The second most common surgery for children is a tonsillectomy.
Results of tonsillectomies (removal of tonsils) have been disappointing in children, as it doesn’t significantly reduce the days of future pharyngitis (i.e. sore throat), nor absenteeism from school. Therefore, what used to be the standard of care to remove the tonsils, only occurs currently when tonsillitis occurs frequently (i.e. 7 or more infections annually), an abscess occurs and/or breathing is disturbed due to the increased size of the tonsils during an infection. The poor outcomes with childhood tonsillectomies made the successfulness of this surgery seem remote for adults.
However, prior to reviewing the results of the first study to look at adults, a background is necessary to understand what tonsils are, and why we have them.
The tonsils are two masses of lymph-type tissues located on either side of the back of the throat (i.e. pharynx). Adenoid tissues are located nearby; they can be found higher in the throat, behind the nose. Other lymph nodes, smaller in stature, also exist in one’s throat.
All the lymph nodes are extremely vascular (i.e. lots of blood vessels). This vascular quality allows the lymph nodes to rapidly circulate blood components which are required to fight off infections. Both the tonsils and adenoids are believed to fight infection by producing antibodies to bacteria that enter through the mouth and nose.
Usually, a slight infection occurs in one’s tonsils due to filtering out harmful germs which may enter the system. This infection alerts the white blood cells to ‘come to the scene of the emergency’ and release antibodies to fight the infection. However, sometimes the bugs are too strong and over-power the body’s normal health mechanisms. That is when tonsillitis results.
So what does all of this have to do with adults who still have tonsils? Adults may also need tonsillectomies, especially if recurrent bouts with Streptococcus A (strep A). Eighty-five percent of tonsillitis is due to a virus, which will resolve itself. In some cases, tonsillitis may also be due to mononucleosis, cold sores, or the flu. But in a few people, the cause is bacteria, namely strep A. Strep A only resolves with antibiotics. It also has very serious consequences if not treated, or if treatment is postponed. Two diseases in particular are important to cite, as they have death-life consequences: glomerulonephritis which affects the kidneys and rheumatic fever which affects the heart. Additionally, it is strep A which is more likely to result in abscesses.
Therefore, adults who have tonsillitis caused by strep A are considered for surgery, if these infections occur frequently. Therefore, it is important to know whether surgery has long term benefits, not seen with children. Or, does one continue to get strep A infections of the throat?
Results of the recent study indicated that tonsillectomy did improve the rate of recurrence of streptococcal pharyngitis. No adverse events were seen with the 90 patients reviewed. Postoperative throat pain existed for 13 days only.
Although larger studies are needed to be conclusive, and patients need to be reviewed for a longer period of time, these results are very hopeful that a potentially dangerous infectious can be eliminated.
National Institute of Allergy and Infectious Diseases (NIAID)
Office of Communications & Public Liaison
6610 Rockledge Drive, MSC6612
Bethesda, MD 20892-6612
Phone: 301-496-5717
http://www.niaid.nih.gov/
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