Raise your hand if you or someone you know has had their tonsils removed. If your hand is sky-high, there’s a pretty good chance that you (or that person you know) are from the US and were born before 1980. Of course, maybe that’s not the case, but tonsillectomies certainly fit in the category of 20th century fads, along with Tamagotchis and the Atkins diet. While the procedure is still widely performed today (and for very good reasons), the frequency of tonsillectomies has dropped drastically from mid-20th century rates. In this episode, we explore why tonsillectomies became so popular, when they fell out of favor, and what about tonsils makes them worthy of removal. Tune in to be horrified by ancient tonsil removal techniques, shocked at how long it takes new knowledge to change policies, and appreciative of just how cool tonsils actually are.
| History | Biology |
| Dwyer-Hemmings, Louis. “‘A wicked operation’? Tonsillectomy in twentieth-century Britain.” Medical History 62.2 (2018): 217-241. | Kuper, C.F., Wijnands, M.V. and Zander, S.A., 2017. Mucosa-associated lymphoid tissues. Immunopathology in Toxicology and Drug Development: Volume 2, Organ Systems, pp.81-121. |
| Grevellec, Armelle, and Abigail S. Tucker. “The pharyngeal pouches and clefts: Development, evolution, structure and derivatives.” Seminars in cell & developmental biology. Vol. 21. No. 3. Academic Press, 2010. | Bathala, S. and Eccles, R., 2013. A review on the mechanism of sore throat in tonsillitis. The Journal of Laryngology & Otology, 127(3), pp.227-232. |
| Grob, Gerald N. “The rise and decline of tonsillectomy in twentieth-century America.” Journal of the history of medicine and allied sciences 62.4 (2007): 383-421. | Arambula, A., Brown, J.R. and Neff, L., 2021. Anatomy and physiology of the palatine tonsils, adenoids, and lingual tonsils. World Journal of Otorhinolaryngology-Head and Neck Surgery, 7(03), pp.155-160. |
| Karchev, Todor. “Specialization of tonsils as analyzers of the human immune system.” Acta Oto-Laryngologica 105.sup454 (1988): 23-27. | Cesta, M.F., 2006. Normal structure, function, and histology of mucosa-associated lymphoid tissue. Toxicologic pathology, 34(5), pp.599-608. |
| Koempel, Jeffrey A. “On the origin of tonsillectomy and the dissection method.” The Laryngoscope 112.9 (2002): 1583-1586. | Brandtzaeg, P., Kiyono, H., Pabst, R. and Russell, M.W., 2008. Terminology: nomenclature of mucosa-associated lymphoid tissue. Mucosal immunology, 1(1), pp.31-37. |
| McNeill, Ronald Alastair. “A history of tonsillectomy: two millenia of trauma, haemorrhage and controversy.” The Ulster medical journal 29.1 (1960): 59. | Brandtzaeg, P., 2010. Function of mucosa-associated lymphoid tissue in antibody formation. Immunological investigations, 39(4-5), pp.303-355. |
| Sepahi, Ali, and Irene Salinas. “The evolution of nasal immune systems in vertebrates.” Molecular Immunology 69 (2016): 131-138. | Mörbe, U.M., Jørgensen, P.B., Fenton, T.M., von Burg, N., Riis, L.B., Spencer, J. and Agace, W.W., 2021. Human gut-associated lymphoid tissues (GALT); diversity, structure, and function. Mucosal immunology, 14(4), pp.793-802. |
| Smith, Heather F., and Wade Wright. “Vestigial organ.” Encyclopedia of Animal Cognition and Behavior. London: Springer, Cham (2018). | Georgalas, C.C., Tolley, N.S. and Narula, A., 2014. Tonsillitis. BMJ clinical evidence, 2014. |
| Younis, Ramzi T., and Rande H. Lazar. “History and current practice of tonsillectomy.” The Laryngoscope 112.S100 (2002): 3-5. | Windfuhr, J.P., Toepfner, N., Steffen, G., Waldfahrer, F. and Berner, R., 2016. Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management. European Archives of Oto-Rhino-Laryngology, 273, pp.973-987. |
| Esposito, S., De Guido, C., Pappalardo, M., Laudisio, S., Meccariello, G., Capoferri, G., Rahman, S., Vicini, C. and Principi, N., 2022. Retropharyngeal, parapharyngeal and peritonsillar abscesses. Children, 9(5), p.618. | |
| Manthiram, K., 2023. What is PFAPA syndrome? Genetic clues about the pathogenesis. Current Opinion in Rheumatology, 35(6), pp.423-428. | |
| Šumilo, D., Nichols, L., Ryan, R. and Marshall, T., 2019. Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records. British Journal of General Practice, 69(678), pp.e33-e41. | |
| Mitchell, R.B., Archer, S.M., Ishman, S.L., Rosenfeld, R.M., Coles, S., Finestone, S.A., Friedman, N.R., Giordano, T., Hildrew, D.M., Kim, T.W. and Lloyd, R.M., 2019. Clinical practice guideline: tonsillectomy in children (update). Otolaryngology–Head and Neck Surgery, 160(1_suppl), pp.S1-S42. | |
| Kay, D.J., Bryson, P.C. and Casselbrant, M., 2005. Rates and risk factors for subsequent tonsillectomy after prior adenoidectomy: a regression analysis. Archives of Otolaryngology–Head & Neck Surgery, 131(3), pp.252-255. | |
| Edmonson, M.B., Zhao, Q., Francis, D.O., Kelly, M.M., Sklansky, D.J., Shadman, K.A. and Coller, R.J., 2022. Association of patient characteristics with postoperative mortality in children undergoing tonsillectomy in 5 US states. JAMA, 327(23), pp.2317-2325. | |
| Wagar, L.E., Salahudeen, A., Constantz, C.M., Wendel, B.S., Lyons, M.M., Mallajosyula, V., Jatt, L.P., Adamska, J.Z., Blum, L.K., Gupta, N. and Jackson, K.J., 2021. Modeling human adaptive immune responses with tonsil organoids. Nature medicine, 27(1), pp.125-135. | |
| Kim, H.K., Kim, H., Lee, M.K., Choi, W.H., Jang, Y., Shin, J.S., Park, J.Y., Bae, D.H., Hyun, S.I., Kim, K.H. and Han, H.W., 2022. Generation of human tonsil epithelial organoids as an ex vivo model for SARS-CoV-2 infection. Biomaterials, 283, p.121460. | |
| Sulibhavi, A. and Isaacson, G., 2021. TikTok tonsils. Ear, Nose & Throat Journal, p.01455613211038340. |
Disclaimer: This post may contain affiliate links. If you buy something through one of these links, you won’t pay a penny more, but we’ll get a small commission which helps us keep things running. Thanks!
One thought on “Ep 134 Tonsils: Underestimated and underappreciated”
Hi! My name is Amy and I love that you’re doing this episode.
I had my tonsils out right after 1st grade. I remember constantly having sore throats and every fall being diagnosed with “tonsilitis” which was always a hoot. Given that this happened like 30 years ago all I really remember is waking up post-op, being taken home, begging for ice cream (cause they always say you can have as much as you want after getting your tonsils out), gagging and throwing up. Cause you know throwing up with raw wounds in the back of your throat is awesome. To be fair I don’t know if this was from the salt in the ice cream or my sensitivity to gas anesthesia. I then lost my voice for two weeks and had the worst sore throat. My little sister loved this period because she blamed me for everything. Also I ate so much JELLO at this time that I still at 37 cannot eat JELLO.
Fast forward 13 or so years and my sister had to get her’s out at the age of 18. She’d suffered from strep throat at least 2 times per year her whole life, but her tonsils never swelled up so no doctors suggested their removal. That’s until you could smell something rotting and mom took her to an ENT. Yep her tonsils were rotting into her throat. She did get them out, but her recovery was definitely worse than mine. Sore throat, no energy, throat felt swollen, and probably because of the constant infections the wounds were slower to heal than normal.
I know doctors are less likely to remove tonsils today (or it seems this way anyhow), but my family thinks my sister’s tonsils should have been removed sooner.
Another funny story really quick is when I went to an ENT because I have horrible sinus problems he looked in my throat and exclaimed that my tonsils looked great. To which I, as a snarky teenager, replied “they shouldn’t look doc they’re not there.” Now listening to this I wonder if everything was removed when I was a kid. O.o
Comments are closed.