In the past, removing tonsils was a common procedure for children. No one thought much of it; it was almost like a rite of passage through childhood, like braces or removing wisdom teeth. Of course, the procedure can be scary for young children, but the promised ice cream and movies can help sweeten the recovery period. Some people may look back on those days nostalgically or maybe with a little pain or perhaps not at all. At the time, after all, it wasn’t an odd procedure to have, it was something many had in common with their siblings, friends, and classmates.
However, recent research has discovered that perhaps some doctors were a little too quick to prescribe tonsillectomies. Tonsillectomies that inadvertently created long-lasting health risks to the patients as adults.
What is a Tonsillectomy?
A tonsillectomy is one of the most common pediatric operations done worldwide. Over 530,000 children under the age of fifteen underwent this surgery every year in the USA.
Tonsillectomies are often done alongside adenoidectomies, which removes the adenoids to improve breathing by unblocking airways.
Since adenoids shrink by adulthood, many doctors used to believe these tissues were redundant for the overall function of the body. However, this has been proven incorrect. Since adenoids and tonsils are positioned in the nose and throat, they act as the first line of defense against airborne pathogens, like viruses and bacteria, and they initiate the immune system to clear these away before they affect the body.
The surgery removes the tonsils, two pads of tissue in the back of the throat, one on each side. Historically, it was prescribed to treat infected and inflamed tonsils (also known as tonsillitis) but nowadays it’s usually used for sleep-disordered breathing and recurring cases of tonsillitis that can’t be treated with any other method. 
Long-Term Health Risks Following Childhood Tonsillectomies
A study examined almost 1.2 million children who had their adenoids or tonsils removed and found that this associated with a higher risk of respiratory, allergic, and infectious diseases. University of Melbourne researcher Dr. Sean Byars and Professor Jacobus Boomsma from the University of Copenhagen led the study with Professor Stephen Stearns from Yale University.
The participants consisted of 1,189,061 Danish children born between 1979 and 1999. They were evaluated in national registers up to 2009, which essentially covered the first 10–30 years of their lives. Their tonsils or adenoids were removed within the first nine years of their lives.
Of the participants, 17,460 underwent adenoidectomies, 11,830 tonsillectomies, and 31,377 adenotonsillectomy; 1,157 684 were in the control group. Otherwise, all of the children were healthy. 
“We calculated disease risks depending on whether adenoids, tonsils or both were removed in the first 9 years of life because this is when these tissues are most active in the developing immune system,” said Dr. Byars. “This age was chosen because it captures when these surgeries are most commonly performed and also when tonsils and adenoids are most active in the body’s immune responses and development.”
The results showed that:
- Tonsillectomy was associated with triple the relative risk for diseases in the upper respiratory tract, like asthma, the flu, pneumonia, and COPD.
- Adenoidectomy was associated with more than a doubled the relative risk for COPD and almost doubled the relative risk for upper respiratory diseases.
“The association of tonsillectomy with respiratory disease later in life may, therefore, be considerable for those who have had the operation,” said Professor Boomsma.
Statistically speaking, the researchers found that one in five people who had tonsillectomies would end up with an upper respiratory disease.
The team also looked into the conditions these surgeries were supposed to treat to evaluate their effectiveness. The results were mixed.
- Adenoidectomies were associated with a reduced risk for sleep disorders.
- All surgeries significantly reduced the risk for further tonsil issues, given that the tonsils were removed.
- There was no change in abnormal breathing in those up to age 30.
- No change in sinusitis after the procedures.
- After adenotonsillectomy, the risk of otitis media (inflammation of the middle ear) and sinusitis showed a four to five increase. 
The researchers did note that there will always be a need to remove these organs with appropriate and severe cases.
“But our observed results that show increased risks for long-term diseases after surgery support delaying tonsil and adenoid removal if possible, which could aid normal immune system development in childhood and reduce these possible later-life disease risks,” said Dr. Byars.
“In 1870 Charles Darwin famously said that ” the appendix was a useless vestige of evolution, predicting it was too small to contribute to digestion in any meaningful way.” We now know it also has an important function in the immune system, protecting against gut infections by encouraging the growth of good bacteria. 
“As we uncover more about the function of immune tissues and the lifelong consequences of their removal, especially during sensitive ages when the body is developing, this will hopefully help guide treatment decisions for parents and doctors.” 
Questions About the Study
Drs. Nikhila Raol and Steven Goudy practice otolaryngology and teach at Emory University School of Medicine in Georgia. They agree that this report makes a good point to exercise caution when it comes to removing tonsils and adenoids.
“I think it’s commendable and admirable, but I don’t think it answers any real questions,” Raol said. “It shows a statistical significance but not a clinical one.”
One issue they raised is that no medical doctor participated in the study. A second is that the reasons behind the surgeries aren’t stated or taken into account. This is a glaring oversight since the findings should examine how the treatment worked (or didn’t) for those issues. Thirdly, the study doesn’t account for the differences between control groups and if all parties were truly identical.
Still, the number of tonsillectomies has gone down since the 70s and 80s. There are now guidelines to consider before these surgeries, such as the rate of recurring infections despite antibiotics, and breathing issues. The operation is usually suggested for kids who’ve had six or more bouts of tonsillitis a year, and for those suffering from sleep apnea.
Goudy states that deciding to go ahead with the surgery isn’t taken lightly between the parents and the doctors.
“Everything we do is shared decision-making,” he said. 
In summary, removing one’s tonsils can certainly be worth the risk if there are health issues that dictate it, such as painful and enlarged tonsils which decrease quality of life. Every case is different, and every individual detail should be taken into account before proceeding. 
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
- Mayo Clinic Staff. Tonsillectomy. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/tonsillectomy/about/pac-20395141 December 13, 2018
- Sean G. Byars, PhD; Stephen C. Stearns, PhD; Jacobus J. Boomsma, PhD. Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2683621
- University of Melbourne. Tonsil and adenoid removal associated with respiratory, allergic and infectious disease. Science Daily. Daily. https://www.sciencedaily.com/releases/2018/06/180607135151.htm June 7, 2018
- Dr Nerissa Hannink. What are the Long-Term Health Risks of Having Your Tonsils Out? University of Melbourne. https://pursuit.unimelb.edu.au/articles/what-are-the-long-term-health-risks-of-having-your-tonsils-out June 8, 2018
- Alex Matthews-King. Having tonsils out as a child increases risk of infections and lung complaints for life, finds study. Independent. https://www.independent.co.uk/news/health/tonsils-removed-throat-infection-colds-adenoids-surgery-childhood-allergies-asthma-a8387801.html June 7, 2018
- Carolyn Abate Why Removing Your Child’s Tonsils May Do More Harm Than Good. Healthline. https://www.healthline.com/health-news/removing-childs-tonsils-may-do-more-harm#7 June 14, 2018
- Kristin Hayes, RN. Tonsillectomy Risks vs. Benefits: Is It Worth It? Very Well Health. https://www.verywellhealth.com/tonsillectomy-risks-versus-benefits-is-it-worth-it-1192152 January 10, 2020