What Everyone Should Know About Tonsillectomy

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.

Please note: I reserve the right to delete comments that are offensive or off-topic.

Leave a Reply

Your email address will not be published. Required fields are marked *

177 thoughts on “What Everyone Should Know About Tonsillectomy

  1. 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,
    Krista

  2. 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..

  3. 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 :)

  4. Jodi,

    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.

  5. Krista,

    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.

  6. 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?

  7. Shannon,

    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.

  8. 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?

  9. Kim,

    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.

  10. 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.

  11. Angela,

    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.

  12. 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!!

  13. CB,

    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.

  14. 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?

  15. 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

  16. Fran,

    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.

  17. 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.

  18. 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

  19. Mandy,

    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.

  20. 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?

  21. Mabel,

    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.

  22. 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.

  23. Rene,

    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.

  24. 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.

  25. 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???

  26. 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?

  27. Ashley,

    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!

  28. 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.

  29. 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.

  30. 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.

  31. 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.

    Questions…
    #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!

  32. 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.

  33. Betty,

    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.

  34. 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

  35. Diego,

    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.

  36. 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?

  37. 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.

  38. Hello,

    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!

  39. H.Madsen,

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

  40. 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?

  41. Hannah,

    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.

  42. Hello!
    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.
    -Jemma

  43. 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!

  44. 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!

  45. 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

  46. 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.

  47. 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.

    Alva

  48. Alva,

    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.