At what age is tonsil surgery recommended?

• Tonsillectomy is most often performed on children between 3 - 4 years of age.
• Surgical treatment of tonsillectomy is rarely performed in adolescents and young adults, ranging from 16 - 35 years of age.
• Men in their 30s and 50s with chronic tonsillitis often require tonsil removal surgery.

Tonsil surgery is no longer systematically performed on children and even less so on very young patients such as babies. 

It is true that the operation is recommended when the child has 6 or more episodes of tonsillitis, fever and plaque in a year, or 5 episodes in 12 months for two years in a row.

The recommended age is from 3 - 4 years old.

On the other hand, it is also necessary to remove the tonsils if they become hypertrophied, i.e. if their size becomes too large and thus causes serious respiratory obstruction and sleep apnoea; the child takes prolonged breathing pauses during sleep. 

This causes the baby to suffer from exhaustion during the day due to poor sleep and the extra effort it takes to breathe properly.

In most cases, the need for tonsil surgery is determined by the frequency with which the child suffers from tonsillitis.

However, as you can imagine, before deciding whether or not to perform the operation, it is necessary that a specialist is in charge of knowing your child's history and, likewise, making an accurate diagnosis after a thorough examination of his or her state of health. 

This is mainly because the tonsils are given to decrease in size as the child grows and normalise their function without producing problems again.

We insist that this information is of a general nature and should be consulted with an Otolaryngologist, who will be the only one able to determine the treatment that best suits the patient's characteristics.

As we have been saying, tonsil surgery is not usually the first-line treatment for tonsillitis in infants. However, if episodes of tonsillitis as well as enlarged adenoids or vegetations are persistent during the year, specialists may resort to surgical treatment to remove the tonsils (sometimes together with the removal of the vegetations in the same surgery).

Tonsil operations in children are usually performed when factors such as the following are met:

• Age: It is advisable to wait at least until the child is 3 - 4 years old and the tonsils have not decreased in size over time. Resorting to tonsil removal surgery in younger patients increases the possibility of intraoperative risks and complications.
• Sleep apnoea: These are pauses in breathing for more than twice the length of a respiratory cycle. This is not the same as the occasional snoring that accompanies colds, which may be considered normal.
• Respiratory problems: hypertrophy of the tonsils can lead to hypoxia and chronic respiratory distress.
• Exclusively mouth breathing: this is not a problem in itself in the short term, but in the long term it can cause additional problems such as malocclusion.
• Voice changes: the obstruction caused by enlarged tonsils can lead to a ‘throaty’ sounding voice as well as persistent bad breath.
• Frequent episodes of tonsillitis: when tonsillitis becomes repetitive. That is, 7 episodes or more in 1 year; or 5 episodes for 2 years in a row and due to haemolytic streptococcus bacteria (many tonsillitis are caused by viruses). This indication can also be given for small tonsils.

Tonsil surgery is recommended for children from 3 - 4 years of age.

As far as adolescents are concerned, tonsillitis can affect young people more frequently between the ages of 4 and 16, however, as we mentioned at the beginning, tonsils are prone to reduce in size over the years (during puberty), so suffering symptoms caused by enlarged tonsils frequently during the adolescent stage is very rare.

Even so, if the adolescent shows the signs mentioned above, tonsil removal surgery is usually the recommended treatment and gives the best results in solving the problems.

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As you have been able to see, as one gets older, the chances of suffering from repetitive or chronic tonsillitis become less and less likely, given that the lymph nodes that make up the structures known as tonsils, reduce their size and become normalised, without becoming inflamed frequently and thus ceasing to obstruct the respiratory passages among other problems, as mentioned above. 

And... what do we mean by all this?

Although tonsillectomy in adults is rarely necessary, the indication for tonsillectomy may occur in the case of recurrent pathology, i.e. when episodes of tonsillitis occur more than 4 times in 12 months.

On the other hand, there are indications from specialists who recommend surgical treatment when the adult patient has fewer or less severe episodes per year. In this type of case, the indication depends on other factors of chronicity, such as:

• General state of health
• Loss of school or work days
• Decreased quality of life
• Being a carrier of group A haemolytic streptococcus

Tonsillitis may not have occurred until an older adult, after reaching an age range of between 30 and 50 years, with men being more prone to tonsillitis. In such cases, patients often present with chronic tonsillitis or problems caused by tonsil enlargement, such as sleep apnoea or loud snoring during sleep.

The need for tonsil surgery, in the case of older adults, is most often seen in men between 30 and 50 years of age.

Although cases in adults occur very rarely, being much more frequent in children, tonsil surgery or tonsillectomy is recommended when non-surgical treatment with drugs has no effect, as well as if symptoms and discomfort worsen over time.

Bear in mind that, as in the previous cases, the first step in determining the treatment that best suits your characteristics and medical problem is to visit your family doctor or consult directly with a specialist, an ENT specialist, so that he or she can assess your diagnostic tests, the viability of the operation and how it can improve your quality of life.

Do you suffer from recurrent inflammation and infection of the tonsils and are you looking for the best solution to eliminate the problem? 

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