Tonsillectomy redux

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.

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.

KC, I have an answer for you . . . below the fold.

But first, a visual aid.

These are tonsilloliths (tonsil stones):

First, I’d like to address some common misconceptions.

  • Tonsil stones are not “trapped food.” They are a byproduct of all the dead epithelium which sloughs off from the lining of the crypt (the pits that dot tonsils are known as “crypts,” and if you’ve ever smelled a tonsillolith, you’ll know why).
  • The problem will, on rare occasion, resolve without treatment.
  • Antibiotics usually don’t help.
  • Removing a male child’s tonsils will not render him sterile.

Yes, that last one isn’t relevant to the discussion, but it comes up in office discussions more often than you might think.

Another misconception is the idiocy espoused by KC’s doc from the 70s: do nothing, and your tonsils will rot away. Well, not exactly. Under ordinary circumstances, tonsils shrink over time. By adulthood, they may appear to be absent, but trust me, they’re still there. Under no circumstances do they ever “rot away.”

Under less than ordinary circumstances, the tonsils remain chronically infected. Patients with chronic tonsillitis complain of a persistent irritation when they swallow, perhaps even pain, and frequent problems with tonsil stones. These grow slowly until the foreign body sensation becomes so annoying, the person picks out the stones, or pokes them out with a Q-tip or other utensil. Humans are ingenious when it comes to sticking foreign objects in their orifices.

Treatment for these buggers: tonsillectomy is the only sure-fire cure, but some people prefer less drastic measures. Adult tonsillectomy can be very painful, and the risk of hemorrhage is greater in adults than in kids. If you don’t want your tonsils out, you might prefer to blast out the stones with a modified water-pik, which my ENT friend Murray Grossan sells. Or you can try using the enyzmes papain and bromelain, which Dr. Grossan also sells (as Clear-ease — same link). You can bet I would try both products before I ever let anyone take MY tonsils out.

But I keep dodging the question. Why did KC’s doc tell him something so bogus? It’s hard to say. Perhaps he had a patient who had had a bad outcome from a tonsillectomy. Deaths are rare, but not nonexistent. (My town’s previous ENT lost a patient.) Doctors are human; a tragedy like that tends to change your practice of medicine, even if a rational examination of the data would NOT support a change in practice.

When it comes to the young patient, some pediatricians and family practitioners are very anti-surgery. Some docs hang onto their patients for years, treating them with this or that antibiotic rather than asking for a surgical consultation. Occasionally, such a practice is prudent, but all too often, this falls below the standard of care. In my field, we see this not just with recurrent acute tonsillitis patients, but also with kids who have recurrent ear infections, chronic problems with fluid behind the ear drums, and kids who have nasal obstruction. (If the stuffy nose is due to big adenoids, no amount of antihistamines or antibiotics is going to clear things up.)

I don’t have a good explanation for this prejudice. Yes, in the past, some surgeons were too eager to take out tonsils. Nowadays, we have good numerical guidelines to help us make these decisions. Do we have surgeons who are cut-happy, who disregard these guidelines? Probably a few; not many, I suspect. But is that any reason to withhold the option of surgery from a kid who needs it? I don’t think so.

You would think in this Internet-savvy age, fewer parents would get fooled into accepting their kid’s doctor’s word as THE last word. But some folks are like that. Go figure.



  1. shaina says:

    whoa! i get those things. little white bumps (a lot smaller than that icky picture) on the back of my throat that don’t hurt, but i can feel them and they’re annoying. my mom told me they were trapped food! they generally go away after a day or two or three. it’s cool (sorta) to know what they are though…

  2. jm says:

    It’s worth mentioning that, in my personal experience, poking at the tonsils to knock those things loose often leads to bigger crypts. Which leads to more of the things, so more poking… It’s a vicious cycle (unless you’re a tonsillolith).

    That is one nasty freaking tonsillolith up there, by the way. Most of them aren’t so, uh, entrenched.

    (I’m going to have to give the enzyme combo a try, to see if it helps with unpleasantly thick mucous.)

  3. Walnut says:

    Shaina: As long as they don’t get any bigger, you’ll probably do juuuuust fine.

    So, how’s my budding bisexual doing today?

    JM: interesting. I haven’t heard that before!

  4. Stamper in CA says:

    I had my tonsils taken out in the 50’s, and I was told several years ago that one had grown back. Haven’t had a problem with it though.

  5. kate r says:

    GROWN back?
    Hey, Dr. H, are you gonna let your sister talk like that? Can they grow back?

    Did you see that tonsils might be like appendices and might be used to store germs? On purpose?

    I like that theory.

    Did you see that Pete Stark APOLOGIZED?

    I didn’t like that one.

  6. Walnut says:

    What’s wrong with “had grown back,” Kate? Did you want her to say “had grew back”? Odd thing is, they both sound correct to me. *scratches head*

    And YES they can grow back.

    On the Pete Stark apology: yup, that pissed me off. I think he should have said, “Go on, censure me, you assholes.” But he didn’t. I wonder what they threatened him with besides censure?

  7. Lyvvie says:

    I wonder if the occasional feeling of something hitting the back of my throat causing me to choke and cough for hours, then suffer a sore throat the next day, is a tosnilrock being let go. (Can I call them tonsilrocks?)

    Now with Kate’s image of tonsils as germ ridden hoarders, launching rocks down the throat, it’s like a war going on – but against who? Are the tonsils angry with the uvula’s central position and are trying to catapult rocks at it to knock it off? I’d rather not know…

    I wish mine would shrink.

  8. kate r says:

    okay so I didn’t know they could grow back, is all. I’d never snark grammar, nope.

    Just thought it was like regrowing a sinus or something. err? they grow back too?

    Figures that a bit of the body that’s not important can grow back.

  9. sam says:

    Oh, unwanted hairs grow back all the time. I figure a tonsil or two can come back.
    My kids had their adenoids out – doc told me they might come back too.
    I wonder if hair, tonsils, and adenoids come from the same place our reptilian brain came from. Way back in dinosaur land when we were lizards, and our tails grew back when the big bad T rex snapped it off.

  10. Doug! Found this story and instantly thought of you!

    (Inappropriate nasal irrigations – dunno why that would make me think of you…)

  11. Walnut says:

    Reminds me of the ol’ Mexican prison torture: pour some cayenne pepper into a bottle of Coca Cola, shake it up, hold under nose of the poor bastard you’re interrogating.

    I left that blogger a comment telling him the right product to buy.