What Everyone Should Know About Tonsillectomy

September 16, 2009

Tonsils are one of the most misunderstood structures in the throat, not only by patients, but by many doctors as well. Traditional teaching states that tonsils are glands in the throat that help to fight infection. Because they are blamed for most cases of repeated throat infections, tonsillectomy is one of the most commonly performed operations in the United States. As I’ll reveal in the remainder of this article, many tonsillectomies today are being performed unnecessarily. Simultaneously, there are too many tonsils still left in place when in fact they should be removed. Here’s the reason why.


What Are Tonsils?

Before I can clear up the contradictory statement above, I must first explain what tonsils are and what they do to merit removal, if at all.

Tonsils are lymphoid tissue, like glands in your neck, armpits or groins. They are part of the immune system and are involved in learning what’s foreign and helping to make antibodies to help fight off infections. In young children, lymphoid tissues are very sensitive and can become greatly enlarged even after a simple cold or infection. If you have young children, I’m sure you’re familiar with their complaints of sore throats whenever they have colds.

It’s also important to note, however, that tonsils can swell up not only after viral or bacterial infections, but also from allergies and acid reflux. Any degree of irritation or inflammation can cause the tissues to swell up. This is normal, and will happen to various degrees in people after any type of infection, irritation or inflammation. As such, not all complaints of a sore throat are viral or bacterial in origin. There are many factors for an enflamed tonsil—this is the reason why antibiotics are not as effective in curing sore throats.

What Do Tonsils Do?

Tonsils are part of Waldeyer’s ring, which is a complete circle of lymphoid tissue that is made up of both tonsils in the side walls of your throat, the adenoids, which are in the midline back of your nose, and your lingual tonsil, which is located at the base of your tongue in the midline. In some cases, you’ll see small connections between all four glands, forming a complete circle. Anything that you breathe in or swallow has to go through this “ring”, so that the body can learn what’s coming into the body. This process is most active around ages 3 to 6.

It’s common knowledge what happens when your tonsils become infected: your throat hurts, you have a fever, your neck glands hurt (lymphoid glands that drain your tonsils), and you don’t sleep well. Anything from simple cold viruses to bacteria, and even allergies can cause your tonsils to swell. Streptococcal bacteria are very common, but there’s one particular strain called Group A beta-Hemolytic Streptococcus (GABHS) that tested for and treated, since toxins produced by this strain can potentially damage the heart or the kidneys. In theory, non-GABHS bacteria can also give you similar miserable symptoms, but if severe, doctors will typically give you oral antibiotics, which will make you feel better in most cases.

When Tonsils Mean More Than Sore Throats

But there’s one more variable that occurs during a tonsil infection that’s usually not appreciated—the fact that the tonsil can swell significantly. As I’ve mentioned in my book, Sleep, Interrupted, and in other related articles, humans have relatively narrowed upper airway breathing passageways to begin with, and even mild inflammation and swelling in the throat can narrow this airway even further, almost always leading to various degrees of obstruction and arousal from sleep.

What this means is that, your enlarged tonsils not only affect how sore your throat feels, they can also cause you to sleep poorly. Here’s the reason why.

If the inflammation and swelling caused by an infected tonsil causes your airway to narrow or obstruct entirely and this in turn, causes you to stop breathing, you’ll either wake up to light sleep immediately, or stop breathing for 10 seconds or longer and then wake up. In this latter situation, you would have experienced what’s called an “apnea” or “loss of breath." Most people will have lots of short obstructions and arousals—this is why if you have a simple cold, you won’t sleep as well, since you’ll toss and turn more often than normal. Luckily, in most situations, once the infection goes away, you’ll return to normal.

However, there’s one more piece to the puzzle that can prevent you from feeling better: This is the piece that many patients and even many doctors overlook as well. If you stop breathing, even temporarily, you’ll create a vacuum effect in your throat, where your stomach juices literally get suctioned up into your throat. Small amounts of acid, bile, digestive enzymes, and bacteria can cause your tonsils to stay swollen, aggravating this vicious process. Even worse, your stomach juices can then travel up into your nose or down into your lungs, wreaking more havoc. Add to this a stuffy nose, then another vacuum effect is created downstream, and the tongue can fall back even further.

Certain viruses such as the Epstein-Barr virus (that causes mononucleosis) attack lymphoid tissues specifically, and as a result, keeps the tonsils abnormally large.

This is one reason why patients with this condition have prolonged bouts of chronic fatigue.

Misleading Throat Pain

Most people (and doctors) naturally assume that if your throat hurts, it means that you have a throat infection. If the antibiotics that you’re given works, then it means that it was an infection after all, right? Not necessarily. One of the most commonly prescribed oral antibiotics is called azithromycin (brand name is Z-Pak), which is a convenient 5 day course. One of the lesser known beneficial side effects from this medications is that it empties your stomach faster. So by keeping your stomach juices from coming up, your throat will feel better relatively quickly, sometimes working faster than what you’d expect from typical antibiotics. The problem with this medication is that it only works sometimes in some people, and the effect begins to wear off after a few doses.

Notice how for many people, cold and sinus “infections” always start in the throat, with a tickling, sore throat, mucous accumulation, hoarseness, cough and post-nasal drip, all of which are symptoms of throat acid reflux. Then as swelling in the throat worsens, more and more juices are brought up into the throat, causing more swelling. If you have larger than normal tonsils, then the narrowing in your throat will be more severe and you’ll stop breathing more and more often. If this process continues, the end result will be the classic bronchitis or sinusitis.

Normally, tonsils shrink down to very small glands by the time you’re an adult, but for some people, they stay enlarged. One possible explanation is that they are subjected to repeated bouts of inflammation from stomach juices, and the large tonsils can bring up more stomach juices.

A Rite of Passage?

In the 50s to 70s, it was a given that if you had tonsils, they were removed. The number of tonsillectomies has dropped significantly since then, but more recently, it’s climbing back up. The main reason for tonsillectomy back then was for recurrent infections, but now obstructed breathing is the most common indication.

We now know that even mild degrees of sleep-breathing problems in children can cause a wide range of problems, from bed-wetting and ADHD to behavioral issues and asthma.

A recent study published in the journal Pediatrics showed that about 50% of children with ADHD could be cured with adenotonsillectomy (this is when you remove both the adenoids and tonsils). Countless studies report significant improvement in children’s cognitive, behavioral, memory and sustained attention scores, after tonsillectomy. Even my son Jonas had dramatic improvements after his tonsillectomy.

Not all children with ADHD have a sleep-breathing disorder, but since it’s such a common condition that can be treated, it’s worthwhile to at least consider it if your child has ADHD. People are always asking why a stimulant medication such as Ritalin helps children focus and remain calmer. The answer is that they’re sleepy.

Poor quality of sleep can also heighten a child’s senses and cause abnormalities in their involuntary nervous system, making him or her have balance problems or become hypersensitive to certain sensory forms of input, such as touch, sounds or odors.

The Truth About Tonsillectomy

Unfortunately, not all children who undergo tonsillectomy improve. A recent meta-analysis combining multiple tonsillectomy studies showed that overall, about 2/3 had significant benefit. Some children do somewhat well, but not as well as some others. The explanation here is that the tonsils are not the only part of the equation. By definition, if your tonsils are large, then your jaws will be smaller. I’ve mentioned in my book, Sleep, Interrupted that modern humans have smaller jaws than our ancestors even a few hundred years back, mainly due to a change in our diets (from organic foods off the land or oceans to processed foods with refined sugars). Bottle-feeding is another modern Western phenomenon that has been shown to aggravate this process. If you have smaller jaws to begin with, you’ll have more inflammation in your throat via the mechanism that I described earlier, which will predispose your tonsils to become enlarged. Having large tonsils will cause more obstructions, causing a vacuum effect, which can also narrow your jaws, especially since a young child’s jaws are relatively soft and malleable.

A recent study showed that compared with tonsillectomy alone, orthodontic palatal expansion was equally effective. When both procedures were performed, the results were additive. This study goes to show that dental and orthodontic issues may be important considerations long before parents consider braces for their teens.

Outgrowing Your Tonsils

Some of you may be asking, if the tonsils are an important part of the immune system, why take them out? Most of the early education of your immune system occurs before age 6. Either during this time, or even long afterwards, if your tonsils are so large that they literally obstruct your breathing at night, then wouldn’t you think that this is a more important issue that needs to be dealt with? Doctors will also say that children will “grow out of it.” Yes, in most cases, they will, but based on all the recent studies, there’s plenty of evidence that before they “grow out of it,” there can be potential long-term consequences, including your risk for developing obstructive sleep apnea, heart disease, heart attack and stroke later in life.

I once heard a presentation at a national sleep meeting, where they showed children who underwent tonsillectomies all improved dramatically. The disturbing finding from this study was the fact that compared with children who did not have sleep-breathing issues, the children who underwent tonsillectomies never fully caught up to the control children in terms of cognitive and behavioral measures. What this implies is that there’s some degree of permanent brain damage. Fortunately, children’s brains are highly adaptable, and can compensate very well.

By no means am I advocating routine tonsillectomies for all children. But if your child has any of the issues that I talked about in this article, or if you’re on the fence about whether or not your child should undergo some type of treatment, these issues are definitely worth thinking about.

154 Responses to “What Everyone Should Know About Tonsillectomy”

  1. Michael K. Wilkerson DDS. MS. on September 22nd, 2009 7:59 pm

    Dr. Park,
    Thanks for a wonderful article about adenotosillectomy. I agree that more children today need their tonsila and adenoids removed due to sleep distrubed breathing issues. Other big concerns of mine are mouth breathing, lip apart oral posture, and allergies. If any of these are present as well , the problem is more complex.
    I have referred many patients to my local ENT’s for T/A. As you are aware, mouthbreathing will lead to a vertical facial growth pattern. This leads to an increased anterior face height. Many of the kids I see on a daily basis have a habitual open mouth posture, and other related problems, that seem to go unnoticed by the Pediatricians.
    But, how do we get the kids to breath through their nose again after the posterior airway space is clear? This has been a tough issue to deal with. Some kids will spontaneously breath thru their nose, which other persist in mouthbreathing? What can we do to help them breath normally, so their face can grow normally?

    Sincerely Michael K. Willkerson DDS., MS.

  2. Steven Park on September 23rd, 2009 6:05 am

    Dr. Wilkerson,

    You’re right. Mouth breathing is a common problem even after tonsils and adenoids are removed. If you haven’t listened to my interview with Dr. Bill Hang last month, I strongly urge you to do so. We talk about pediatric orthodontic issues and sleep apnea and he goes into some detail about what to do, as well as some good resources regarding myofacial exercises. Email me at doctorpark@doctorstevenpark.com and I’ll send you the link to the recording. You may also want to contact Dr. Hang yourself at facefocused.com. Let him know that I referred you. As you’ll hear from his talk, taking out tonsils and expanding the palate is a good “start.”

  3. Andrew Porter on October 27th, 2009 12:16 am


    Having been through a tonsillectomy at age 22 years, the process was extremely painful, and yet the medical doctor concerned simply decided that rather than determining why I had repeated tonsillitis, removing my tonsils was the only option. However, post surgery, I developed a throat infection, or to be precise an upper respiratory infection suspected as being caused by a Streptococcal bacteria and, nearly 25 years later, I remain ill. Tests show that I have a chronic Streptococcal bacterial infection, suspected as being protected from my immune system and antibiotics through the formation of a bio film. In other words, my tonsillectomy hit my immune system, exposed nerves in my throat, and presented a serious risk of developing post surgical infection, which is what happened.

    The diagnosis is M.E., often called C.F.S, but as very recent tests show that 97% of those with M.E. have a chronic Retoviral infection, albeit not HIV, means that quite clearly, as in my case, removing my tonsils did not deal with the reason why I kept getting infections in my throat area, removed a defence barrier, and made my health considerably worse, not better.

    The golden rule must be to fully understand the problem before pursuing a solution, as simply tackling the problem based upon assumptions can cause considerable damage rather than dealing with the underlying problem.

  4. Maryanne on March 18th, 2010 8:23 am

    our nearly 7 yo has snored since birth — after switching to an all natural, no processed food diet her health has been fantastic…no ear infections, minimal colds and generally ridiculously healthy in comparison to her peer…but she still snores only less so.  our dentist recommends tonsil and adenoids removed as her adenioids are quite large…also starting to have the elongated face…it is not visible to me but to them.
    basically he did a scan and it is limiting her breathing capacity..the operation seems like an obvious choice but can you recommend palate expansion options?  she has a t4k myobrace and her teeth are coming in quite crowded.
    thanks!  Maryanne

  5. Steven Park on March 18th, 2010 9:04 am

    Sounds like you have a reasonable plan. I do agree that your daughter will probably need both adenotonsillectomy as well as palatal expansion. A recent Stanford study showed that undergoing both procedures had a additive effect. I can’t recommend any one palatal expansion system, as that’s’ a personal choice made by dentists that perform these procedures. Did you get a chance to listen to my interview with Dr. Bill Hang?

  6. Patrick Ricardson on October 3rd, 2010 6:43 pm

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  7. Steven Park on October 3rd, 2010 7:08 pm

    Mr. Ricardson,

    Thanks. To subscribe to my RSS feeds, go to the orange RSS feed button/link in the upper right corner or my site. I have other options on the right side as you scroll down mid-way.

  8. louis on December 13th, 2010 5:46 am

    my girlfriend has this similar Tonsillectomy.
    she is 47 years of age.
    her fear is, the danger of having her tonsils removed because of her age
    how dangerous could it be for her.
    we need more opinions

    cheers and hope some of you could give out some information

  9. Steven Park on December 13th, 2010 9:57 am


    The more important question is the reason why her tonsils need to be taken out. You have to weight the benefits versus the risks. Age really has nothing to do with risks.

  10. Mary on February 18th, 2011 12:46 pm

    I am over 50+ years old and I have a problem with my tonsils swelling and snoring. I have notice that when I eat nuts my tonsils tend to swell more. Do you think this could be an allergic reactions to nuts at times?

  11. Steven Park on February 18th, 2011 1:16 pm


    An allergic response is certainly possible, but sometimes small nuts can get trapped in small spaces inside the tonsils. If you’re not sure, you can see an ENT doctor in your area to make sure.

  12. raya on February 26th, 2011 10:13 am

    Dear Docotrs

    My child is just 3 years old. He is suffering from a repeated throut infection and he had to used 8 times antibiotics during the last 9 months. This includs strong ones by injection for five days when we noticed a swolen glands in his nick from outside in both sides. in the last two months he used four different types of antipiotic. He has enlarged tonsils and large adenoids which caused difficult breathing during his illness and he mostly breath from his mouth. the ENT doctors advised to remove his tonsils and adenoids and the pediatrics advise not to do so in such age and they keep prescriping antibiotics. My child ammunity seystem seems very week and he get sick easly. his hemoglobin is only 11.6 though he takes iron sublement and his overall health seems week though he takes vitamins sublimints since he was a baby. I am afraid his ammunity system is week and this is why he has an enlarged tonsils even if they are not infected.
    I will be greatful if you kindly advise whether I shoule remove his tonsils or not in sutch age and if so, do I need to take any precautions to improve his health before the operation. Many thanks

  13. Steven Park on February 26th, 2011 1:29 pm

    There are different philosophies by different specialists on the right age for adenotonsillectomy. He has large tonsils and adenoids due to inflammation from breathing pauses and reflux, which causes his tonsils to stay big. Not breathing properly can cause physical, cognitive and developmental delays. A 3 year old is not too young for surgery.

  14. Wendy on August 5th, 2011 6:23 pm

    My 7 year old has been diagnosed with PANDAS. We did not know about this, or have clearly documented strep infections, although my other 3 kids did, and 2 oldest had T&A. Our dr. wants us to have her tonsils out ( adenoids were out at age 5.5), in case she is harboring strep in tonsils. My fear is in what you stated: “the tonsils are part of the immune system and are involved in learning what’s foreign and helping to make antibodies to help fight off infections.” PANDAS is an autoimmune response to strep, where antibodies to strep are made erroneously by the immune system, and start to cause inflammation in the basal ganglia. I have heard of kids developing PANDAS AFTER T&A. Can you explain anything about this. I had thought T&A might help, but wouldn’t hurt. But now, with the autoimmune issue of it, and Tonsils being part of immune fighters, I wonder. Thanks.

  15. Danielle on January 23rd, 2012 2:13 pm

    I know this article is a few years old, but it all falls inline with what my son (who just turned 3) is experiencing. My ENT says he won’t do a tonsillectomy for a child under 4 because it’s too dangerous. I feel completely helpless at this point and don’t know where to turn to next. My son wakes up constantly during the night due to sleep apnea. His tonsils are huge. Even a minor irritation compounds his problems. Today my sitter had me come pick him up because she was so freaked out by it during his nap and she said his mouth was turning blue as he was trying to catch a breath. I relayed all this the ENT nurse today – we have an appointment this afternoon, but she said there’s probably nothing they can do for him and they won’t do a tonsillectomy because he’s under the age of 4. My worry is also that he already is a year to 6 months behind cognitively from where my oldest son was at this age. He barely puts 3 words together in a sentence, doesn’t completely form most of his words and is sleepy and/or irritable throughout the day. I’m at the mercy of their willingness to do something about this. We’re going to another ENT on Friday for a second opinion if nothing comes out of our appointment today. Is there any venue to find doctors here in California that don’t have this ‘not if under the age of 4’ policy?

  16. Veronica modi on February 9th, 2012 4:21 am

    My daughter 5 has snoring problem during the night ,she does not wake up on her sleep ,but if given alergy drugs the snoring goes away only to come back again after a while.My worry is that she cannot be on drugs on a daily basis .what should i do

  17. Steven Park on February 9th, 2012 6:58 am

    Ms. Modi, it sounds like you may need to have your daughter see an ENT doctor to more definitively address her nasal congestion issue that is aggravated by allergies. Good luck.

  18. Anna on March 11th, 2012 8:42 am

    My son has follicular tonsilitis.
    Many have advised us to approach ayurvedic doctors for treatment
    I have reservations about this
    My child had high fever for two days inspite of the antibiotics.
    I just dont want to take a risk with respect to his health.

  19. akin kayode on April 9th, 2012 7:10 pm

    Dear Dr Park,
    i have found your write up very enlightening and informative. however i’m in a terrible turmoil over what to do. i’m 47 i’m a singer and for the last four years i have been experiencing insistent inflammation of my throat (tonsils) worsened by the frequent appearance of white smelly pellets. when i go to hot climates it worsens thus my job becomes very painful. my fear is the period of recovery with relation to my age and the effect it would have on my voice. thanks once again

  20. dr.priti yadav on April 19th, 2012 5:47 am

    i am 34 yr old suffering from chronic tonsillitis since last 9 yrs. i have repeated bouts of infection that hampers my quality of life. i am also planning my first pregnancy . iwant to know whether tonsillectomy will help me at this stage?

  21. Louise on May 19th, 2012 9:14 pm

    My 19 year old daughter is a runner at a D1 school. Her coach had her see an ENT due to repeated tonsillitis (2-3 times/year) – who suggested she have her tonsils removed. Her coach has now told her she needs to get this done and the only available time is during the school year – after track season. I’m concerned about the actual need for this procedure, and if she goes forward, her recovery while she’s away at school. Would you suggest a second opinion from an ENT, or will most of them suggest tonsillectomy? (her tonsils have always been very large and grooved – so I’m guessing this will be no small procedure for her). thanks

  22. Snark on June 7th, 2012 7:59 pm

    I, and my five siblings, had our tonsils removed in the 70s. Each of us have struggled with physical issues- mostly auto-immune dysfunction/disease, including Myasthenia gravis, ME/Chronic Fatigue Syndrome (http://www.prohealth.com/me-cfs/me-chronic-fatigue-syndrome-basics.cfm), etc. Now I’m having cardiac issues (after years of meditation, yoga and eating healthfully). I would strongly urge parents to read medical articles on the surgery and resultant physical issues (including effects on metabolism/insulin and the heart). So sad to be 45 and so sick.

  23. kimberly on June 13th, 2012 10:41 pm

    My throat has been giving me so many problems. And my throat is so puffy feels like it could close up any min… everyone says I need my tonsil out, but reading on here its just gonna cause more problems if I do…don’t know wat to do..

  24. Madelin on June 22nd, 2012 10:05 am

    Hi my 5 year old son has had two sleep studies, and both came out to be that he does have sleep apnea. he snores but at times only, now he started to sleep with his mouth open. He does have allergies and acid reflux. he is to have surgery next month for a T&A. I just dont want him to haVe surgery unless he really needs it due to the fact that this is going to be his fourth surgery. Any advise please. Thank u

  25. Madelin on June 22nd, 2012 10:13 am

    sorry his tonsils are a little large. He moves when he is sleeping but I dont think hw wakes up due to that but to go into my bed.

  26. Abbi on July 16th, 2012 6:28 am

    My 2yr old had her tonsils and adenoids removed however she still snotes, not as bad and mainly when she has a cold, is this normal?

  27. Steven Park on July 16th, 2012 6:35 am


    It’s always a good idea to treat obstructive sleep apnea, no matter how minor. Even small amounts of sleep-disordered breathing has been found to have detrimental effects on the child’s developing brain. Tonsillectomy is the best option for children, but unfortunately, it’s not perfect. About 1/3 of children will have residual sleep apnea. In this case, it’s usually due to smaller jaws and a large tongue. Palatal expansion and orofacial myology are other additional options.

  28. Brittany on July 18th, 2012 12:49 pm

    Dr Park,
    When I was 19, I had my tonsils out due to constant and severe strep. At 20 I was diagnosed with Ulcerative Colitis. I take medication that lowers my immune system, and I am getting strep just about every other month. I am now 32 and when I look in my throat, it looks as though my right tonsil has grown back. When I had the surgery at 19, I remember the Dr saying that I had a lot of scar tissue in the back of my throat.
    Do you think having them out again could be beneficial?

  29. Amanda on August 22nd, 2012 7:20 am

    My son is 4yrs old. He has bad allergies. His tonsils keep swelling up. He wakes up so many times in the night crying. He tells me his mouth hurts. I don’t know what to do he is so miserable. He snores alot.he only breaths through his nose. Please help me!

  30. Steven Park on August 23rd, 2012 9:02 pm


    You should have your son see the pediatrician or an ENT specialist to address his nasal congestion. I did an interview with an orthodontist about nasal congestion last night. Good luck.

  31. Katrina on September 6th, 2012 7:36 am

    Dr park,
    My son is 20months and had suffered from tonsillitis since 3months. He has been a terrible sleeper since birth, crying most of the night from what I recently believe is from reflux. He also sleeps with his mouth open and has a runny nose 24/7. He is yet to be diagnosed with anything and I am so worried about him. Any advice would be greatly welcomed.
    Thank you. Katrina, sleep deprived.

  32. Steven Park on September 6th, 2012 9:04 pm


    I can’t say without examining him, but it sounds like you may need to take him to an otolaryngologist to see what can be done to help him breathe and sleep better. Good luck.

  33. Donna on September 6th, 2012 10:25 pm

    we have had 2 young adults and 1 child 30 months old all have their tonsils out with in 4 months . Now our 4 yr. old child needs her”s out. Is it possible that is a family related issue?

  34. Steven Park on September 6th, 2012 10:28 pm


    It can definitely run in families. You inherit your parent’s genes, and therefore their anatomy as well.

  35. Suzan on September 27th, 2012 9:25 pm

    Very informative site Dr Park. I would love to know if repeated bad bouts of tonsilitis could have harmed my health? I had it all my life, four or five times a year. I was extremely ill but the doctors refused to take them out. Hence I was on penicillin many times a year up to the age of 22 when I developed Steven Johnsons syndrome. After that it was erythomycin and doctors in the US said I should have them out when I got ill over there. On return to the UK the doctors refused to take them out. the infections continued, I got weaker and more ill and developed heart palpitations. Eventually I got diagnosed with quincy throat and put on drips for two weeks and they finally agreed to take them out. But now even twelve years later I still feel weak and get ill a lot. Could these many many years of being so ill have weakened me or my immunity somehow?

  36. Steven Park on September 27th, 2012 9:34 pm


    In most cases people feel better after having their tonsils out, but sometimes, not at all. In general, tonsil infections are only a small part of the big picture. However, since they’re the most visible, it’s usually addressed first (but not in your case). If you read my articles on sleep, breathing and even the articles on reflux, it may give you some clues about some of the other causes for your chronic illness. Good luck.

  37. Jaclyn on September 28th, 2012 3:19 pm

    Hello Dr. Park,

    I’ve recently discovered that I have very porous tonsils and that they accumulate tonsil stones. I’ve only found one stone in each so far. There really isn’t consistent information on tonsil stones and it sounds like they can be caused by a numerous number of things (allergy, runny nose, dairy, dirty mouth). I’m considering getting my tonsil stones removed. Should I fear the tonsil stones returning? Are they dangerous?

    Thank you very much for your advice,


  38. Steven Park on September 30th, 2012 6:30 am


    In general, tonsils stones are formed when food particles get trapped in small spaces in or around your tonsils. They are not life-threatening, but very annoying. Tonsillectomy is always an option. Risk of recurrence is very small, although not impossible. Good luck.

  39. Katie on October 4th, 2012 4:30 pm

    Hi Dr. Park,

    I was recently told by my ENT that I need my lingual tonsils removed because my right lingual tonsil is slightly larger than my left, and I also have a swollen lymph node on the right side of my neck. This seems like a pretty intense procedure (I am 24 yrs old); should I get a second opinion? Or is this procedure pretty routine? Thank you very much!


  40. Steven Park on October 4th, 2012 10:12 pm


    I can’t say for sure without examining you in person, but if removing large lingual tonsils can help improve breathing during sleep.

  41. Bianca on October 8th, 2012 3:45 am

    I have a 4 year old daugter when her tonsils starts she always snors than she got a high fever and cannot eat and she is shiffering and sweating and just sleepy.My 1year and 9months baby also got tonsils when she gets sick her tempreture got so high that she always gets fever fits and im very scared I feel only If i remove them they wont get sick again please help. despiret mother

  42. Ugo on November 14th, 2012 3:04 pm

    Hi Dr.Park,

    My 16 month old son is scheduled to have an adenoidtonsillectomy and I am worried for two reasons- he is too young and his symptoms aren’t severe. He was born 6 weeks early but has caught up.
    He snores only very lightly and you can’t hear him outside the bedroom door. He has his mouth open occasionally but not always. He used to reposition himself at night frequently but he doesn’t anymore. He used to have recurrent ear infections but his last episode was in June. He has runny nose which can come out greenish but again this has lessened somewhat.
    He hasn’t started walking independently but cruises holding furniture or his walker. He is doing well weight wise about 75th percentile for age group. He is 95th percentile for height. He sleeps through the night from 7pm until 6:30-7pm. He also naps during the day for 2 hours. He eats everything and swallows fine. He says a few words like daddy, mama, nana, no. He still dribbles though.
    I would like to wait until he’s about 3 years. What do you think?

  43. Steven Park on November 14th, 2012 10:50 pm


    I can’t say anything definitive without examining your son, but any degree of snoring as an infant/toddler has been shown to increase one’s risk of developmental problems later in childhood. If there’s any doubt about the procedure, a sleep study is a consideration to guide you and your doctor in whether or not to do surgery. Good luck.

  44. Audrey on December 2nd, 2012 2:11 pm

    Hi Dr. Park,
    I am 25 years old and will be seeing my family doctor soon to discuss my tonsil problems. As a child I had tubes in and out of my ears because of multiple ear infections. I have always been a mouth breather and have been noticing within the last 2-3 years or so always seen to be getting sick or getting whatever cold is going around. I had strep throat 2 times in one month, and just recently laryngitis 2 times in one month. I have also had quite a few sinus infections in my life and when I do get sick it seems to stick in my sinuses for a long time.This last time being sick has been going on for over 2 weeks now and just recently took a look down my throat to see that my tonsils have taken over my throat and are huge, especially the right one. I can see crevasses in my tonsil where there is white stuff, possibly food stuck in them? With this cold I am getting over I have been having quite a bad cough and waking up at night, but I find with my tonsils being so enlarged cause my to choke when I am coughing. With them being so large right now, I have not had a good nights’ sleep in about a week, getting up a few times a night. I have read and heard that adult tonsillectomies can come with many complications and it does not out-weigh the issues at hand. I am not sure if I should see a specialist or worry about it at all, but I am sick of always being sick. Hoping for some advice, thanks!

  45. Steven Park on December 3rd, 2012 12:37 pm


    Taking out our tonsils may help some of your problems, but it’s not expected to cure all your problems. You’ll have to be seen by an otolaryngologist to determine if you’re a candidate for surgery. Ultimately, it’s your jaw structure and anatomy that’s causing all your problems (please read my other articles or my book for more information). However, taking out your tonsils can be a good start.

  46. Steven Park on December 3rd, 2012 12:38 pm


    You should consider taking your children to see your local ENT doctor.

  47. amy on December 5th, 2012 1:31 am

    Hi Dr! I caught tonsillitis from my 5 year old 3 days ago bit for the last 2 nights I’ve been waking around every hour with really bad acid. so bad that i vomited thisorning as a result. Is this normal?

  48. Stephanie on December 6th, 2012 12:57 pm

    Dear Dr. Park, My son is 6 and his ENT has recommended taking out his adenoid, his tonsils are ok at this point. I am so afraid to have the adenoid removed because I fear that his immune system will weaken. I worry that with a weakened immune system that he will be more prone to disease. I prefer a holistic approach over surgery, but I am concerned that will not work or may take too long. His is having some hearing problems, but is doing well in school. Will the tonsils be over-taxed if the adenoid is removed? Does the tissue in the adenoid function exactly the same as the tissue in the tonsils so that perhaps the tonsils will make up the slack of no adenoid? Will the adenoid function properly if it is only partially removed?

  49. Steven Park on December 6th, 2012 8:31 pm


    Tonsils and adenoids have their role in immune system development, but when they’re too big, they can block breathing during the day and at night, when it can lower your child’s levels of oxygen to dangerous levels. Plus mouth breathing can change your child’s facial growth and development, predisposing to a number of detrimental health conditions. There are non-surgical ways of treating these conditions that can work in some cases, but to date none are proven to be as effective as surgical therapy. Either way, talk with your doctor about this important decision. Good luck.

  50. Steven Park on December 6th, 2012 8:32 pm

    Amy, it sounds like you may have caught a viral or bacterial infection, which should go away within a few days in most cases. You should see your doctor if it does not improve after a few more days.

  51. Nikia Carter on December 11th, 2012 9:46 pm

    Hi Sir I just found your site and its very informative. My question is that I have been suffering from tonsil stones for about the past 10 yrs. I have been to a couple of ENT’s with no help at all. ( They have all said to 1. Rinse after every meal, 2. They are nothing to worry about, 3. Just pick them out, 4. Gargle with Dr.So and So These stones are sometimes very large and smell terrible. I usually end up with scratches,and bleeding from my tonsils from where I have been trying to squeeze or pop the stones out. I don’t think you can imagine giving a interview or team meeting with these things in the back of your throat. The first misconception is that you didn’t brush your teeth this morning because of the smell. I feel as if there is always something sticking in my throat and my gag reflex is 0% One tonsil is larger than the other and often, if I do catch a cold I get painful sore throat. How can I go about expressing my concerns to an ENT and get result? I have sang the same story I am telling in this post to other ENT’s but have found no relief. Please let me know your thoughts.

  52. Arjun on December 15th, 2012 2:33 am

    Dr, i ve remove my tonsill a year ago, but when i eat chilly and and hot spicies my heart beats more and causes faint, i ve checked my bp it’s also normal, i want to know that why i could not eat too hot, and the cause of faint

  53. Arjun on December 17th, 2012 9:19 pm


  54. Misty on December 22nd, 2012 3:43 pm

    At age 4, my son, had his tonsils and adenoids removed due to recurrent throat infections and enlarged tonsils that were causing breathing issues. It’s been six months since the procedure and he has had 3 throat infections, strep, and tonsillitis. Is this normal or should I be concerned???

  55. Suzanne Shelain on December 23rd, 2012 7:11 pm

    Dr. Park,

    My son is 5 years old and is scheduled to have his adenoids and tonsils removed 12/27/12. All day yesterday and today he has had a pretty continuous cough, so we went to the walk in clinic. He has previously been on albuterol via nebulizer, and the Dr. prescribed that yet again today. Additionally, because the cough was a little more “phlegmy” than his normal constant dry cough, she prescribed Azithromycin. I asked if taking this would effect his ability to still have surgery on the 27th, and she said she did not think so, but to make sure to disclose it. As we are traveling from Rockford Il to Madison WI for the surgery, and really hoping to get it in before the end of the year, I wanted to do a little additional research. I saw on the paperwork from the pharmacy, it states in caps “BEFORE YOU HAVE ANY MEDICAL OR DENTAL TREATMENTS, EMERGENCY CARE, OR SURGERY, TELL THE DOCTOR OR DENTIST YOU ARE USING THIS MEDICATION.” Do you think I should just do the albuterol and hold off on the z pack? Is there a possibility the surgery will be delayed if we do the z-pack? I would appreciate any advise, as the medical center where he will have his procedure is closed until the 26th. Thank you!

  56. Steven Park on December 23rd, 2012 9:06 pm

    Misty, taking out the tonsils and adenoids alone do not guarantee that infections will go away. There are a number of reasons why this can occur. I recommend you speak to your ENT surgeon about your son. Good luck.

  57. Steven Park on December 23rd, 2012 9:08 pm

    Ms. Carter, after a long trial of conservative treatment, tonsillectomy is a legitimate indication for tonsil stones. You should talk to your ENT surgeon about your concerns. Good luck.

  58. Morgan on December 28th, 2012 1:47 am

    I am 21 years old and I had mono when I was 18. It feels like when I got mono all of my energy went away and didn’t come back…ever. I have ADHD as well diagnossed at age of 4. My tonsils are always swollen and produce tonsil stones daily. Do you think that I would benefit from a tonsillectomy? Would it help with my fatigue or even my ADHD at this age?

  59. Steven Park on December 28th, 2012 6:32 am

    Morgan, I can’t say for sure without examining you, but the larger your tonsils, the more likely it’ll help. However, as you’ll see from reading my other articles, it’s not just your tonsils that are preventing you from breathing properly at night and being able to get good, quality deep sleep. Having smaller jaws and dental crowding can cause ADHD, fatigue, and mono symptoms. Please search for these terms on my website. Good luck.

  60. Fara on January 26th, 2013 12:38 am

    Hi Dr Park

    My two year old son suffers from obstructive sleep apnea. Initially my GP referred me to a pediatrician and without thinking twice he told me my son has enlarged adenoids since he “could hear it a mile away and doesn’t even need to do an exam to tell me this”, however he did an exam and also requested an X-ray which showed that it was slightly enlarged. With that being said, he paid no attention to the fact that my son has a large tongue as well as no frenulum which causes his tongue to fall back during his sleep and obstructs the airway passage (when I physically push the tongue down or tilt the head back the passage way opens up and breathing improves). I was not happy with his opinion and went to see an ENT specialist. The same scenario occurred but this time upon the appointment my son had a cold with a blocked nose and according to him enlarged tonsils. Hence he suggested both the removal of the tonsils as well as the adenoids. When my husband asked him if the tonsils are possibly swollen due to the cold, he answered no!!!!!

    So now my dilemma and question to you, will having a T&A possibly create a bigger airway passage or will the tongue still fall back regardless. I do not want my son to undergo unnecessary surgery only to find out that the problem was in fact with the tongue and then possibly more surgeries.

    Please advice

  61. Sesh on February 5th, 2013 11:33 pm

    my wife is 51 yrs and has severe throat infections at least 3 times a year since 6-7 years, but does not have sleep apnea……….in fact ,at the age of 10yrs ,there was a proposal for tonsillectomy but idea was dropped as in the neighboorhood, a fatal case was noticed on account of tonsillectomy……….In these last 6-8 years , several ENT specialists ( 4 different specialists ) have always discouraged tonsillectomy as the tonsil size were small even at severe throat infection stage and since did not pose any breathing problems, focussed on acid reflux etc……

    Last month one ENT specialist said that let us go for tonsilectomy…….are we heading the right way or creating new unknown post tonsilectomy problems?

    Please advise

  62. lyndee on February 7th, 2013 9:27 pm

    We have an 11 year old who has had post nasal drainage for the past 3 plus years. He also has Asthma, but that has gotten better. He was on Advair 45 which just got switched to something different that I can’t remember but it only has 1 medicine in it instead of two. The drainage down the back of his throat has been so severe that he coughs almost constantly for the last 3 plus years. We’ve tried almost everything and now are trying Rymed which seems to be working. I am guessing at this point he would have to be on it indefinitely. I haven’t noticed snoring, but he is often tired. Maybe that’s just him? I hate to have him on all these different meds long term. Do you think it would benefit him to have his tonsils and adenoids out? The doctor did say they looked a little big.

  63. Courtney on February 13th, 2013 3:09 pm

    Thank you very much for your website. Today, I found out that my 4 year old should have her tonsils and adenoids removed. She snores at night, has had strep throat twice and tonsilitis once in the past six months. She always appears to be stuffy. The ENT we saw advised that my daughter breathes primarily through her mouth, which is something I never even noticed. She also advised that although my daughter is very articulate already, this will improve her speech. I am just really afraid for her going through an operation at this young of an age. :(

  64. becky on February 16th, 2013 12:24 am

    My 15 yo son has had strep 4 times in the past 5 months. The first time, he tested positive for mono also. He is athletic and healthy normally. He does have pollen and hay allergies. Since birth, he has had a slight pause between breaths, and while he has never had an ADD diagnosis, he has always been a stimulus-seeking, annoying tendency kid. His pediatrician never mentioned large tonsils. We will see an ENT in a few days. Your site has been very informative, with information I have not found elsewhere. My question is: Given that his strep infections have all been since or with the mono virus, are the two related? Has the mono impacted his immune system? Several doctors have shrugged their shoulders when I ask this. If they are related, it seems we should wait it out some more, give him immune system a chance to strengthen. On the other hand, if tonisillectomy would improve his focus and self-control, that makes it very appealing. Thank you!

  65. Rachel on February 27th, 2013 4:18 pm

    Dear Dr. Park,

    I have a 16 month old who had tubes placed at 6 months of age and has been recently suffering from repeat ear infections. He has been ill since before Christmas with various things ( viral pneumonia which he was hospitalized for, tonsillitis, bronchiolitis, and 4 ear infections). He also has a slightly low IgM. His pediatrician and his immunologist are recommending he have his adenoids out. He also has had trouble with nasal congestion since he was born. He had terrible trouble with GERD until age 1. He has been on antibiotics with no break longer than a couple of days since Dec. 24th. He also frequently snores at night. His brother had his Tonsils and adenoid removed and second set of tubes put in at age 3. Is my 16 month old too young to have his tonsils removed at the same time to try to avoid future surgeries?

  66. Paige on March 9th, 2013 9:52 am

    Hello, I am 18 years old. I have big tonsils and had white stuff on them last fall. My doc is saying its ” okay to have big tonsils and haves white stuff on them”. I really don`t believe him at all. Cus nothing on the internet says ” okay to have big tonsils and haves white stuff on them”.

  67. Paige on March 9th, 2013 10:18 am

    Hello my name is Paige and I am 18 years old
    Ever sents last fall tonsillitis so I went to my regular docter and he gaved me so meds for it so atfer cuppler days of taking it the white stuff went away but I still have swollen tonsils. Cuppler weeks latter I gotten tonsillitis agen so I went back to my docter and told him that my tonsils never went back down to the normal way and I gotten white stuff on them agen. So he told me to go to another docter therefore I did. He just tod me that I have swollen tonsils n white stff on them. Then I have to do a sleep apnea so next week I will be doing that. If I do have it thm I will get thm removed I think that’s what he said. Then I asked him so why do I have white stuff on my tonils and he pretty much said its okay to have white stuff on them. I am thinking no? It’s not rigth so I looked on the Internet to see if ” it’s ok to have white stff on thm” and Nothing on here says its ok to have ” swollen tonusl with white stff on thm” therefore he is lying to me! And now I can’t really eat hot, spicy foods, and some other types of foods or even some types of drinks Cus my tonils borns. Then it’s hard to swollow when I am about to swolle my food. Also I have troubler of breathing to. So I’m just confused, aggravated and I want answers. Cus it’s not rigth to deal with this for five mouths. Plus I am on Medicaid so yeah..

  68. Tiffany on April 2nd, 2013 9:22 pm

    Dr. Park,
    this is a sensitive question regarding the psychiatric effects of sleep apnea. I haven’t heard anyone discuss the very distinctive facial features of the young man who massacred the children and adults recently at the elementary school. He appears to me to have classic mouth breathing characteristics to his very elongated face which also lacks cheek bones. I also noticed he, and the young man who massacred the minute goers at the Barman film both have a very big eyed appearance.

    Is there any correlation that you are aware of with sleep apnea and this effect on the eyes? Also, do you have an opinion on any correlationship between untreated sleep apnea and extreme psychiatric disturbance? I know off the connect with depression and anxiety and am wondering about mute extreme symptoms, albeit possibly rare.

    Thank you

  69. Tiffany on April 2nd, 2013 9:34 pm

    Sorry about the typos above. I an typing on my phone. I meant to refer to the movie theater goers killed at the midnight Batman movie, and the bug-eyed appearance of both of the killers of these two tragedies. I also know some have connected Aspergers with sleep apnea, and Adam Lanza is said to have possibly had that. I certainly don’t mean to disparage sufferers of this sleep disorder by making these connections. Sleep apnea runs in my family and treating it has greatly impacted mood issues (depression/anxiety/irritability). I can always tell when my mom has used her Cpap, and tonsillectomies significantly reduced my son’s and my ADHD. Now, I will look into jaw widening as a result if your articles. Thank you. I feel thus is greatly under diagnosed, and I appreciate your website. I an just wondering whether it may have a farther reaching effect than many have yet considered in the psychiatric arena.

  70. Steven Park on April 2nd, 2013 9:54 pm


    I see what you’re trying to say. It’s not too far fetched to say that if sleep-breathing problems can cause ADHD, depression or other mood disorders, then it’s also possible to cause more severe forms of mental illnesses. There’s lots of research on the damaging effects of sleep-related breathing disorders on the brain.

    Regarding the big eyes that you mention, that’s likely due to underdeveloped cheekbones, which leads to what’s called scleral show. Take a look at Dr. Belfor’s example (see link below) of functional appliance treatment which develops the cheekbones. Notice how the whites of the sclera under her pupils go away and her eyes get “smaller.”


  71. ASHER on April 6th, 2013 4:20 pm

    Hello, My brother is going to have his tonsils removed tomorrow.
    His problems were.
    1- He was getting this infection more than three times a year.
    2- He sleeps with an open mouth
    3- He has bad breath
    4- He is very weak and doctor says that he will gain height and weight after this.
    5- He wakes up in the night only the days when he is suffering from the infection
    Doctors also say that he’ll improve in his studies.
    I need your suggestion that should we proceed with this treatment ?
    Thanks & Regards. (It would be great if you reply early)

  72. JoAnna on April 8th, 2013 12:16 pm

    Thank you so much! You just put everything I have been searching for in one great article. My 7 year old son was diagnosed with sleep apnea a few weeks ago and the ENT wants to put him on a cpap instead of remove his tonsils (his adnoids were removed at age 2). This decision was based on the fact that his tonsils were only 2+ at the office visit. What this doctor didn’t bother to listen to was that he had just completed 21 days of antibiotics due to a sinus infection which contributed to their current size, otherwise they would be and have been much larger. He has a history of chronic sinusitis, chronic allergic rhinitis, tonsilitis(never cultured since they were treating with antibiotics anyway), ear infections, asthma, reflux, sensory issues, and now possible ADHD and sleep apnea. He is taking the max of everything possible to control symptoms so I feel like treating the cause is more in order, right? He let me know that he didn’t feel that removing his tonsils would open the airway enough to benefit him then told me that he won’t have to use a cpap his whole life because his tonsils would shrink as he gets older creating more room for him to breath. Yeah, he said that! I realize that the doctor may be causious because he also seen a history of pulmonary stenosis in the chart but it is very mild and he has been cleared for another surgery that has been put on hold until this is dealt with. I have lots of questions for you. Isn’t there enough indication for a tonsilectomy with a diagnosis of sleep apnea even if you don’t consider the remaining list of indicators? What can I do to convince this man that this will help him even if it doesn’t cure sleep apnea 100%? How the heck do you keep a cpap or bi-pap on a 7 year old with sensory issues when grown rational adults can’t tolerate them well? Aren’t cpaps contraindicated for people with reflux due to aspiration and bi-paps contraindicated for those who have chronic congestion? The most important question is can you move your practice to WV and bring a good peds group with you, we REALLY need you? LOL ;-)

  73. Selma Bicic on April 9th, 2013 4:45 pm

    Dr. Park,

    I was diagnosed scleroderma circumscripta two years ago and was recommended for several times to undergo Tonsillectomy procedure. I was wondering do you have any experience with effects of it to autoimmune diseases, especially scleroderma and would you recommend it? I come from a country where autoimmune are not as often and doctors often do not have right treatments for these.

    Thank you in advance.

  74. susan wilson on April 29th, 2013 6:48 pm

    I am 58. A month ago I had very infected tonsil on my left side. After a zpac I recovered fully and quickly. Today I can feel the same pain on the right side starting. Is this common? Never before have I had tonsil issues.
    thank you

  75. Laura on May 12th, 2013 2:34 am

    Please answer question re pandas and tonsilectomy. Do u think it should be removed to cure pandas

  76. Steven Park on May 12th, 2013 9:19 pm


    There are no good prospective studies on treating PANDAS with tonsillectomy, but many of the symptoms of PANDAS can in theory be a complication on obstructive sleep apnea. So in this regard, tonsillectomy may be an option, especially if they are enlarged.

  77. Holly on May 13th, 2013 10:43 am

    Dr. Park

    My son is 10 years old and over the past 2 years he has had strep almost back to back. He will get it, go through the antibiotics and then get it again 2-4 weeks later and after that we hear no more from it till the next year. This has only happened the past 2 years. His ped says his tonsils are size 1 and doesn’t recommend removal. The ENT has said that if we are worried about the antibiotic intake we can get them removed, but I am concerned about the risks. He had his adenoids removed at age 18 mos. Slight asthma that only flares up occasionally and is not on any “preventative”. Does he sound like a good candidate for tonsilectomy or do the risks outweigh the benefit here?

  78. Keri on May 25th, 2013 1:32 pm

    Hello, I have a 16 month old girl who has been suffering from PFAPA since she was 9 to 10 months old. I am not completely ok with the treatments that are claimed to only maybe help since there is no cure for this. I’m hearing all kinds of stories regarding a tonsillectomy. I’m so torn on what to do for her but I have to do something, I can’t imagine having to see her suffer clear into young adulthood. I’m exploring all avenues before I let them do anything. I’m curious what your opinion is on having a tonsillectomy done as a treatment for PFAPA?

    Thank you

  79. Claudia Bester on May 26th, 2013 4:38 pm

    Dr Park
    My son is 26 months old with recurrent tonsillitis. In the last year +/- 20. He breathes through his mouth and snores a lot (adenoids already removed – grommets x 3). The ENT wants to remove his tonsils, but the paediatrician not, because of possible serious respiratory problems. Do you have any additional information regarding the occurrences of serious lung infections/respiratory issues that occurred more frequently because the body had no defence before the bug reached the lungs?
    Please also confirm if it is possible that immunity can be affected negatively by teething and if the occurrences of tonsillitis would be decreased after teething.
    Thank you!!

  80. Tammy on May 29th, 2013 10:01 pm

    Dr Park,
    Over 3 weeks ago I had a tonsillectomy. I am 31. I am still experiencing agonising neck throat and ear pain. I am scared that there may be permanent damage. I have been back to the emergency department several times, and on my last presentation, the doctor got in touch with my surgeon who said that my procedure was the most difficult he had done and was the worst he had seen in years. I have a post op appointment with the surgeom next week and am wondering what I should be saying to him. I am on oxycodone for the pain but all it seems good for is relaxing my muscles around the site, but am also taking ibroprofen and paracetamol, viscous lignocaine, and an anaesthetic spray.
    Any advice would be much appreciated, as I am unable to work, eat, speak (due to the swelling of my tongue still) and I am beginning to become very afraid of what the future holds.
    Thanking you in anticipation.

  81. Linda Thomson on June 3rd, 2013 5:05 am

    My son was 6 years old when he had his tonsils and adenoids out. He had ADHD, and seemed to have a mood disorder but wasn’t quite sure what it was. He was getting strept throat often and had enlarged tonsils. The ENT took them out and about a week later, he turned into a little boy noone knew. He was raging, cursing, non- compliand on a regular basis for about a year. He’s still doing this in school and everyone in a while at home. I have taken him to neurologists, neuropsychologists, psychologists, his family physician, and now a new psychiatrist who is looking into PANDAS for me because his psychologist that comes to my home every week went to a conference and says that sounds like he has that. I need all the help I can get because his behavior is pretty bad in school and sometimes in public places. At home is better, but gets bad too. So if anyone can help me with any information, I would be so grateful. Thank you.

  82. Yolanda on June 12th, 2013 4:00 am

    Dear Dr,

    I’m a 36year old singer who’s HIV positive for 15years now. In these 5 few years I’ve developed sleeping and breathing problems, especially snoring and insomia.

    Now I’ve recently noticed that my facial structure has changed massively and my tonsils are very large that they are bulgy below my cheek bones. Earlier this year my doctor advised against removing my tonsils but now I strongly feel I should as my snoring and facial structure are depressing me.

    So, I wanna find out if removing my tonsils will have negative effect on my singing career and also, will my immune system deteriorate? I honestly think my depression and stress from keeping them will make my immune system faster than the after effects on the surgery.

    Please advise.

    Many thanks

  83. Steven Park on June 12th, 2013 6:19 am

    Ms. Thompson,

    That sounds a bit unusual. However, obstructive sleep apnea can sometimes worsen after routine upper airway surgery. In general, a sleep study is recommended in these type of situations if it hasn’t been done already. Persistent or worsened obstructive sleep apnea can cause these type of symptoms. I can’t say for sure without examining him, but persistent sleep disturbed breathing should be ruled out. Good luck.

  84. Steven Park on June 12th, 2013 6:26 am

    In general, taking out tonsils won’t change your voice, but it may seem to change temporarily since your throat acts as a resonator for your voice box, until you get used to it. At a certain point, you have to weigh your health vs. your career. There are no guarantees, but in general, singers are much happier after improving breathing. When I see patients with your situation, I usually order a sleep study to assess for obstructive sleep apnea.

  85. Yolanda on June 12th, 2013 6:37 am

    Dear Dr.

    Thanks for your prompt response and it is quite helpful at this stage. My health comes first and fortunately I’ve also been blessed immensely as I’m also a fashion designer. So, if I’m not satisfied with the quality of my voice after the surgery, then I still have my creativity and fashion business.

    Take care and thanks for doing an amazing JOB!


  86. Marcio on June 27th, 2013 6:30 pm

    Dear Dr,

    I am a 26 year old male and never really had problems being sick. Just recently about a year ago I noticed that I was getting a cold about twice a month and always feeling tired. I thought nothing about my tonsils until just last month I had an abscess growing in my throat. I went to an ENT here in Brasil and he gave me antibiotics which I took and the abscess went away. In just two weeks it came back and now he says I should get my tonsils removed. I don’t feel comfortable with surgery but he thinks its important. What do you think (in general)?? Thanks so much

  87. Chloe on July 4th, 2013 4:02 am

    Hi Doctor Park.

    I am 29 and in the past few years I have had recurrent tonsillitis (4 times a year). This year I have not had the illness, only a low-grade sore throat, at the back near my tonsils, that goes on for weeks at a time. An ENT has placed me on the waiting list for a tonsillectomy. My tonsils do not seem to be causing any sleeping problems. I am afraid the procedure will lower my immune system. Is recurrent tonsillitis something you can “grow out of” or is it likely to keep re-occurring?

    Thank you

  88. kate on August 30th, 2013 12:13 am

    Hi Dr,

    I am a 30yo women booked in tonsilectomy in a week’s time as I’ve suffered terrible tonsilitis over the last few years. I am also on nexium for what they think is acid reflux. Will the post operation recovery be effected my my acid reflux as the nexium doesn’t seen to control it very well. Thanks in advance

  89. Rima Sachdev on September 23rd, 2013 4:25 pm

    Hi Doctor Park,

    I am 30 years old and have had tonsilitis since I was 18. Ive always suffered from colds as a child but suddenly one fine mprning i woke up with my right tonsil enlarged with pus pockets. I tried antibiotics but the pus was just stuck to my tonsils. I did a homeopathy course over a period of 5-6 weeks and the pus was gone. But ever since then i keep getting recurring sore throats really terrible colds which always leads up to my tonsils inflammed and now sinusitis every time I eat drink or breathe something ‘wrong’ or just randomly by merely existing. It happens at least once in two months.The ENT’s have told me my right tonsil(which is still very large) has become scar tissue. But now my left tonsil and peritonsil and everything else gets inflammed. I dunno what to do feels like i live a half life and im always anxious that ill get sick any minute. Will I get better if I eat healthy? because my immune system is weak? ….i also have psoriasis which is an auto immune disease. any cconnection there? please please help me.
    Thank you,

  90. Steven Park on September 23rd, 2013 9:41 pm

    Ms. Sachdev,

    It’s difficult to say without examining you, but at a certain point, recurrent tonsil problems like what you mention requires thinking about surgery. There are some associations between tonsil infections and skin issues, but not enough to formally recommend surgery. Anecdotally, I have had patients that said their psoriasis went away after being treated for obstructive sleep apnea.

  91. james baisel on October 27th, 2013 3:28 pm

    I’m 23years old I had my left tonsil bigger after I got choke with a piece of rubber I went to the hospital and I was told my left tonsil is a bit swollen so I was given amoxicilline . Is been 3weeks now but it’s has not gone down though I don’t feel any pain but I can’t not breath properly or deeply on the left side of my nose but I’m good with the right. If make me feel very uncomfortable when swallowing my saliva which makes me feel that there is something there do u recommend any drug. Please reply me ASAP. Thank U

  92. chanelle on October 28th, 2013 10:33 am

    My daughter is 4 and going 4surgery in the next 2weeks but her tonsills are swollen what can I give her or do to make them go down asap

  93. Andrea Clavijo on November 26th, 2013 7:04 pm

    My 18 year old daughter was diagnosed with mono about 3 months ago. her tonsils became so enlarged she ended up in the ER with difficulty breathing. she’s been on 3 different rounds of steroids and a round of antibiotics. The steroids help almost immediately! However, about 2 weeks after the steroids end, the tonsils become severely enlarged again. We have been seeing the ENT. She has recommended a wait and see course of action indicating the mono is what’s causing the tonsils to be so enlarged and her body needs to fight it. The doctor said it could be 6 months or mute. My daughter woke several times through the night gasping for air. She continues to have difficulty eating and drinking. If we push to have the tonsils out now, how does that affect the mono? what are the risks in this situation? She’s at college and I fear the worst if we don’t try to get the tonsils out.
    One thing to note, I was 18 when I had my tonsils out due to numerous bouts of tonsillitis in a short amount of time.

  94. Steven Park on November 26th, 2013 9:06 pm

    Ms. Clavijo,

    Sorry to hear about your daughter. Unfortunately, I can’t make any formal recommendations for your daughter without examining her. However, tonsillectomy can be done in cases of mono, but it’s something that you need to talk to your doctor about. It’s also important to know that having suddenly enlarged tonsils can bring on obstructive sleep apnea.

  95. komal on December 7th, 2013 12:58 pm

    Hi doc,
    I am here for my mother. she is 48 years and diabetic for the past 7-10 years. She is also suffering from neurosarcodosis , she has bilateral facial nerve weakness. and shes also on thyroxine. Apart from this, thedocs say she has latent tb. Her mantoux induration measured 36mm and the tb came up on blood test. They sayits somepreviousinfection.
    She has been having sore throat for the past I dont know how many years but for the last 6 months the frequency has increased to twice every month. She just completed penicillin V 10 days course 7 days back for acute on chronic tonsillitis but it occured again 3 days after the course completion. Right now, she has chest infection, severe cough with pale yellow phlegm and hypertrophied congested tonsils. Breadth sounds are harsh on the left side. The tonsils are close to what you call kissing tonsils.
    Her tonsils didnt shrink after antibiotic course she took 6 months back. They are huge and obstruct breathing at times and pose difficulty in swallowing. We have consulted three ENT specialist and all of them say that at this age and with so many problems, tonsillectomy isnt safe. I know it is going to be hard but what are the odss? I really need an honest opinion. I’ll be highly thankful.
    P.S she keeps her diabetes under control. She takes glucophage 850mg TDS (before meal) but she is obese. Weighs around 84 kg and is 5’2

  96. PurpleJ on December 14th, 2013 12:53 pm

    My son is 7 and has suffered with large tonsils for years he snores and breathes very heavily in general, he also eats very slowly. he was getting recurrent tonsilitus last year but has not had a bout for about 8 months should i proceed with the tonsillectomy as he is booked in next month? and have you heard of a connection with night terrors and bedwetting due to large tonsils before as he suffers with both these things?
    Many Thanks

  97. Danielle on December 17th, 2013 10:49 am

    After hearing about the recent death of the 13 year old Oakland girl, I have stepped my research into overdrive in anticipation of my 13 year old’s tonsilloadenoidectomy, and am pondering the different techniques.

    In your professional opinion, which is the safest technique that warrants a reduced amount of post-op pain? What method do you use and recommend?

    What do you think about this ENT’s technique?


  98. Danielle on December 17th, 2013 11:10 am

    BTW, my son had his adenoids removed when he was 6 years old and per a recent x-ray, they have grown back. In addition he had tubes put in, but they have since fallen out. He is a mouth breather, but does not suffer from chronic or atypical infections of the throat.

    When he sleeps he breaths through his mouth and when awake can breathe through his nose if he focuses, but it’s an unnatural state, so back to the mouth breathing he goes. This is my primary concern, hence the visit to the ENT. I may also add that he is significantly ADD/ADHD and exhibits behavioral issues at home and at school.

    The ENT we went to and after looking at the x-ray recommended a tonsilloadenoidectomy , but I am seeking a second opinion for my peace of mind.

    We have tried allergy sprays (Nasonex) and pills (Allerclear/Claritin), but they make zero dent in the issue.

    Thanks for any input you can provide.

  99. Steven Park on December 18th, 2013 10:22 pm


    No matter which technique is used, the overall complication rate is still very low. I can’t comment on the Oakland case without having been in the OR and reading the medical records, but I take every news story about medical complications with a grain of salt. Yes, it’s always tragic, but most newspapers never publish follow-up findings after an investigation is made. I generally don’t recommend one technique over another. There are more important aspects to a tonsillectomy procedure than the type of cutting tool that’s used. Sorry, but I can’t comment on your daughter without examining her. You’ll have to go with someone that you trust. Good luck with your child’s surgery.

  100. Stephanie on December 19th, 2013 12:24 am

    Hi, when my son was 6 he had recurrent ear infections which led to significant (but not permanent) hearing loss. We were sent to an ent. They recommended surgery to put in tubes and remove the inflamed adenoid. I was reluctant to do the surgery. I asked her why he was having this issue, she told me that he is having an allergic reaction to something. So, we went to an allergist. He was all clear with the allergist, nothing came up in the tests. I still wanted to know what he was “allergic” to and I definitely was afraid of the surgery. I decided to seek the opinion of a naturopathic doctor. They ordered “IGG” and another test, which were more allergy tests, but more thorough. The results came back that he had an issue with casein, found in dairy products. The naturopath took him off of ALL dairy for 2 months to “dry him out”. After we took him off dairy for 2 months we took him back to the ent to test his hearing and recheck adenoid, there was significant improvement, without meds or surgery. We made another appointment for 3 months later, all the while keeping him off of dairy. His hearing is now back to perfect and his adenoid is normal in size again. My son is now 7 and doing beautifully. I have SLOWLY reintroduced some dairy, not milk though. He is happy drinking almond milk, which also has calcium and vitamin d, so he always had the nutrients he needed. I’m not suggesting that your child has an issue with casein, but I would strongly recommend seeking the opinion of a naturopath and request intensive allergy testing until they find something that makes sense to you. Good Luck

  101. Krista on January 27th, 2014 10:23 am

    Dear Dr. Park,

    At this time I ate-year-old daughter has tonsil hypertrophy. She has a history of allergy induced asthma which I have mainly controlled through changing her diet to organic non-processed and elimination of certain other ingredients or foods from her diet. She is currently taking albuterol nebulizer as needed, daily text Claire 10 as well as Flovent. She has been on these medications for about six years now. Prior to changing her diet she would have 6 to 12 asthma episodes yearly and which in most cases she would be hospitalized for three days to two weeks at a time – a few of these episodes lead to pneumonia. Now she’s doing much better however she has had some shortness of breath and wheezing twice in the past six months and which I had to take her to the emergency room and she was placed on steroids both times. The steroids kick the problem within a few days. Recently her PCP referred her to an ENT. He wants to do tDNA due to the hyper trophy but on the basis of sleep apnea. I have never observed her awaken from sleep or have positing of respirations during her sleep – not saying it doesn’t occur. This week I will be staying up at night and watching her sleep to ensure thorough observation conclusion of whether or not she may have sleep apnea.

    I am a nurse and my common sense tells me that removing her tonsils, thus removing the part of her immune system that is localized as a first line of defense to the throat and upper airways would be contraindicated due to her asthma. The tonsil hyper trophy does not cause any airway obstruction at this time as her underlying issue is the asthma. Her ENT thinks I’m crazy because I recently canceled her appointment to have her TNA done. I go back-and-forth between the explanation he gives me for the benefits and my common sense.
    My commonsense also leads me to believe that it is possible that one of the reasons why many people today are sick as they are with respiratory infections and other issues could be related to those of had tonsillectomies and that local defense system gone. So I am asking you what your opinion is, knowing a summarized history of my daughter and her asthma, if her having a TNA would be beneficial or nonbeneficial?!
    Thank you for your response in advance!

    A very concerned mom,

  102. vietti on March 16th, 2014 10:48 am

    i would give anything to have mine back i had the surgary when i was 12 and my voice is completely imbarassing. It was one of the biggest mastakes of my life.. i have always been so mad at my partent for doing it..

  103. Jodi on April 14th, 2014 2:52 pm

    Hello Dr. Park,

    I am 46 years old and scheduled to have my tonsils removed on April 29th. I have had a history of tonsil issues; including tonsiliths, a peritonsillar abscess in the right tonsil, and many, many sore throats and very recently, 2 bouts of strep back to back. I went to a infectious doctor and he suggested having the tonsils removed. I have read many threads/posts on line and I am scared. It seems like everyone who posts says they have had lots of bleeding, yet the statistics say the chances of bleeding are 2-3%. So this does not make sense to me. Also, are the chances of bleeding in adults after tonsillectomy greater than that of children who have a tonsillectomy? In addition, I have bronchial asthma. Do you know if I can take Advair (corticosteroids) prior to the surgery to prevent swelling and excess Phlegm ? And can I take this afterwards to prevent my bronchial asthma? Also, I know it is not recommended to cough a lot after surgery, but with my bronchial asthma, I can almost guarantee that I will have to cough. Is coughing ok?

    Thank you so much in advance for answering my questions :)

  104. Steven Park on April 15th, 2014 9:00 pm


    Sorry to hear about your problems. I can only generalize, since I haven’t examined you. In real life, tonsil bleeds are rare. In the age of the internet, people who suffer from complications tend to be more vocal, so the results may seem skewed. What’s most important is the rate of bleeding by your surgeon, NOT what the Internet says. Good luck.

  105. Steven Park on April 15th, 2014 9:06 pm


    Your apprehension about removing tonsils is understandable. I can’t comment specifically about your daughter, but in general, sleep-disordered breathing can be significantly detrimental to your health in many different ways. Not getting enough oxygen to your brain and body, along with interrupted sleep is not a good thing. Yes, the tonsils are part of the immune system and the lymphoid tissues help to educate the immune system, but when they get too big and start to obstruct breathing, then it’s a good idea to remove them. It’s not going to cure everything, but it can help any other complementary option since you’ll be able to breathe and sleep much better. This way, your immune system will be much healthier and do a better job. Hope this helps. Good luck.

  106. Shannon on May 7th, 2014 9:26 am

    This was very eye opening to me. Thank you! I actually found the article while attempting to find out whether my son’s palette expander (which he’s had for 5 weeks) could be harboring the Strep infection he’s been fighting for 8+ weeks. I was shocked to find the possible connections between his high palette & small jaw to enlarged tonsils and sleep issues. We are actually now discussing tonsillectomy with his ENT specialist (thought there is some debate about whether it can be performed with the expander in). We’re having a hard time with this decision because this is only the second time in his 9 years of life that he has has Strep throat (the first time being when he was 7). However, we had originally visited the ENT specialist to merely discuss enlarged tonsils and possible sleep disturbance (our son just so happened to be battling Strep when the appointment came around). I understand you can’t provide recommendations for a patient you’ve never seen. I am wondering if you are willing to share what your initial reaction is to our case, and whether you think we should get a second opinion re: tonsillectomy?

  107. Steven Park on May 7th, 2014 5:17 pm


    There shouldn’t be any technical reason for undergoing tonsillectomy while the expander is in place. There are two major reasons for removing tonsils: obstructed breathing and recurrent infections. There’s no right or wrong answer, but anything to remove the potential for infections or obstructed breathing can only help in the long run. Hope this helps.

  108. Kim on May 15th, 2014 6:56 pm

    I have had a chronic dry cough 2 years s/p tonsillectomy. It began 6 months after and hasn’t let up. I have not responded to asthma treatment, as they thought I may have that. The only thing I can think of is a complication of the tonsillectomy. Thoughts?

  109. Steven Park on May 15th, 2014 10:03 pm


    Tonsil surgery is usually completely healed by 3-4 weeks. Your symptoms may be unrelated. Chronic cough is a very common condition and often difficult to treat.

  110. Angela on May 17th, 2014 10:42 am

    Dr. Park,
    I am a 51 years old woman that was diagnosed with Sjogrens, Lupus, and Arthritis (Mixed Connective Tissue Disease) a year 1/2 ago. I have experiences problems with my tonsils for many years now. However, the other symptoms of this disease has worsened. That’s why I ended up at a Rheumatologist. I am between meds right now because everything gives me side effects. My tonsils and mouth are in a bad flare right now. I am really concerned about my tonsils. One of my tonsils had been swelling a lot and when I would push on it, white liquid (not the stones as much) would come out. For years, I would just have problem with stones. Then it lead to white liquid. NOW the white liquid has turned to green when I push on the tonsil. I notice this more when I am having a flare and my tonsil is sore and my joints are swollen. I am very concerned about the green stuff. Last year when my MCTD was beginning I went to a ENT and he did say this was from the Sjogrens. Now the green pus has developed and it concerns me. Should I go back to the ENT? Does it sound like I need to have my tonsils removed? That also scares me. Having surgery may be risky with all these symptoms I have from this disease. Just don’t know. I have an appt. with my Rheumatologist next week. I will tell her this but she is just going to try to find a new med to put me on. Thanks for your time.

  111. Steven Park on May 17th, 2014 10:48 am


    Sorry to hear about your tonsil issues. Whether or not to take out your tonsils is an individual decision between you and your ENT surgeon. There’s no harm in having a discussion with your surgeon. Good luck.

  112. CB on May 19th, 2014 11:09 pm

    Great site Dr Park, and fantastic that you are still answering questions on this article. I hope you’ll also be able to offer some advice.

    I’m particularly interested in this: “We now know that even mild degrees of sleep-breathing problems in children can cause a wide range of problems, from bed-wetting and ADHD to behavioral issues and asthma.
    A recent study published in the journal Pediatrics showed that about 50% of children with ADHD could be cured with adenotonsillectomy (this is when you remove both the adenoids and tonsils). Countless studies report significant improvement in children’s cognitive, behavioral, memory and sustained attention scores, after tonsillectomy. Even my son Jonas had dramatic improvements after his tonsillectomy”.

    My son is 6.5, is exceptionally gifted, and has APD (as suggested by both the educational psychologist, and speech pathologist who specialises in APD; we’ve yet to have the audiology testing, due to his age… though he’s very large, so will push for that soon), and has some degree of hyperacusis. My son’s reading and writing ability are not as advanced as his intellect would suggest (though his reading is advanced for his year), and that has been somewhat addressed with speech therapy.

    However, it has recently come up that he is increasingly distracted in the classroom, and is not focused and fidgety. This is clearly largely due to his mismatch in educational placement (though he has now been accelerated to Y2 for maths… he’s doing Y3 maths and beyond at home; he is disinterested and frustrated with school). ADHD has been discussed, which both the educational psychologist and paediatrician believe is not the case. His tonsils are, and have been for some time, a grade 4, and a grade 3 (they may have increased to that size over a period, but they have now been chronically enlarged for years). They are reasonably inflamed, with the left (3) showing veins on the surface. We were checked last September, and are going back to the ENT this Friday. He has had only one (or two, if it was 2 the second one cleared without antibiotics) bout/s of tonsillitis in the last eight months. And approximately three in the last year. He snores when he’s ill… but we haven’t really noticed much it at other times (we are not in his room much at night though); occasionally perhaps.

    I’d never heard of this possibly resembling ADHD. I suspect the ENT might suggest removal on Friday due to the fact they haven’t decreased in size. I’m just wondering what your thoughts would be on this; to remove as a precaution, in case it is causing the poor behaviour, distraction etc… Or wait and see if they decrease… (can’t see that happening given how big they’ve been for so long).

    Many thanks!!

  113. Steven Park on May 20th, 2014 6:04 am


    Thanks for sharing your son’s story. Many ENTs will recommend a sleep study to see if he or she has obstructive sleep apnea. Regardless, having 3-4+ tonsils will give you sleep-related breathing disorders, even if there are no apneas (see my articles on upper airway resistance syndrome). Some ENTs will say that without any snoring or frequent infections, there’s no reason for surgery, and that the child will “outgrow” it. I disagree. Ultimately, the decision for surgery will have to be made between you and your ENT.

    Good luck with your son, and please keep me updated.

  114. Jane squire on May 28th, 2014 9:37 pm

    My daughter is 2 1/2 and had a adenotonsilectomy at the beginning of the month due to enlarged tonsils and adenoids that caused her to snore, have sleep apnea and as we waited for the surgery she developed severe feeding aversions from constant choking, gagging and vomiting to the point that she had been on a predominantly liquid diet for the last few months. We will begin working with an occupational therapist as her feeding issues are now behavioural, but my concern is that she is gagging a lot throughout the day on just her own spit and seemingly on nothing at all. Is this a learned hypersensitivity that she will learn to control or something I should be concerned about?

  115. Fran on June 7th, 2014 1:44 pm

    Dear Dr. Park,
    Our son is 3 and just had his tonsils and adenoids removed as well as grommets inserted, 3 weeks ago. We were referred to ENT after he suffered from re-current ear infections. He was diagnosed with bilateral glue ear and hearing loss. He also used to mouth breath and snore and would wake up every night. His speech is delayed and over the last few month he developed a bad stammer, which we think is as a result of continuous sleep deprivation. We were hoping that after the operation his sleep would improve as well as his speech. He seems to be using more words and speaks clearer, but he still wakes at night and seems tiered during the day. (no more snoring and breathing through his nose now).
    Does the recovery period, in your experience, take this long and if not can I assume that he still sufferers from OSA? Also, we are very concerned about his bad stammer and I feel, that if we don’t get the sleep sorted he will struggle even with speach theraphy.

    Many Thanks

  116. Steven Park on June 8th, 2014 7:37 am


    Thanks for posting. It’s still very early post-op, and you need to give it some more time. It can literally take months before you see positive results. You can discuss any issues that are persistent with your ENT. For persistent sleep-breathing issues, a sleep study can be performed (or repeated if one was done already). Good luck.

  117. Jane squire on June 8th, 2014 10:33 am

    I thought I would follow up to say that this week my daughter has really started to show progress. It wasn’t the immediate fix all cure that I had wished for but seeing the improvements she is making is really encouraging and I have come to understand that she is adjusting to a new obstruction free world and trying to unlearn behaviours and fears that she previously had. Thank you for this thread and your responses.

  118. Mandy on June 16th, 2014 6:20 pm

    Hi please help I have had tonsillitis 3 times over the past 12 months. First case was in May 2013 then again in April/May 2014 twice I had tonsilitis in these 2 months each time it was very painful and I was given antibiotics on all 3 occasions. After the last case a month ago I had throat swab done while I had the infection this came back as bacterial. I went to see my doctor again on the 30th May for a 3 week check she looked my throat 3 times went to speak to another doctor came back and told me she was referring me to my local hospital. I received a letter that week to go to ENT on Monday 6th June . When I arrived I called in to see a registrar whom told me my doctor had referred me through the urgent pathway for cancer I was gob smacked couldn’t believe it did not expect this the next thing she asked me questions about my general health, then looked in my throat with a light n lolly stick and told me that my left tonsil was larger than my right, next she placed a camera up my nose, told me that I need to have my tonsils removed to see if they is any cancer there. She then filled in the consent for I signed it then was again seated in the waiting room to be called again this time to book in the operation which is booked for this Thursday 19th June 2014. After I came home and calmed myself down and stooped crying the following day I rang my doctor to say I wanted a second opinion from a private doctor and that I would pay for his/her consultation. My doctor convinced me to back to the hospital and see the boss of ENT she would ring him and tell him my concerns she did this then the following day his secretary rang to confirm an appointment for today at 3.55pm. I have been to see him he was quite to the point saying that my doctor, his registrar, and himself had made the right choice in taking my tonsils out on Thursday this week because there is no way he can tell without taking them out if they are cancerous or not I am frightened to death in having this operation and don’t know weather I want to through with it or not please please help . Thank you Mandy

  119. Steven Park on June 16th, 2014 8:51 pm


    I realize it’s difficult to go through a situation like what you’re going through right now. Your best option is to follow-up with your surgeon to see what the results showed and to discuss what the next steps will be, if any.

  120. Mabel on June 17th, 2014 8:36 am

    Dear Dr. Steven, thank you for this article. I have a decision to make whether my 3 year old daughter must do a tonsillectomy. She underwent an adenoidectomy when she was 2 years old, she was diagnosed with allergic rhinitis back then. Then there was an improvement in her sleep patterns for a couple of months until she started getting episodes of allergic rhinitis again during winter months. We do not know the allergen but it appears to be seasonal. So, now she has been getting allergic rhinitis with post nasal drip for the past 5 months every two weeks or so with inflamed tonsils even though she is on Avamys spray and desloratidine. There are periods of complete absence of symptoms but only last to about 2 weeks. Her ENT looked at her tonsils today and said they grade 3 or one away from the biggest tonsils grade. He also said they are not infected but inflamed by the post nasal drip. They have never been infected but always inflamed for at least 5 times in the last 5 months. Her one tonsil was big since 1 year but it was not taken out during the adenoidectomy because she was still young and it wasn’t inflamed. She does not have sleep apnea or snoring but a very audible breathing and is a very poor sleeper with frequent awakenings every night. I have noticed that she is hyperactive on days she hasn’t had a good nights sleep but is much calmer when she has no symptoms of the rhinitis. She is to continue with the medications given above and is advised to undergo a tonsillectomy which will help with her drooling as well.
    Please advise if a tonsillectomy would be a good decision for her considering she has an ongoing allergic rhinitis and no sleep apnea. Can she still develop pulmonary hypertension and right heart failure in the absence of sleep apnea? Can she afford to put off the tonsillectomy until she is 4 years perhaps?

  121. Steven Park on June 17th, 2014 8:09 pm


    I realize it’s a difficult situation for you and your daughter. Unfortunately, I can’t recommend anything without seeing her first. However, generally speaking, if you’re not sure about whether to undergo tonsillectomy for large tonsils, it’s good to have a sleep study to see to what degree she may have obstructive sleep apnea. This can usually help you make a decision one way or another. Ultimately, this is conversation that you’ll have to have with your ENT surgeon.

  122. Rene DeMattei on October 8th, 2014 4:49 pm

    Having raised an ADHD son I’ve studied the disorder for years. There is no blood or urine test for it; diagnosis is iffy at best. I really don’t think that removing tonsils to solve apnea issues “cures ADHD.” I think that kids with apnea-related concentration and behavioral problems have apnea NOT ADHD. If removing tonsils and clearing out the throat so a child can sleep well stops the behavior issues, he didn’t have ADHD to begin with. If we had better diagnostic tools for ADHD I wonder if we’d see any correlation between the two at all.

  123. Steven Park on October 8th, 2014 9:42 pm


    I completely agree with you. There are a number of children with ADHD who are clearly misdiagnosed, but there are also a significant number that have no OSA or sleep-breathing problems whatsoever. The challenge is in differentiating the two. My feeling is that any child with a formal ADHD diagnosis should be screened for obstructive sleep apnea. It’s also important to realize that you can have severe sleep-breathing problems and not have any significant apneas on a sleep study.

  124. Ashley on October 11th, 2014 7:07 pm

    Dr. Park, I would appreciate your advice. I am 26, female and had my tonsils out 6 weeks ago. After 3 weeks I was feeling 95%healed. About 1.5 weeks ago I started to feel pain in my throat like I did when I had my tonsils. There is I guess you would call whatever is left when the tonsils are taken out which seems to be inflamed, red and white and has not improved in this time, while taking aleve and allergy medicines. I have noticed that it seems to be that the soft palate, surrounding my uvula is lower down in my mout or swollen it’s hard to tell, and I feel like its uncomfortable to speak and even a little airway blockage. I went to see my ENT yesterday and he said nothing is wrong, but recommended I get a second opinion if that makes me feel better. I would appreciate your input, if you’ve heard of this before. I’m worried. Not sure if this something allergy related maybe edema of some sort ? Is it possible my adenoids are involved ? I plan to go to my allergy dr and a second opinion from ent to make sure all is okay.

  125. Brenda on October 15th, 2014 10:27 pm

    Dr. Steven ….. Iam 26yrs old and i suffer of my tonssels since i was a child, I get really sick of my tonssels at least one a month get fever, ear infection, body aches, headaches, cant eat because the pain and very painfull to swallow saliva. .. and my tonssels are very small cant really see them, i dont have problems breathing. .. How dangerous is this??? Do i need to remove them???

  126. Brenda on October 15th, 2014 10:29 pm

    Dr. Steven ….. Iam 26yrs old and i suffer of my tonssels since i was a child, I get really sick of my tonssels at least one a month get fever, ear infection, body aches, headaches, cant eat because the pain and very painfull to swallow saliva. .. and my tonssels are very small cant really see them, i dont have problems breathing. .. How dangerous is this??? Do i need to remove them??? What should i do?

  127. Steven Park on October 16th, 2014 7:09 am


    Sorry to hear about your situation. I can’t say for sure without examining you, but your situation is a classic example of recurring symptoms despite taking out the tonsils. What this implies is that there’s something else that’s irritating the throat, such as allergies, or reflux. Nasal congestion due to any reason can also aggravate reflux. If you don’t feel refreshed after sleeping, or have more than usual fatigue or drowsiness during the day, then a sleep-related breathing disorder is another consideration. Good luck!

  128. Steven Park on October 16th, 2014 7:09 am

    Brenda, please see my response to Ashley.

  129. Peter Mazzone on October 16th, 2014 8:43 am

    Dear Dr. Parks, Thank you for fielding my question.
    I have a 15 yr. old daughter, who’s had many problems in the past and still continuing with fluid draining into her stomach, nausea, tiredness, at times a sense of dizziness, no fever. Has problems sleeping as a result of mind control, not sleep apnea. Complains about restriction of breathing normally. Occasional headaches. She was diagnosed with Mono last winter and has missed many days of school. Pediatrician is frustrated as are we with what to do next. Tonsils are not enlarged or inflamed This has been going on for about 5 yrs. She has been seeing a local Natural Path using a New specialized machine to do blood tests and also felt with diagnosing Lime Disease last spring. She has recently seen the Natural Path 2 days ago and has come home with another $400.00 worth of supplements. They seem to work until dosage stops then things return as previously mentioned above. Her mother’s side of the family , 6 aunts and uncles, all haver had their tonsils out when it was a popular remedy for many issues. Her Mother had similar issues at age 6-7 until she had her tonsils out and has never been sick since. She is 52 yrs. old. Should I believe that this could be a genetic situation and have her tonsils extracted? Comments please.

  130. Steven Park on October 16th, 2014 8:22 pm

    Mr. Mazzone,

    One of my suspicions is that mono is exacerbated by underlying obstructive sleep apnea. With an already narrowed airway (from your genes), rapidly enlarging tonsils from mono can tip you over the edge, causing more obstructions and reflux which causes more tonsil swelling, and perpetuate a vicious cycle. I can’t comment specifically about your daughter, but it’s probably worthwhile in this situation to see an otolaryngologist (ENT) for an upper airway evaluation. Good luck.

  131. Betty on October 17th, 2014 3:39 pm

    My niece has had strep ever winter and twice last year. She has very, very, very bad breath. She sometimes snores when sleeping and has allergies and wakes up every morning sneezing. Does her bad breath come from her tonsils or the allergies? I want to help her, she is being teased.

  132. Monique Herriman on December 19th, 2014 1:55 am

    Hi Dr. Park. I’m hoping you can shed some light on a few things for me and my husband. When my husband was a child, it was recommended to get that my husband’s tonsils and adenoids be removed (due to several size throats and steep). Well, she was more concerned with putting him through the pain of surgery than she was with any long-lasting effects of leaving things be.

    Currently my husband is 44; he has obstructive sleep apnea (CPAP at 18# of pressure), so very very close to kidding tonsils, a tongue much to large (especially by width) for his mouth, has a funny sound to his voice (of which I can’t tell if it’s from his tongue or his extremely large tonsils) and is a complete mouth breather (awake or asleep). I wish you could hear him speak, I’d bet you would know immediately what the cause and solution both are! I really think it sounds like it stems from the back of his throat.

    #1 – Would removing his tonsils help with his breathing in general?
    #2 – If so, could we re-train him to be a nose breather?
    #3 – Would it help with his obstructive sleep apnea?
    #4 – Would it help with the way his speech sounds?

    I know you can’r answer these for certain, I’m looking for possibilities & probabilities or even some percentages (within his age group or an age group close to his).

    He really only gets sick one to three times a year, so sickness, sore throats or steep are no longer issues or concerns. The concern(s) is having such a small entrance/access to his airway. He once got a tooth infection that sent us to the ER. It was after hours and he was having significant trouble breathing…because it was his bath tooth and there was swelling the staff immediately went into action noticing his airway was almost blocked. Maybe I’m wrong, I’m certainly not a physician or a dentist, but I’d be willing to surmise, had his tonsils not be so large naturally, the tooth/gum inflammation wouldn’t have posed a situation the hospital team called life or death. All I knew was I could tell he wasn’t able to breathe; he was trying to hide his fear but I could see it so I said we were going to the ER whether he liked it or not. I was not taking no for an answer, he’s never scared! He may not “want” to go or “feel” like going but that is different than fear! His thought…,”what can they do for me, they don’t have a dentist on staff”??? I said we”‘ll have to go to see, now won’t we?

    I know you cannot diagnose, treat or recommend treatment without having examined the patient, but I figured I would give you too much information rather than not enough; I thought maybe I might be more apt to get some of the answers I was searching for earlier in the post.

    ANY information will be helpful at this point!

    Thank you for your time, review and consideration. I really do appreciate it!

  133. Steven Park on December 19th, 2014 5:51 am

    Ms. Herriman,

    Thanks for sharing. Your husband sounds like he may have classic obstructive sleep apnea. In answer to your questions:

    #1 – Would removing his tonsils help with his breathing in general? It may help, but not completely, since he will likely have other areas of blockage.
    #2 – If so, could we re-train him to be a nose breather? Most people with OSA have nasal congestion due to deviated septum, turbinate inflammation, and flimsy nostrils. This has to be taken care of medically or surgically as well. I often perform nasal surgery along with tonsillectomy.
    #3 – Would it help with his obstructive sleep apnea? Perhaps somewhat, he may have other areas of obstruction, such as his nose and tongue. Nasal surgery can help with CPAP effectiveness.
    #4 – Would it help with the way his speech sounds? Hard to say, but in many cases, it does improve.

  134. Steven Park on December 19th, 2014 5:53 am


    There are a number of different reasons for bad breath. One reason related to tonsils is tonsillitis, or stones. She should consider seeing an ENT for a full evaluation.

    Good luck.

  135. diego on January 6th, 2015 1:45 pm

    Dear Dctr.
    I’m 35 and Just had my tonsils removed yesterday. They were giving me problems like bad breath because of tonsil stones. Horrible breath.And now after surgery i notice that taste and smell is gone thank god. But ive also noticed that my post nasal drip now is worse. I figure before the surgery my tonsils were absorving the drip and now The drip getS stacked in the back of my throat. Still i rather this than the horrible breath. My question would be Whats the risk of post nasal driping down my throat and swallowing it or beathing it?
    thanks very much Dctr

  136. Steven Park on January 6th, 2015 9:41 pm


    Since you just had surgery, a number of different things will happen. Please give it a few weeks to months and it’s likely to improve with time. Good luck.

  137. Ms. Bell on January 22nd, 2015 9:14 pm

    Dear Dr. Park, I am a 58yr old woman who needs to have my tonsils removed. They are very large. I have had sleep apnea since childhood and have a cpap. the large tonsils are the cause of this, say the Doctors. I am in good physical shape and the Apnea is not due to being overweight , as mine is 115. the concern is that I have bean a smoker for 30+ years. Should I be considering this operation?

  138. Steven Park on January 23rd, 2015 6:30 am

    Ms. Bell,

    I can’t say whether you need you tonsils removed without examining you, but in general, there’s no absolute contraindication or tonsils, regardless of your age or smoking status. In theory, it should be helpful, but not likely cure your sleep apnea completely.

  139. H. Madsen on January 24th, 2015 10:59 pm


    I was just wondering about the likelihood of a doctor performing a somewhat-elective tonsillectomy. I say ‘somewhat’-elective because while I feel that the multiple holes in my tonsils and subsequent tonsil stones are affecting my quality of life (if I do not clean them out constantly, it can start to feel like I am choking; I have woken up in the middle of the night gagging from the tickling sensation), my GP has told me that this is not enough cause for the procedure. At this point, I’m nearly desperate. Do they perform tonsillectomies in Mexico? :-/

    Thanks in advance!

  140. Steven Park on January 25th, 2015 11:01 am


    What you’re describing is called tonsillitis, or stones. It’s a legitimate indication for tonsillectomy. I’m sure it’s available in Mexico.

  141. Hannah on February 18th, 2015 7:27 pm

    My son, seven years old, has been diagnosed with sleep apnea and the ENT specialist has recommended removal of his enlarged tonsils. Before going ahead with surgery which always carries some risk, I have consulted a naturopath who has identified several food allergies. Do you think avoiding certain foods is a legitimate alternative to surgery, i.e. in the way of scientific evidence?

  142. Steven Park on February 19th, 2015 10:06 pm


    There’s no doubt that any kind of allergies (environmental or food) can cause additional inflammation in the upper airway, leading to enlarged tonsils and obstructed breathing. It’s worth a try. However, even if your son feels better, it’s important to get a follow-up sleep study to make sure that the sleep apnea is controlled. In my experience, allergy control works sometimes, but it’s hard to predict when it will work or to what degree.

  143. Jemma on March 2nd, 2015 1:02 pm

    I am 14 years old, and I had my tonsils out yesterday. My surgeon said it went very well, so I went home the same day. (He suggested staying overnight, but I told him I’d prefer to go home, and he said it was fine.)
    I managed to eat a whole ham sandwhich in the hospital (it was pretty good c: ), plenty of ice blocks, some juice (though it kinda irritated my throat), and a tiny bit of banana.
    They have a pain level rating from 1 – 10. Not moving my mouth at all was a 0, speaking was a 3, and swallowing was a 5.
    Eating that banana, it shot up to a ten. I couldn’t even speak, and when my mum asked what was wrong, I held up ten fingers. Luckily I had a sleep in the hospital and woke up feeling a bit better.
    That isn’t my main concern, I just felt like adding it in.
    I am feeling fine now at home, but my balance seems to be off. I was told ear pain was possible, and although I don’t feel any pain in my ears, is it possible that the surgery upset the fluid in my ears slightly? I tried a google search but didn’t get any clear results.
    Also, I’ve noticed that the spot where my tonsils used to be is yellow and slimy looking. I know this is normal, but is it on the second day?
    Sorry – I’m a bit of a hypochondriac! But I’m definatley not squeamish, as I took my tonsils home and put them in the fridge! :3 My parents can’t even look at them. Will keeping them in the fridge keep them fresh? Or can I have them sitting around at room temperature and not fear them rotting. They’re sitting in saline, but I’m no professional with chemistry stuff so I don’t know how to take care of them. I know eventually they’ll probably go off, but I want to make the most of them before they get all yuck.
    By the way – I had my tonsils out due to repetitive and annoying tonsil stones. I was also self conscious of the bad breath it caused. Because, you know, what if my crush goes in for a kiss? d:
    Just kidding, haha!
    Thanks so much for your information and even after a few years, you still respond to questions! What a lovely person you must be.

  144. shawn on March 2nd, 2015 2:40 pm

    Hello there,

    I noticed a change in my breath (or i should say, i noticed that other people noticed that i have bad breath) I’ve tried all kinds or mouth washes and tongue brushes.
    I’ve read alot of blogs and responses about people who tried all these things and come to find out it was their tonsils that was causing it. I’ve gone to 2 different ENT’s and they both said that the deep pockets in my tonsils could be the cause (neither smelled my breath) but wasn’t sure. They both said they could perform the surgery to remove my tonsils but couldn’t guarantee that it would cure the problem. I’ve ruled out the dental aspect of possibly being the problem, so i have scheduled the surgery for next week. I’m wondering if my tonsils is not the problem what else could it be? I’m about to take 2 weeks off of work and $1700 later and i want to know are there other test i should consider.

    Thank you for your time!

  145. shawn on March 2nd, 2015 2:41 pm

    its been about 4 years now, and I finally have the money and the courage..

  146. Dahlia on March 26th, 2015 9:41 am

    My son has been suffering from trouble breathing during his sleep ( ie sleep apnea – but no sleep study confirming this because of his age) since he was 10 months old. It started when he started to Teeth and had a runny nose, his nose is like a open water faucet since then. Nothing stops it except antibiotics , he has been on antibiotcs 6 times in the last 6 months. An X-ray showed his adenoids are quite large and there is hardly enough room for airway passage. He is always a mouth breather even during the day. His pediatric ENT has recommended for him a T&A surgery. He is now 18 months old. Please advise and tell me your opinion. Thank you!

  147. crystal on April 3rd, 2015 6:41 pm

    My 4 year old daughter just had her tonsils and adnoids removed due to 2 seizures and chronic sleep apnea but she has had a persistent cough since getting them out is. That normal to cough a lot

  148. Ms. Thomas on May 2nd, 2015 9:48 pm

    I had a very sore throat for three weeks with stabbing pain and difficulty talking and breathing. Dr said I was strep negative and the culture was negative too. Prescribed antibiotics for 7 days. Symptoms not as bad, after the treatment but still had pain in the throat. Next used a medrol pack and 10 day antibiotics. Pain not resolved yet and throat still hurts and difficulty swallowing and speaking. Your opinion will be appreciated.

  149. Alva L. Storli on May 14th, 2015 7:46 pm

    Hi, I’m 28 days post op, and I just came over this article about tonsillectomy in relation to ADHD which of course I had no idea about before removing my tonsils, and which of course I have. (ADHD) I’ve also been troubled with sleep apnea, and acid reflux problems for years. I’m currently 23. So I’m really excited about this news, and looking forward to see if it makes a change in my sleep and concentration. My main concern is that I seem to have lost my gag reflex. Is this normal? After i noticed I’ve really made an effort to try an make my self vomit just to test it, and no luck. Will it get back? Don’t i need my gag reflex in case of anything dangerous? Or should i just be happy I don’t almost vomit every time i brush my teeth any more?

    Thank you for an amazing and informative article doctor.

    Kind regards.


  150. Steven Park on May 14th, 2015 10:08 pm


    Thanks for sharing your story. Research studies average all comers, so as they say…results may vary. It’s too premature to say if you’re going to feel better, as it can take many months to notice anything. Regarding your gag reflex, it’s not normal to gag every time you brush your teeth. It may be a good thing. Good luck, and please keep us posted.

  151. Alva L. Storli on May 15th, 2015 8:50 am

    Thank you for your reply, I’m glad the gag reflex is gone then, and I’m looking forward to see if I’m one of the lucky ones with good results. I’ll definitely keep you posted!

  152. shannon on September 4th, 2015 6:27 pm

    So I had absolutely no gag reflex before my tonsillectomy,but acquired one afterwards. Ive tried researching why this could happen but have always come up blank. Any explanation would be appreciated.

  153. imran akhtar on September 9th, 2015 5:44 am

    Thank you sir for your wonderful article. But i have one major problem. The problem is that i had tonsillectomy in the age of 19. The reason for tonsillectomy was that i always had sore tonsils that cannot be corrected even i take strong medicines, therefore i had tonsillectomy. Now the condition is that i always have allergy in my tonsils and runny nose, mostly 4 a.m in the morning, . i have ignored all the food which makes allergy. But still i have this problem. Kindly please guide me how to remove allergy for ever.

  154. Jeannie on September 25th, 2015 2:41 pm


    I had sinus surgery, deviated septum surgery and tonsil surgery two months ago. My ENT doctor decided to cut my tonsils and uvula down to help with snoring and because I had large tonsils. Now my right tonsil is swollen larger than it was before I had the surgery and he wants to go ahead and remove both tonsils. Why wouldn’t he have just removed them to begin with? He thinks there might be some type of infection deep down inside of the tonsil, it sucks that I am going to have to go through this again.

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