Overview
Why Tonsillectomy Is Performed
Tonsillectomy removes the palatine tonsils when their disease burden or contribution to upper airway obstruction outweighs the operative risk.
Tonsillectomy removes the palatine tonsils when their disease burden or contribution to upper-airway obstruction outweighs the operative risk. Common indications include well-documented recurrent throat infection, obstructive sleep-disordered breathing, recurrent peritonsillar abscess, and asymmetric or otherwise suspicious tonsillar enlargement. For recurrent throat infection, surgery should not be based on a vague history of “frequent sore throats.” The episodes should be documented and clinically qualifying. Watchful waiting is generally favoured when there are fewer than 7 episodes in the preceding year, fewer than 5 episodes per year for 2 consecutive years, or fewer than 3 episodes per year for 3 consecutive years. Meeting or exceeding those thresholds supports a shared decision about tonsillectomy; it does not make surgery automatic. When obstruction is the indication, ask what happens during sleep: loud or worsening snoring, witnessed pauses, gasping, restless sleep, unusual sleep positions, daytime behavioural change, or excessive sleepiness. Symptoms can be more informative than tonsil size alone. Polysomnography is used selectively, particularly when the history and examination do not agree or when conditions such as obesity, craniofacial differences, neuromuscular disease, Down syndrome, or...