really pushing the tonsillectomy and the ENT being reluctant. I am 34 so I guess tonsilectomies were out of vogue at the time. I don’t remember how many sore throats I had, but it seems like the second grade was just one long series of them. The ENT was all gung-ho to remove my adenoids, but didn’t want to touch my tonsils. I woke up on the morning of my scheduled adenoidectomy with a case of..you guessed it..tonsilitis.. My parents would not consent to rescheduling the surgery until he agreed to take the tonsils as well.

  18. Walnut says:

    Erin, I’m downloading as we speak. Um, write.

    Jim: let me at ’em!

    KariBelle, we think there’s an actual change in innervation during adolescence. Either that, or adults are wimps.

  19. keith says:

    Yeah, mine went when I was six. Put me off doctors and hospitals for life…

    Occasionally I work in the hospital where they were snatched, and evem mow I still get a shiver when I pass the ward I was on.

  20. keith says:

    ‘evem mow’?

    Sorry, tonsillectomy-induced finger trouble :-)

  21. Lyvvie says:

    I still have mine. They never gave me a lick of trouble until I started smoking. While I was a smoker I’d have a flare up a few times a year and couple times I got really sick with infected tonsils where they turned black, but no one ever suggested I have them out. I quit smoking three years ago and I’ve never had a problem since.

    I do occasionally get the bastards shooting some kind of high speed acid at the back of my throat that causes me to choke and cough for about ten minutes with tears streaming down my face. Stings like a bitch and I hate when that happens. why does that happen?? Or am I tonsil freak…?

  22. Walnut says:

    Hi Keith! How goes the sequel? I know, I know . . . I should check in at the website.

    Lyvvie, I wouldn’t call you a tonsil freak, but I have NO idea what that could be. You’ve stumped me.

  23. Lyvvie says:

    Great…stumped the expert. I keep thinking about that nasty little dinosaur in Jurrasic Park who spits acid in the man’s face and then eats him. Perhaps I’ve decended from them. All ENTs should beware *wink*

  24. Nurse Angie says:

    Hi. I’m Angela, 34 years old and one of the ‘lucky ones’ that still has my tonsils.. Docs never wanted to take them out when I was little ??? even though they took out my adenoids. What the hell? Anyway, I have them until tomorrow, at least. D-Day: 7/18. They are coming out! I have had recurring tonsilitis the past 3 years and stayed sick so often. Anywho, I have finally had an ENT Doc say ‘oh yes, it is time’. (His comments on exam were: “Oh those are UGGGLY, diseased tonsils” He even ‘shivered’ – and this was once they were looking a tad bit better! LOL) My freakin airway nearly closed up 3 weeks ago with my latest bout of of this mess – those suckers were huge!!! After 2 different antibiotics… it finally cleared it up with 2000mg of Augmentin BID. (My poor kidneys!) So now, tomorrow is the day. Feel funny asking questions but hey, I’m a cardiac nurse so the surgical stuff just isn’t my forte – that whole cliche ‘use it or lose it’ seems fitting here. I can’t remember all that i should do / shouldn’t do post operatively. Any tips? I realize pain is going to be a beotch and the risk of bleeding increases with age … just kind of curious as to what to expect. I do remember not to eat anything red due to mocking bleeds, etc. – As far as pain control, any ideas? ENT guy said he normally gives Tylenol w/ Codeine Elixir – please tell me that will be enough! LOL Just curious guys, any advise / info will be appreciated. Have a good one! Ang

  25. Walnut says:

    Main thing for pain control: drink like a fish. Really really push the fluids. Having a good liquid pain med on hand (such as lortab, which is liquid hydrocodone) helps, too, but if you get dehydrated, NOTHING will help you.

  26. KC says:

    here’s one for ya…. i used to get tonsillitis a lot as a child. my mom asked the dr. if he thought i should have them removed and he said “No, they’ll probably rot out on their own.” What the HECK? I don’t have trouble with tonsillitis as an adult, but I do have crypts in them like crazy so suffer the dreaded tonsil stones. YUCK. Wish I had them out years ago so I wouldn’t have these nasty tonsil stones to deal with.

    What’s up with my doctor saying that my tonsils would rot out on their own?

    This was in the 1970’s by the way.

  27. […] Tonsillectomy redux By Walnut I feel like the publisher of Playboy. While most of my hits come from this cleavage photo or that J-Lo butt photo, occasionally rarely, newcomers are here to read things. In response to last year’s post on tonsillectomy, KC writes, here’s one for ya…. i used to get tonsillitis a lot as a child. my mom asked the dr. if he thought i should have them removed and he said “No, they’ll probably rot out on their own.” What the HECK? I don’t have trouble with tonsillitis as an adult, but I do have crypts in them like crazy so suffer the dreaded tonsil stones. YUCK. Wish I had them out years ago so I wouldn’t have these nasty tonsil stones to deal with. […]