Medical Edge Newspaper Column

Removing Tonsils In Adults

January 28, 2008
Dear Mayo Clinic:
My 41-year-old son has bad tonsils. His tonsils swell and have white patches on them. He runs a temperature for several days. He's talked with several ear, nose and throat doctors but they don't want to take the tonsils out. I realize adults may take longer to heal than children, but is it more dangerous? Why are doctors so hesitant to remove tonsils in an adult?

Answer:
When other treatments don't help, neither children nor adults should have to put up with repeated bouts of tonsillitis - inflammation of the tonsils caused by infection. From the information you provided, it sounds like your son would be a candidate to have his tonsils removed.

In children, we typically don't consider removing the tonsils unless a child tests positive for strep throat four times a year or more. In adults, removing tonsils is considered with fewer episodes of infection. The most common reasons to remove tonsils in adults include recurrent infection, malodorous tonsil stones and snoring. Nothing makes tonsil removal more dangerous or difficult for patients your son's age. But you are correct that he would need to plan ample time for recovery. Adults tend to perceive the pain far more acutely than children. I tell adult patients to expect 10 to 14 days of serious downtime, with much of that time on narcotic-strength pain medication.

For both children and adults, tonsillectomies are performed less often than in the past. Tonsils used to be blamed for many different conditions, including skin problems, arthritis and other health problems. Tonsil removal was often the treatment. Today we know that tonsils are beneficial because they filter harmful bacteria and viruses that could cause serious health problems.

Most often, patients with tonsillitis don't need tonsil removal. When tonsillitis is caused by a viral infection, the first-line treatment is self-care — drinking warm liquids, resting, gargling with salt water and taking over-the-counter pain medication for fever. Antibiotics are prescribed when tonsillitis is caused by a bacterial infection.

I suggest that your son talk with his primary care doctor about his condition and ask for a recommendation for an ear, nose and throat physician who could work with him on an effective treatment plan that might include tonsillectomy.

— Ray Gustafson, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.