Indications for a tonsillectomy

A tonsillectomy, the surgical removal of the tonsils, is a common procedure primarily performed to address recurrent infections and obstructive sleep-disordered breathing. Understanding the indications for this surgery is crucial for both patients and healthcare providers, and here to tell us when this operation should be performed is highly renowned consultant ENT and thyroid surgeon, Mr Joseph Sinnott. 

Recurrent tonsillitis

One of the primary reasons for a tonsillectomy is recurrent tonsillitis. A tonsillectomy is recommended for children who experience at least seven episodes of tonsillitis in one year, five episodes per year for two consecutive years, or three episodes per year for three consecutive years. Each episode should be documented with symptoms such as fever, cervical adenopathy, tonsillar exudate, or a positive test for group A beta-hemolytic streptococcus.

Obstructive sleep-disordered breathing

Another significant indication for tonsillectomy is obstructive sleep-disordered breathing (oSDB), which includes conditions like obstructive sleep apnoea (OSA). Enlarged tonsils can obstruct the airway, leading to breathing difficulties during sleep.

This can result in poor sleep quality, behavioural issues, and growth problems in children. Tonsillectomy can alleviate these symptoms by removing the obstruction, thereby improving airflow and sleep quality.

Complications of enlarged tonsils

Enlarged tonsils can also lead to complications such as difficulty swallowing (dysphagia), speech abnormalities, and dental malocclusion. In such cases, a tonsillectomy may be recommended to improve the patient’s quality of life. Additionally, recurrent peritonsillar abscesses, which are collections of pus near the tonsils, can be a reason for surgery if they do not respond to other treatments.

Other Indications

While less common, other indications for tonsillectomy include chronic tonsillitis that does not respond to medical treatment, bleeding from the tonsils, and certain rare diseases of the tonsils. In some cases, tonsillectomy may be considered for poorly validated indications such as halitosis (bad breath), febrile seizures, and psoriasis.