Q: If You Need Your Tonsils, Why Take Them Out?
September 25, 2008
A: Tonsils are part of the immune system, but when they are too large or are prone to frequent infections, then surgical removal is a consideration. One or two infections every year is not too worrisome, but having an infection every month can be debilitating for most people. For many children (and some adults), very large tonsils can lead to breathing problems at night.
More Questions About Tonsils
Q: What are tonsils?
A: Tonsils are paired lymphoid or glandular tissues that sit on the side-walls of your throat just behind your tongue. They are part of a complete circle of lymphoid tissues that is involved in programming your immune system what is foreign and what is self. The adenoids sit in the mid-line at the back of your nose and the lingual tonsils are also in the mid-line at the rear of the tongue, just above the voice box. They are most active from ages 3-5, and this is the time that most problems arise.
Q: Do you need tonsils?
A: Yes, especially when you have an infection. Most of the immune system programming occurs in early childhood. As you get older, the tonsil shrink to a much smaller size in adulthood. However, if there is chronic irritation, such as from allergies, colds or acid reflux, they can remain enlarged. Tonsils and adenoids are only a small part of a much larger system of lymph glands and immune mechanisms.
Q: What happens if my tonsils are too big?
A: Just because your tonsils are big does not mean they have to be removed. If you have no problems, then with time, they should shrink. But if you have signs or symptoms of a sleep-breathing disorder, such as daytime fatigue, poor concentration, memory problems, attention problems, asthma, cough, nasal congestion, or snoring, then they should be looked at by an ear, nose and throat physician. Sometimes I see young children who snore heavily, with severe asthma, attention and behavioral problems, and who are on Ritalin for ADHD. On exam they are found to have very large “kissing” tonsils. Due to the prevalent myths about tonsils and surgery, the parents refuse any form of surgical therapy. They would rather treat the end result of their child’s sleep-breathing problem (asthma, ADHD) with long-term medications, when surgery could be curative. On the flip side, there are also too many people with tonsils that are taken to the operating room prematurely, with no clinical reasoning whatsoever.
Q: Can large tonsils cause snoring?
A: Yes. Anything that narrows the upper airway, from the nose to the voice box, can cause snoring or other breathing problems. In children, large tonsils are a common cause of snoring. Snoring itself in children has been linked to behavioral, memory and concentration problems, asthma, and chronic cough. A significant number of children (and adults) who snore are also found to have obstructive sleep apnea, which can lead to fatigue, depression, high blood pressure, heart disease and many other conditions. It’s also associated with sexual dysfunction and frequent urination at night.
Q: Doesn’t undergoing a tonsillectomy hurt?
A: Yes. But with advances in technology, it doesn’t hurt as much. Traditional tonsillectomy using an electrocautery device will leave you with a very sore throat for 4-7 days. You’ll be on soft or liquid diet until the pain subsides, after which you slowly progress to foods of more solid consistency. The best part is that you can eat lots of ice cream. With newer techniques (such as the Coblator) you’ll have only 2-5 days of pain, with some people not taking any pain medications at all.
Q: What are the potential complications of tonsillectomy?
A: As with any operation, there’s always a very small chance of bleeding or infection. If it occurs, then it will be addressed appropriately. Specific to the procedure, there is a small chance that you may have persistent symptoms even after surgery. There are many reasons for this, including not taking enough tonsil tissues out, or it may be due to something entirely different. Two common reasons include post-nasal drip and laryngopharyngeal reflux disease. There’s also a very small risk to general of complications from anesthesia is lower than being hit by a car.
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29 Responses to “Q: If You Need Your Tonsils, Why Take Them Out?”
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Dr. Park,
I’ve been reading your articles and have been amazed at everything I learned!
I can’t understand why these issues aren’t more aggressively pursued.
I have Ehlers Danlos Syndrome and Chiari Malformation I. I can’t find many Doctors that are able to look at the body as a whole and treat my myriad of symptoms by beginning at the root of the problems.
It would be wonderful if you would be able to help me…?
The laxity in my joints makes my neck so loose that it turns too far when I am sleeping, causing a lot of pain when I wake up.
My jaw also hangs so loosely that it causes terrible TMJ problems. Sometimes I will flex my jaw while I sleep so that it won’t fall to the side, then I wake with horrible jaw and neck pain.
My tongue is huge and my jaw is small. I never thought of how that could affect sleep!!
My kids also have the same problems. My 8 year old still wets the bed and my 20 year old didn’t stop until he was 16.
They both take awhile to wake up fully, but fall asleep easily AND they both sleep with fans in their face. I noticed that when my 8 year old doesn’t have a breeze on her face she grunts, moans and kicks even more frequently through the night. (I thought maybe it worked like a CPAP affect?)
Well, if this is too long, could you maybe just explain any Ehlers Danlos Syndrome – related sleep issues?
Thank you,
Pari Anderson
Ms. Anderson,
Sorry to hear about all your troubles. As far as I know, there isn’t any known strong associations between EDS, CM and obstructive sleep apnea. But micrognathia (small jaws) is described in one subtype of EDS. All these conditions can also overlap with other connective tissue disorders, including Pierre Robin sequence (very underdeveloped jaws). If you haven’t done so already, you may benefit from undergoing a formal sleep study, to more definitively assess your sleep quality as well as how many times you stop breathing every hour. Even if you don’t have EDS and CM, a sleep-breathig problem can cause or aggravate many of the symptoms that you’ve described.
Unfortunately, it sounds like your children may have similar issues. Bedwetting is a common symptom of obstructive sleep apnea, especially in children.
There’s nothing you can do about your anatomy (actually, there is, but you’re not going to like it, and doctors will be reluctant to offer it to you). But what you can change is how well you breathe at night.
I doubt the fan is acting like a CPAP machine—it’s probably more related to temperature regulation. You need to be cooler when sleeping.
Hope this is not too confusing. As you may be aware, it’s a complicated situation.
Dr. Park
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My little boy is almost 5 he was diagnosed with ashma when he was about a year old. The past 4 1/2 months his had a prolong uncontroled cough that makes him gag and have like choking epesoded at night. His ben on steroids, antibiotics and albuterol. He was hospitalized for 13 day (discharged 10-15-08) at the Long beach childrens hospital. It was and has been very frustrating because my son looks fine at the time he has Dr. appointments and during the day time at times. His epesodes are at nigh and some of the pulmonary team would tell me that he was fine but I knew he wasent. They ended up duing a broncoscopy which showed them that he had a lot of inflamation in the lungs and they had to clean his lungs as well. Also, he had a number of test done which show that he has large anoids and large tonsils as well. In the process of the broncoscopy a GI dr also di a PH prove and notised that he has a small hernia in his esophogus, (Sorry, Im not sure of the spelling) and the ph prove showes that he also has some reflex. I was also told by the pulmonologist that he has some fatty cells in his lungs. My son was discharged, he was put on steroids, Qvar, albuterol, Nasolnex, singular, preveset and in an antibiotic. Today is December 6th and my son is still the same. Now I’m being told that he will need surgery and that his nosils and anoids will be removed January 6h and he was also change to Advair HPA 2 puffs 2 x a day and he continues the same. His severe cough that comes in goes worries me. He gets better for 2 or 3 day and he suddenly gets severe coughfing epesodes that scare me specialy at night. Im scared about the surgery and I don’t know if this will help him. I would appreciate a few you can advise me if this is the best thing to do or if his uncontrolable cough can cause any other problems for him. My little Christopher will appreciate if you can help his mommy as Im confused and very scared. Thank you for you time and please excuse all my spelling errors.
Ms. Lopez,
Based on everything you’ve described, undergoing a tonsillectomy and adenoidectomy sounds like a reasonable option. Having very large tonsils and adenoids (especially at this age) can lead to breathing problems at night, leading to acid reflux in the throat, causing inflammation. In children, many ENTs will perform the surgery without undergoing a sleep study to diagnose sleep apnea. If you have any doubts about surgery, you should talk to your doctors about the reason for recommending the surgery. If you’re still not sure, a second opinion with another surgeon is another option. Good luck.
Dr. Park,
My son is going to be 4 year old in Jan 2009. I took him to see ENT because his tonsils are huge. The ENT said it has to be removed because it was so big it is touching each other. In my son case, he does not have a lot of infection nor does he has a problem breathing or eating. His tonsils are huge don’t get me wrong, if you look in his mouth you can see that it ia so big it seems like it is on his tongue. He complain about it a couple of times while sleeping but that is it. Should I take him in for 2nd opinion? His surgery date is Jan 6th. He just had his adenoids out 6 months ago and I don’t want him to go through another surgery if he does ot need it.
Thank you so much,
Anissa
Hi Anissa,
Was there a discussion to take out the tonsils when he had his adenoids taken out? Yes it’s much bigger surgery taking out tonsils, but he would be a great candidate for a Coblation tonsillecomty where 95% of the tonsils is vaporized, without touching the sidewall of the throat. With this technique, pain is much improved and children eat much quicker. Even though it doesn’t seem to bother him now, they will most likely cause problems later on in life, such as learning or behavioral problems, dental and jaw crowding, depression, high blood pressure. His jaw is probably already somewhat narrowed by now.
If his tonsils are as big as you say they are, they are most likely causing breathing problems at night while he’s sleeping. Even with my son who had moderate sized tonsils at age 5, I could see a big difference after the surgery.
Hi;
I m abdul hadi qureshi.
I m putting here a Question about my brother who is having disease of high blood pressure. He got checked from various doctors at hospital in sukkur,sind,pakistan. None of the doctor has diagnosed the symptoms of high blood pressure. His age is 32. But one doctor said that he is having hight blood pressure due to the TONSILS. He got is VMA test but it was fine. Does TONSILS cause the high blood pressure. PLZ kindly do something.
Mr. Qureshi,
If you brother has large tonsils, one possible condition that can cause high blood pressure is obstructive sleep apnea. Usually it’s not just the tonsils but also the tongue that falls back in deep sleep due to muscle relaxation. If he is tired during the day, no matter how long he sleeps, and whether or not he snores, he may want to consider undergoing an overnight sleep study to see if he has obstructive sleep apnea. This is a common condition that is a very common cause of high blood pressure in young adults.
HI
Im 20 years old and since i was little they have told me that my tonsils are to big.
In recent weeks i feel my ears like plugged and a roaring noice. I went to see a doctor and he told me this is due because of my big tonsils, can this be possible? Can big tonsils bring health problems?
Big tonsils can cause a number of health problem from minor ear problems and sinus infections to major problems like obstructive sleep apnea. It’s not only that your tonsils are big, but your jaws are too small.
thank you .. I still have some questions
Can they cause like a certain feeling of fatigue?
Feeling of muscular pain like in my legs?
I feel at time like i want to faint or fall is this because of my ears?
I did a blood test and everything came out normal so i really dont know if what im feeling is just due to the tonsils because the doctor said i had infection on them but i dont have any cough or anything
Not breathing intermittently while sleeping is a good reason for you to be tired during the day. If this is happening long-term, then other neuromuscular problems can occur. Your involuntary nervous system, which regulates blood pressure, will also be affected. No blood test is going to show up anything. It’s not an infection or a biochemical problem. It’s an anatomic problem. Your tonsils are staying enlarged because of your sleep-breathing problem.
Although taking out huge tonsils is generally a good idea if you are symptomatic, don’t count on it completely curing all your problems. Bu definition, you’ll still have remaining small jaws, by definition.
can you still get tonsillitis if you have had them removed
Anne,
Even if you don’t have any tonsils, you can still get an infection of the throat. More often than not, acid reflux is frequently misdiagnosed as a throat infection.
Dr Park,
My daughter turned 4 in Feb 2009. When she was 3 year old, we found she has some hearing loss, we took her to an ENT, where to our surprise he said she had big tonsils and adenoids, and of course hearing loss, and he advised to have her ear tubes and remove tonsils and adenoids at the same time, we were worried about tonsillectomy and opted only for ear tubes. At her 4 year old appointment her pediatrician told that the tonsils are almost touching each other, But she does not have any symptoms which doctor was refering to. she doesnot have throat infections, her snoring got better now, sometimes at night she rolls back and forth, topsy-turvy, but I dont see any breathing gaps, she is active at school, but she eats very slow, cannot swallow like other kids. Please advice us. we are confused whether to relieve her from tonsils or just leave them and avoid risks associated with surgery.
Thank You.
Suma,
In the past, I used to advise parents that a tonsillectomy was not necessary if there were no symptoms. But over the years, I’ve seen many studies as well as my own clinical experiences seeing the long-term consequences of upper-airway obstruction. The problem is, children are very resilient. They will accommodate and adjust to almost anything, unless it too severe. Having problems swallowing could be due to having golf-ball sized tonsils. If her tonsils are causing sleep-breathing problems, then it may also affect jaw and dental development, predisposing to sleep-breathing problems later in life.
Officially, it may be hard to justify taking out tonsils and adenoids in your daughter, but I can tell you from personal experience that taking out my 5 year old son’s moderately enlarged tonsils was well worth it. He wasn’t having any major problems, but what a dramatic improvement afterwards. If there’s any doubt, consider getting a sleep study. If it shows any degree of sleep apnea, it may be justified in going with the surgery.
Dr Park,
Thank You for your response.
I heard the risks like bleeding etc are less in big kids compared to smaller kids, and they can manage pain better. Do you think it is better to wait for couple more years until she is 5 or 6, or it doesn’t matter and doing it right away helps her?
I don’t want to minimize possible complications, but the risk of bleeding is very small, regardless of the surgeon or age of the patient. There are studies suggesting cognitive delay from untreated sleep apnea, so the earlier the better.
wow! thank you for all the info. My son has surgery next month for both tonsils and adnoids.I was very worried about the surgery and even thinking about canceling it. But now after reading everything i feel alot better. And now i see he has almost all the symptoms.
thank you,elizabeth
Great Blog. I am 27 years old and in the past as a child I had tonsilitis over and over again. My tonsils were supposed to be taken out but something happened with my mother’s insurance and the surgery was canceled. From about 16 to 25 I never got sick anymore! I maybe got the flu one time and was healthy as an ox.
My tonsils, however, always remained very large. Then I noticed a small clear bump on my left tonsil. I had it checked out, doctor said it was nothing. A year later it was bigger and developed a white head. It kept filling up with pus, then it would burst I think, go away, then be there again over and over. Antibiotics didnt really seem to do anything to solve it.
The past year now I’ve been getting sick all the time. The bump on my tonsil is now very large and the tonsils are red and angry. Actually it looks like a red vein is on the bump on my tonsil. There are white patches on my soft palate that wont go away (discoloration). I tested positive for Strep B and then got what I think was rhuematic fever (tongue turned white) and experience heart palpitations. (Also: just to be sure, I got an HIV test and I was negative, which is good considering I’m not active) On occassion I could also hear my heart beat in my left ear, and now, seemingly at random, the back top of my throat becomes inflamed and my neck and tonsils ache shortly after.
I was sent to an ENT and he is going to remove my tonsils next week. He is also going to have the tonsils biospied once they’re removed. I’m very nervous about this because I’ve been healthy for so many years and now I feel like Im falling apart.
Can bad tonsils really cause all the problems I’ve been having, and do you think the tonsillectomy is a good idea?
Just nervous, thank you for your time,
Lane.
It sounds like you have recurring cystic infections on one part of your tonsils, which is most likely benign, but it’s part of something else that’s causing your tonsils to become enlarged and inflamed. If they’re that big, then removing them is a good first step. As I mentioned in previous posts, it’s probably aggravating obstructions and arousals, with more stomach juices being suctioned up into your throat, causing more inflammation and swelling. Hopefully, removing your tonsils will get you towards felling better. If not, then there are issues that can be addressed. If you get a chance take a look at my book, which describes my sleep-breathing paradigm, which explains in more detail all the problems that you’re going through. Good luck.
Q. How long do the doctors put u to sleep for when removing your tonsils because I’m kinda scared I might wake up while there taking my tonsils out..
Q. What all do u have to go through when getting your tonsils removed
I have a project to do in school and I need a test that proves you need your tonsils. If you know anything please share ASAP thank you.
Matt, what’s the context of your project? Can you be a bit more specific?
I am 21 yrs old and I have been considering getting my tonsils taken out. When I was younger I was always coughing up little white specs (i now know that they are tonsil stones). I went to the doctor he looked at the tonsils of both me and my younger brother. Told me that it wasn't a big deal and that if anyone was going to have an issue it was my brother. He basically told my mother that I was over exaggerating about my pain levels.
I was about 10 at the time. That summer I had a fever of 106. He told my mom that I probably caught something from camp and just gave me some medicine. I kept complaining about my throat and inner ear. He ignored it. Later on he upped my asthma medicine and yes that did get rid of most of the pain but i always had a runny nose (I'm used to it now). Also from then until about age 17, I lost my voice every year going into springtime. In high school again, I had a fever of about 104. I didn't even tell my doctor. By now, I just gave up on him.
I started with the tonsil stones again when I began college and the school nurse said in plain words. Go to the doctor, get referred, those need to come out. She actually flinched when looking at them. What could have possible been a justifiable reason for my doctor to ignore my initial cries for help? Now I'm not covered for the procedure… what can I do about this? By the way, my brother has never complained about his tonsils.
Bri,
It sounds like you have significant tonsil issues, and you need to address it definitively. What do you mean that you're not covered for the procedure? Do you not have insurance? It sounds like you may also have a possible sleep-breathing problem, which can cause your tonsils to become large. If this is the case, taking out your tonsils may help you feel better, but it won't take care of the problem completely.
Has anyone ever heard that when you get in your 50's and 60's your tonsils should of dried up and went away and Has anyone heard of problem with the tonsils if they haven't went away.