Tonsillectomy: Tonsilloliths, Pandas, and Other Great Band Names

January 31, 2019

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I can’t tell you how many times people at parties find out that I’m an ENT and have me look at their tonsils. I can’t tell you because you’re already bored. (Look at you, already thinking about checking Facebook. Maybe you need that Screen Time app.)

So let’s just jump in. When should you get your tonsils out? There are about 3 main reasons.

The first is that you’re snoring. Man, do you snore. You are keeping everybody up, and if your bedroom had a Yelp review it would be one star because, “Idk, the floor was clean, but like, there was a train going by or something lol.” If you’re snoring like that, then that’s a pretty good reason to get a sleep study to check for sleep apnea, and sometimes taking your tonsils out is a good treatment for sleep apnea. If you’re thinking about your kid, then our threshold is even lower. If that kid is snoring every night or stopping breathing at night sometimes, then we can take those tonsils out, and we feel pretty confident that will cure most kids’ sleep apnea. Sometimes kids need a sleep study too, sometimes they don’t. It depends on the story and the situation and how convinced we are that the kid really does have sleep apnea.

The second is that you have trashy tonsils. That is the medical term for it. You have tonsil infections all the time, or you have chronic tonsil pain, or you’ve had an abscess in or around your tonsil that had to be drained by a doctor yelling at you to keep your mouth open and keep still while he waves sharp instruments around your mouth. Particularly with kids, there are formalized criteria. The recommendations from our academy are to take tonsils out when there have been 7 documented episodes of tonsillitis in the last year, 5/year for the last two years, or 3/year for the last 3 years. There are a few other extraneous circumstances that would push us to be more aggressive, for instance if the kid has allergies to multiple antibiotics or something by the non-catchy title of PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis. It sounds like a penguin cursing).

The third is a grab-bag of other reasons. Some tonsils can be so big that they actually cause trouble swallowing. There are infrequent times when we have to take them out because we’re concerned about cancer. There’s something called PANDAS that’s not nearly as cute as it sounds.

“BUT WHAT ABOUT MY TONSIL STONES???” you’re yelling at me while showering the screen with smelly pearls from your mouth. (Man, you have some issues with anger. Maybe you should try that Headspace app. I’ve heard good things.) Your tonsil stones are called Tonsilloliths—that is the scientific name for them. They are not an absolute reason to get your tonsils out, if you don’t have any of the above reasons. I will often try to get patients to try using a water pick (what your grandma used to clean her teeth) to try to clean their own tonsils in the mirror. No, I don’t want you sticking a rusty clothes hanger back there to pry the little stones out. Yes, that obviously hurts, and you should stop doing it. If it’s gotten to that stage, then sometimes I will take the tonsils out for that reason. You just need to know the recovery from taking your tonsils out is not so much fun, and it usually requires at least a week off work.

Your tonsils are beautiful. Really, they’re your number one quality. If you can keep them, you should. But if you have any of those issues above, then you should see your ENT doctor to get a tonsillectomy.