Editing Tonsillectomy (section)

==Medical uses==
Tonsillectomy is mainly undertaken for [[sleep apnea]] and recurrent or chronic [[tonsillitis]].<ref name=Oto2019/> It is also carried out for [[peritonsillar abscess]], [[periodic fever, aphthous stomatitis, pharyngitis and adenitis]] (PFAPA), [[guttate psoriasis]], nasal [[airway obstruction]], [[tonsil cancer]] and [[diphtheria carrier state]]. For children, tonsillectomy is usually combined with the [[adenoidectomy|removal of the adenoid]]. However, it is unclear whether the removal of the adenoid has any additional positive or negative effects for the treatment of recurrent sore throat.<ref name="Burton2014" /> In cases of chronic tonsillitis in adults, there is strong evidence of increased quality of life, reduction of symptoms, and economic benefit.<ref>{{Cite journal |last1=Witsell |first1=David L. |last2=Orvidas |first2=Laura J. |last3=Stewart |first3=Michael G. |last4=Hannley |first4=Maureen T. |last5=Weaver |first5=Edward M. |last6=Yueh |first6=Bevan |last7=Smith |first7=Timothy L. |last8=Goldstein |first8=Nira A. |date=January 2008 |title=Quality of life after tonsillectomy in adults with recurrent or chronic tonsillitis |url=https://onlinelibrary.wiley.com/doi/10.1016/j.otohns.2007.08.015 |journal=Otolaryngology–Head and Neck Surgery |language=en |volume=138 |issue=S1 |pages=S1-8 |doi=10.1016/j.otohns.2007.08.015 |pmid=18164373 |s2cid=704501 |issn=0194-5998|url-access=subscription }}</ref><ref>{{Cite journal |last1=Bhattacharyya |first1=Neil |last2=Kepnes |first2=Lynn J. |date=November 2002 |title=Economic Benefit of Tonsillectomy in Adults with Chronic Tonsillitis |url=http://journals.sagepub.com/doi/10.1177/000348940211101106 |journal=Annals of Otology, Rhinology & Laryngology |language=en |volume=111 |issue=11 |pages=983–988 |doi=10.1177/000348940211101106 |pmid=12450171 |s2cid=46503189 |issn=0003-4894|url-access=subscription }}</ref><ref>{{Cite journal |last1=Schwentner |first1=I. |last2=Höfer |first2=S. |last3=Schmutzhard |first3=J. |last4=Deibl |first4=M. |last5=Sprinzl |first5=G. M. |date=2007-08-11 |title=Impact of tonsillectomy on quality of life in adults with chronic tonsillitis |url=https://smw.ch/index.php/smw/article/view/760 |journal=[[Swiss Medical Weekly]] |language=en |volume=137 |issue=3132 |pages=454–461 |doi=10.4414/smw.2007.11735 |pmid=17705110 |issn=1424-3997|doi-access=free }}</ref> A randomised controlled trial of tonsillectomy versus medical treatment (antibiotics and pain killers) in adults with frequent tonsillitis found that tonsillectomy was more effective and cost effective. It resulted in fewer days with sore throat.<ref>{{Cite journal |last1=Wilson |first1=Janet A |last2=O'Hara |first2=James |last3=Fouweather |first3=Tony |last4=Homer |first4=Tara |last5=Stocken |first5=Deborah D |last6=Vale |first6=Luke |last7=Haighton |first7=Catherine |last8=Rousseau |first8=Nikki |last9=Wilson |first9=Rebecca |last10=McSweeney |first10=Lorraine |last11=Wilkes |first11=Scott |last12=Morrison |first12=Jill |last13=MacKenzie |first13=Kenneth |last14=Ah-See |first14=Kim |last15=Carrie |first15=Sean |date=2023-06-17 |title=Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial |journal=The Lancet |volume=401 |issue=10393 |pages=2051–2059 |doi=10.1016/S0140-6736(23)00519-6 |issn=0140-6736|doi-access=free |pmid=37209706 |hdl=10023/27774 |hdl-access=free }}</ref><ref>{{Cite journal |date=5 September 2023 |title=Removing tonsils is effective and cost-effective for adults with frequent tonsillitis |url=https://evidence.nihr.ac.uk/alert/removing-tonsils-is-effective-and-cost-effective-for-adults-with-frequent-tonsillitis/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_59646 |s2cid=261565310 |url-access=subscription }}</ref>

===Sore throat===
Surgery is not recommended for those with fewer than seven documented throat infections in the last year, fewer than five each year for the last two years, or fewer than three each year for three years.<ref name=Oto2019/> Severely affected children who undergo surgery on average have one fewer sore throat per year in the subsequent one or two years, compared to those who do not.<ref name=Oto2019/><ref name=Burton2014/><ref name=Peds2017>{{cite journal | vauthors = Morad A, Sathe NA, Francis DO, McPheeters ML, Chinnadurai S | title = Tonsillectomy Versus Watchful Waiting for Recurrent Throat Infection: A Systematic Review | journal = Pediatrics | volume = 139 | issue = 2 | pages = e20163490 | date = February 2017 | pmid = 28096515 | pmc = 5260157 | doi = 10.1542/peds.2016-3490 }}</ref> Specifically one review of five randomized controlled trials, found a decrease from 3.6 to 3.0 episodes in the year following surgery.<ref name="Burton2014" /> In less severely affected children, surgery results in an increase, rather than a decrease of sore throats when the sore throat directly following surgery is included.<ref name="Burton2014" /> Surgery results in a reduction in school absence in the following year, but the strength of evidence is low.<ref name=Peds2017 /> Surgery does not result in an improvement in the quality of life.<ref name="Peds2017" /> Benefits of surgery do not persist over time.<ref name="Oto2019" /><ref name=Peds2017 /> Those with frequent throat infections often spontaneously improve over a year without surgery.<ref name=Oto2019/><ref name="Burton2014" /><!-- Quote = observed children with recurrent throat infections and found high rates of spontaneous resolution over 12 months --> Therefore, a certain number of people who undergo surgery will do so unnecessarily as they would not have had further episodes of tonsillitis had they not had surgery.<ref name="Burton2014" /> Evidence in adults is unclear.<ref name=Burton2014/>

In 2019, the [[American Academy of Otolaryngology|American Academy of Otolaryngology & Head and Neck Surgery]] (AAO-HNS) recommended:{{blockquote|Caregivers and patients who meet the appropriate criteria for tonsillectomy as described here should be advised of only modest anticipated benefits of tonsillectomy, as weighed against the natural history of resolution with watchful waiting, as well as the risk of surgical morbidity and complications and the unknown risk of general anesthesia exposure in children [younger than] four years of age. In considering the potential harms, the guideline panel agreed that there was not a clear preponderance of benefit over harm for tonsillectomy, even for children meeting the Paradise criteria [seven episodes in the past year, five episodes per year in the past two years, or three episodes per year in the past three years].  Instead, the group felt there to be a balance that allows either tonsillectomy or watchful waiting as an appropriate management option for these children and does not imply that all qualifying children should have surgery. The role of tonsillectomy as an option in managing children with recurrent throat infection means that there is a substantial role for shared decision making with the child's caregiver and primary care clinician.<ref name="Oto2019" />}}Many cases of the sore throat have other causes than tonsillitis and tonsillectomy is therefore not indicated for those cases.<ref name="Burton2014" /><ref name="Peds2017" /> The diagnosis of tonsillitis is often made without testing for bacteria.<ref name="Peds2017" /> The [[National Health Service|UK National Health Service]] states that it is very rare that someone needs to have their tonsils taken out, and it is usually only necessary in case of severe tonsillitis that keeps recurring.<ref>{{Cite web|url=https://www.nhs.uk/conditions/tonsillitis/|title=Tonsillitis|date=23 October 2017|website=nhs.uk|language=en|access-date=2019-06-22}}</ref>

===Obstructive sleep apnea===
Tonsillectomy improves obstructive sleep apnea (OSA) in most children.<ref name=Oto2019/> A 2015 [[Cochrane (organisation)|Cochrane]] review found moderate quality evidence for benefits in terms of quality of life and symptoms but no benefit in attention or academic performance.<ref name=Ven2015/> It recommended that physicians and parents should weigh the benefits and risks of surgery as OSA symptoms may spontaneously resolve over time.<ref name=Ven2015/> An [[AHRQ]] review however did find improvements at school.<ref name=Oto2019/> The procedure is recommended for those who have OSA that has been verified by a [[sleep study]].<ref name=Oto2019/> Studies have shown that treatment success of [[uvulopalatopharyngoplasty]] with tonsillectomy increases with tonsil size.<ref>{{Cite journal|last1=Tschopp|first1=Samuel|last2=Tschopp|first2=Kurt|date=2019|title=Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/lary.27899|journal=The Laryngoscope|language=en|volume=129|issue=12|pages=E449–E454|doi=10.1002/lary.27899|pmid=30848478 |s2cid=73503702 |issn=1531-4995|url-access=subscription}}</ref>

===Other===
There is no good evidence for other uses such as [[tonsil stones]], [[bad breath]], [[trouble swallowing]], and an [[abnormal voice]] in children.<ref name=Oto2019/><!-- The last category contains a series of poorly validated indications for tonsillectomy that have not been tested in any controlled trials or case series: chronic tonsillitis, febrile seizures, muffled ("hot potato") speech, halitosis, malocclusion of teeth, tonsillar hypertrophy, cryptic tonsils, and chronic pharyngeal carriage of GABHS.  -->