Tonsillectomy in adults: Indications
- Nicholas Busaba, MD, FACS
Nicholas Busaba, MD, FACS
- Associate Professor of Otology and Laryngology (part-time)
- Harvard Medical School
- Shira Doron, MD
Shira Doron, MD
- Associate Professor of Medicine
- Tufts University School of Medicine
- Section Editors
- Mark D Aronson, MD
Mark D Aronson, MD
- Editor-in-Chief — Primary Care (Adult); Hospital Medicine
- Section Editor — General Medicine
- Professor of Medicine
- Harvard Medical School
- Daniel G Deschler, MD, FACS
Daniel G Deschler, MD, FACS
- Section Editor — Otorhinolaryngology
- Professor of Otology and Laryngology
- Harvard Medical School
The number of tonsillectomies performed in the United States peaked around 1959 with 1.4 million operations, the majority being performed in children. The rate decreased to 500,000 in 1979 and to 380,000 in 1996 [1,2]. Approximately 130,000 of the tonsillectomies performed in 1996 were for individuals over 15 years of age .
The literature regarding indications for tonsillectomy is largely focused on children. The extent to which pediatric data can be reliably extrapolated to older patients is unclear.
This topic will review indications for performing tonsillectomy in adults. Tonsillectomy procedural techniques and complications in adults, evaluation of the adult with pharyngitis, treatment and prevention of streptococcal tonsillopharyngitis, and tonsillectomy in children are discussed separately. (See "Tonsillectomy in adults" and "Evaluation of acute pharyngitis in adults" and "Treatment and prevention of streptococcal tonsillopharyngitis" and "Tonsillectomy and adenoidectomy in children: Indications and contraindications".)
Tonsils are lymphoid tissue. The lymphoid contents are covered by respiratory epithelium that can invaginate and cause crypts. The common term "tonsils" refers specifically to the palatine tonsils. Waldeyer's ring, a ring of lymphoid tissue in the pharynx, is formed by the palatine tonsils, as well as the pharyngeal tonsils (adenoids), tubal tonsils, and lingual tonsils (figure 1 and figure 2).
Tonsillar crypts can harbor bacteria. Solidified "plugs" may form within the crypts, and are termed tonsilloliths ("tonsil stones"). These often have a foul smell and can contribute to bad breath. (See "Bad breath", section on 'Tonsils'.)
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- PHARYNGEAL ANATOMY
- RECURRENT AND CHRONIC PHARYNGOTONSILLITIS
- Criteria for surgery
- OTHER POSSIBLE INDICATIONS
- - Peritonsillar abscess
- - Streptococcal carrier state
- - Infectious mononucleosis
- Suspected malignancy
- - Asymmetric tonsils
- - Unknown (occult) primary
- - Obstructive sleep apnea
- - Halitosis
- SUMMARY AND RECOMMENDATIONS