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/or 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'.)
- Rosenfeld RM, Green RP. Tonsillectomy and adenoidectomy: changing trends. Ann Otol Rhinol Laryngol 1990; 99:187.
- Hall MJ, Lawrence L. Ambulatory surgery in the United States, 1996. Adv Data 1998; :1.
- Owings MF, Kozak LJ. Ambulatory and inpatient procedures in the United States, 1996. National Center for Health Statistics. Vital Health Stat 1998; 13:139.
- Darrow DH, Siemens C. Indications for tonsillectomy and adenoidectomy. Laryngoscope 2002; 112:6.
- Hoddeson EK, Gourin CG. Adult tonsillectomy: current indications and outcomes. Otolaryngol Head Neck Surg 2009; 140:19.
- Bisno AL. Acute pharyngitis. N Engl J Med 2001; 344:205.
- McIsaac WJ, Kellner JD, Aufricht P, et al. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA 2004; 291:1587.
- Sadeghi-Shabestari M, Jabbari Moghaddam Y, Ghaharri H. Is there any correlation between allergy and adenotonsillar tissue hypertrophy? Int J Pediatr Otorhinolaryngol 2011; 75:589.
- Akcay A, Tamay Z, Dağdeviren E, et al. Childhood asthma and its relationship with tonsillar tissue. Asian Pac J Allergy Immunol 2006; 24:129.
- Proenca-Modena JL, Pereira Valera FC, Jacob MG, et al. High rates of detection of respiratory viruses in tonsillar tissues from children with chronic adenotonsillar disease. PLoS One 2012; 7:e42136.
- Koskenkorva T, Koivunen P, Koskela M, et al. Short-term outcomes of tonsillectomy in adult patients with recurrent pharyngitis: a randomized controlled trial. CMAJ 2013; 185:E331.
- Alho OP, Koivunen P, Penna T, et al. Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial. BMJ 2007; 334:939.
- Hsu AP, Tan KL, Tan YB, et al. Benefits and efficacy of tonsillectomy for recurrent tonsillitis in adults. Acta Otolaryngol 2007; 127:62.
- Senska G, Ellermann S, Ernst S, et al. Recurrent tonsillitis in adults: quality of life after tonsillectomy. Dtsch Arztebl Int 2010; 107:622.
- Baumann I, Kucheida H, Blumenstock G, et al. Benefit from tonsillectomy in adult patients with chronic tonsillitis. Eur Arch Otorhinolaryngol 2006; 263:556.
- Ovesen T, Kamarauskas A, Hlidarsdottir T, et al. Good long-term results after tonsillectomy in ear, nose and throat practices. Dan Med J 2013; 60:A4637.
- Witsell DL, Orvidas LJ, Stewart MG, et al. Quality of life after tonsillectomy in adults with recurrent or chronic tonsillitis. Otolaryngol Head Neck Surg 2008; 138:S1.
- Paradise JL, Bluestone CD, Bachman RZ, et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N Engl J Med 1984; 310:674.
- Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011; 144:S1.
- Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012; 55:1279.
- Herzon FS. Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines. Laryngoscope 1995; 105:1.
- Johnson RF, Stewart MG, Wright CC. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg 2003; 128:332.
- Kaplan EL. The group A streptococcal upper respiratory tract carrier state: an enigma. J Pediatr 1980; 97:337.
- Rezk E, Nofal YH, Hamzeh A, et al. Steroids for symptom control in infectious mononucleosis. Cochrane Database Syst Rev 2015; :CD004402.
- Chan SC, Dawes PJ. The management of severe infectious mononucleosis tonsillitis and upper airway obstruction. J Laryngol Otol 2001; 115:973.
- Windfuhr JP, Chen YS, Remmert S. Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg 2005; 132:281.
- Sunkaraneni VS, Jones SE, Prasai A, Fish BM. Is unilateral tonsillar enlargement alone an indication for tonsillectomy? J Laryngol Otol 2006; 120:E21.
- Spinou C, Kubba H, Konstantinidis I, Johnston A. Role of tonsillectomy in histology for adults with unilateral tonsillar enlargement. Br J Oral Maxillofac Surg 2005; 43:144.
- Cinar F. Significance of asymptomatic tonsil asymmetry. Otolaryngol Head Neck Surg 2004; 131:101.
- Bisht M, Bist SS. Human papilloma virus: a new risk factor in a subset of head and neck cancers. J Cancer Res Ther 2011; 7:251.
- Zautner AE. Adenotonsillar disease. Recent Pat Inflamm Allergy Drug Discov 2012; 6:121.
- Delanghe G, Ghyselen J, van Steenberghe D, Feenstra L. Multidisciplinary breath-odour clinic. Lancet 1997; 350:187.
- American Academy of Otolaryngology-Head and Neck Surgery. Clinical indicators: tonsillectomy, adenoidectomy, adenotonsillectomy. 2000 Available at www.entnet.org/practice/products/indicators/tonsillectomy.html. (Accessed December 21, 2008).
- Rio AC, Franchi-Teixeira AR, Nicola EM. Relationship between the presence of tonsilloliths and halitosis in patients with chronic caseous tonsillitis. Br Dent J 2008; 204:E4.
- Al-Abbasi AM. Tonsillectomy for the treatment of halitosis. Niger J Med 2009; 18:295.
- 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
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS