7 Sleep Apnea Surgery Myths On The Internet, Debunked

#2: Tonsils and Adenoids Can Grow Back After Surgery

Re-posting an article from 5/5/16.
Amy felt great a few weeks after undergoing tonsillectomy for mild obstructive sleep apnea. She was sleeping better and was able to focus again in school. This lasted about 2 years, but her symptoms of fatigue, brain fog, and sleepiness slowly started to come back. It wasn’t to the same degree as before her surgery, but she felt a difference from just after surgery.
When I looked at her mouth, her tonsils did seem slightly enlarged. Before surgery, they were touching in the midline (called kissing tonsils). Now they were about 10-20% enlarged, especially in the highest part of the tonsil bed, near the soft palate. 
One of the most common questions I get from patients when I propose tonsillectomy is if tonsils can grow back after surgery. My general answer is that yes, in theory, but the overall chances are very small. It really depends on two main variables: how completely the tonsils were originally removed, and whether or not you have persistent inflammation that can cause additional swelling. 
In the old days, surgeons used to take out the entire tonsil, including the capsule that surrounds the tonsil on the sidewall of the throat. This was done for recurrent tonsillitis or for sleep apnea. With advances in technology, we can now shave down about 95% of the tonsils (sub-capsular or partial tonsillectomy), leaving a very thin cuff of tonsil tissue next to the capsule. This has been found to be relatively equivalent to total (extra capsular) tonsillectomy for obstructive sleep apnea, as well as being slightly less painful with with faster recovery. 
However, if you have persistent sources of inflammation, then any remaining tonsil tissues can slowly get bigger. This can aggravate more obstructed breathing, leading to more stomach juices being suctioned up into the throat, causing more tonsil swelling. Your tonsil tissues are made of lymphoid tissues, which helps educate your immune system and fight infections. In addition to your two tonsils, you also have adenoids (behind the nose) and lingual tonsils in the back of your tongue, just on top of your voicebox. Additionally, you have countless lymph nodes spread throughout your entire body.
Here’s what the research says:
Of 636 children (age < 11) who underwent partial tonsillectomy using Coblation technology, 33 patients (5%) had regrowth. Of these 33 patients, 5 needed repeat surgery due to recurrent symptoms. Of note, these 5 children’s age ranged from 1 to 3 years (1). Other studies found tonsil regrowth after partial tonsillectomy ranging from 6 to 17% (2,3). In most cases, patients did not feel any worsening of symptoms. As far as I can tell, there are no studies on rates of regrowth after total tonsillectomy. 
Adenoid tissues are more likely to come back, since it’s impossible to remove 100% of adenoid tissues (there’s no capsule). Investigators from Temple University found that 2 to 5 years after adenoidectomy, 46 out of 175 patients (26%) had symptoms of nasal congestion. Of the children who agreed to nasal endoscopy, not one patient had more than 40% regrowth, and about 70% had only trace or minimal degrees of regrowth (4). Another study from the Mayo clinic looked at 163 revision adenodectomies out of 8245 original cases. Initial younger age at surgery, presence of ear infections, and signs of acid reflux were significant risk factors for patients needing repeat adenoid surgery. Surgical technique, surgical experience, or the presence of allergies were not significant risk factors for needing repeat surgery (5). A third study found that about 13% of children had adenoid regrowth, but most were asymptomatic (6).
Lingual tonsils are not commonly taken out, and sometime can be a major source of obstructed breathing, Not surprisingly, the presence of acid reflux was strongly correlated to lingual tonsil size (7).
If you’re considering tonsil or adenoid surgery for yourself or your child, the good news is that for the vast majority of patients, tonsils and adenoids don’t grow back, but even if it does, it won’t cause any problems. Rarely do you have to go back to repeat the surgery.
What are your experiences with tonsil or adenoid regrowth? Did you have to go back to the operating room again?
1. Doshi, H. K., Rosow, D. E., Ward, R. F., & April, M. M. (2011). Age-related tonsillar regrowth in children undergoing powered intracapsular tonsillectomy. International journal of pediatric otorhinolaryngology75(11), 1395-1398.
2. Zhang, Q., Li, D., & Wang, H. (2014). Long term outcome of tonsillar regrowth after partial tonsillectomy in children with obstructive sleep apnea. Auris Nasus Larynx41(3), 299-302.
3. Çelenk, F., Bayazıt, Y. A., Yılmaz, M., Kemaloglu, Y. K., Uygur, K., Ceylan, A., & Korkuyu, E. (2008). Tonsillar regrowth following partial tonsillectomy with radiofrequency. International journal of pediatric otorhinolaryngology72(1), 19-22.
4. Buchinsky, F. J., Lowry, M. A., & Isaacson, G. (2000). Do adenoids regrow after excision?. Otolaryngology–Head and Neck Surgery123(5), 576-581.
5. Dearking, A. C., Lahr, B. D., Kuchena, A., & Orvidas, L. J. (2012). Factors associated with revision adenoidectomy. Otolaryngology–Head and Neck Surgery, 0194599811435971.
6. Kim, S. Y., Lee, W. H., Rhee, C. S., Lee, C. H., & Kim, J. W. (2013). Regrowth of the adenoids after coblation adenoidectomy: cephalometric analysis. The Laryngoscope123(10), 2567-2572.
7. DelGaudio, J. M., Iman, N., & Wise, J. C. (2008). Proximal pharyngeal reflux correlates with increasing severity of lingual tonsil hypertrophy. Otolaryngology–Head and Neck Surgery138(4), 473-478.

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 *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

One thought on “7 Sleep Apnea Surgery Myths On The Internet, Debunked

  1. Appreciate the info/resources on the site. Thanks. I did have a follow-up question: “What is the risk/harm of having to repeat a tonsillectomy?” Aside from the obvious like recovery, cost, general risk associated with any surgery, etc. Depending on the rate of regrowth if a person has to have 2-3 surgeries in their lifetime …. seems worth it compared to the downsides of OSA?