Tonsils: when is it time to take them out?

Mandeln entfernen: Wann ist es sinnvoll? Mandeln entfernen: Wann ist es sinnvoll?

Tonsil surgery has no long-term effects. Or so we have always believed. But a major study has now cast doubt on this belief. Be that as it may, it's still worth thinking long and hard about this operation.

Part of the immune system

The tonsils and adenoids play an important role in the human body. As part of the immune system, they immediately and reliably fight off germs. But they can also be the source of problems. If they become enlarged or repeatedly inflamed, they are often removed.

Until now, it was assumed that a tonsillectomy had no negative impact on the patient's future health.
Séverine Niederer-Wüst, Chief Medical Officer (ENT) at St. Gallen Cantonal Hospital

However, a new, international study has now brought different findings to light. 1.2 million people were observed 10 to 30 years after they had been operated on as children. Of these, around 61,000 children who had their adenoids, tonsils or both removed in the first 9 years of life were found to be at greater risk of asthma and chronic obstructive pulmonary disorder (COPD).

Séverine Niederer-Wüst refuses to jump to any hasty conclusions. "This is an observational study that does not demonstrate any kind of cause and effect." She believes that too little attention has been paid to the underlying cause. For example, as children with respiratory infections, asthma or allergies are taken to see a specialist more often than healthy children, they are also more likely to be operated on. In these cases, they are genetically predisposed to the condition even before the operation. What is more, there are other factors that favour respiratory diseases – such as having parents who smoke. The study failed to look at this aspect.

Remove if certain criteria are met

Regardless of the findings of the study, the risks and benefits of the operation should always be weighed up beforehand. The former practice of removing the tonsils as a precaution has long been a thing of the past. Today's ENT doctors refer to the "Paradise criteria" before performing tonsillectomies.

According to these guidelines, an operation may be considered if children, young people or adults have had at least seven bacterial throat infections in the previous year. Or at least five episodes in each of the previous two years, or at least three episodes in each of the previous three years. An abscess in the surrounding tissue, tumours and suspected tumours – in which a tonsil often looks different or enlarged on one side – may also necessitate surgery.

Reduction rather than removal

Instead of removing the tonsils, they are nowadays often simply made smaller. This can help children with major breathing difficulties, for example. The advantages: the risk of secondary bleeding is lower, there is less pain after the operation and the tonsils retain their immunological function. However, in a very few cases, they can grow back or become inflamed again.

In children under seven, the adenoids often become enlarged. The main reason for removing them is to cure obstructive sleep apnoea syndrome, in which breathing stops and starts during the night. In these cases, doctors often remove the tonsils at the same time. An operation may also be worthwhile for children who have difficulty breathing through the nose, causing them to constantly breathe through the mouth. It also makes sense for middle ear infections or if hearing is impaired and this delays speech development.

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