Why Don’t Doctors Perform Tonsillectomies Like They Used To?

Kids do still get their tonsils out—but only when it’s medically necessary.
The vast majority of tonsillectomies are performed on children.
The vast majority of tonsillectomies are performed on children. / aquaArts studio/E+/Getty Images

The surgical extraction of the tonsils was a hallmark of a 1950s childhood, alongside hula hoops, Howdy Doody, and bomb shelter drills. In 1959, the number of tonsillectomies performed in the United States reached a peak of 1.4 million. The vast majority were conducted on children. That number has slunk down to about 500,000 annually in recent years, though the number of Americans under age 18 has increased. 

So what happened to tonsillectomy as a rite of passage? 

In the first half of the 20th century, infectious diseases were a burning source of anxiety and a paramount concern of the medical establishment. Any parent could remember outbreaks of flu, typhoid, or polio. Antibiotics were in their infancy. 

The palatine tonsils—the lumps on the right and left sides of the back of the throat—were prone to a bacterial infection called tonsillitis. Some physicians saw them as “portals of infection,” an input for bacteria that could cause reoccurring infections across the body. Despite tonsils’ role in the immune system—they’re packed with white blood cells that help prevent pathogens from entering the body through the nose and mouth—a prevailing thought was that it was best to remove the them as a preventative measure.

This thinking has not held up to subsequent review. In the 1960s, Dr. Jack Wennberg, a Dartmouth College researcher who pioneered the practice of studying medical systems for differing results, came upon two neighboring towns in Vermont. Because of the recommendations of their respective pediatricians, in one town, 60 percent of children had their tonsils removed. In the other, it was 20 percent. There was no difference in childhood disease rates between them. (Some other scholars have blamed the eagerness and self-interest of surgeons for the prevalence of tonsillectomies.)

The National Institutes of Health convened a panel of experts and, in 1978, they concluded there wasn’t sufficient evidence to show that the benefits of a preemptive tonsillectomy outweighed the risks of surgery. Since then, the standard of care has been to perform a tonsillectomy only in response to a medical issue, like an infection that causes serious problems and does not respond to antibiotics. Many other nations have come to the same conclusion and their rates of tonsillectomies have also decreased. 

Thanks to the rise of evidence-based medicine, most tonsillectomies have gone the way of JELL-O molds and coonskin caps.

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