Body Parts: Tonsils: Helpful, troublesome guardians

By: BRADLEY J. FIKES - Staff Writer | Saturday, January 13, 2007 7:05 PM PST ∞

Tonsils are guardians of health. Located on either side of the back of the throat, these sentinels are the first line of defense against microbes that enter the body through the nose or mouth.

Tonsils contain "lymphoid" tissue that harbors antibody-making cells called B cells and other white blood cells. The antibodies attack some common infectious bacteria. And the tonsils' activity alerts the rest of the body's disease-fighting immune system.

Unfortunately, these guardians are unreliable. Tonsils often get infected themselves, causing inflammation called tonsillitis. They can keep getting infected, with recurring sickness for the patient. That's when the surgeon gets called in and tonsils go, a procedure called a tonsillectomy.

Tonsils may be removed if they are so large they interfere with breathing when the person is asleep. Constant interruption of breathing while asleep, called sleep apnea, is potentially very serious. So once again, the tonsils' infection-fighting function is sacrificed.

Tonsils are most important in childhood, and these organs tend to shrink as people grow older.

Back in the 1940s and 1950s, an estimated half of American children had tonsillectomies. However, tonsillectomies aren't performed nearly as often today. That's because more is known about how the body's immune defenses work. The tonsils, being part of the immune system, may have benefits we don't fully understand.

Pediatricians are especially reluctant to recommend tonsillectomies. A 1977 article in the journal Pediatrics found that among California doctors, the children of pediatricians had a lower rate of tonsillectomies than the children of other doctors. This reluctance continues today.

Doctors are looking harder for evidence that treatments actually help patients. If there's not clear evidence the treatment is helpful, doctors are less likely to perform it. This is especially true in surgery. Even though tonsillectomies are safe as far as surgeries go, there can always be complications.

As for the evidence of tonsillectomy effectiveness, it all depends. According to medical journal articles, in certain cases, removing tonsils produces a clear benefit. But if patients don't fall into those categories, doctors will usually let the tonsils stay in.

A 2004 article in the journal BMJ recommended "watchful waiting" instead of tonsillectomies for children with moderately frequent throat infections (defined as about three in the last year). The study found that children with more frequent infections got some benefit from tonsillectomies, by having fewer throat infections.

Children who have had recurring strep throat infections benefit from tonsillectomies, according to a study by the Mayo Clinic published in the Nov. 2 issue of the medical journal Laryngoscope.

Showing that there's still much to be known about the tonsils, an April 2006 study from the University of Michigan found that children who had tonsillectomies had less hyperactivity, sleepiness and attention deficit/hyperactivity disorder. This was found to be true whether or not the children had sleep apnea.

The researchers, who published their findings in the journal Pediatrics, cautioned that their study, while suggestive, doesn't prove a cause-and-effect link between tonsillectomies and reducing those disorders. They are now starting a more extensive study.

Contact staff writer Bradley J. Fikes at (760) 739-6641 or bfikes@nctimes.com.

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