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Permalink Reply by Daniel on May 9, 2009 at 2:35pm

My understanding is that tonsillectomies can be very effective for OSA in children with crowded airways, but that it seldom helps for adults.

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Permalink Reply by Tams on May 9, 2009 at 2:39pm

Daniel said:

My understanding is that tonsillectomies can be very effective for OSA in children with crowded airways, but that it seldom helps for adults.

thanks , i went to a ENT 2 days ago and he wants to remove mine but says that it might help my sleep apnea MIGHT, but i think i need a second opinion as a friend of mine said she heard it will, but he wants to remove mine due to mine are deteriating and causing bad breath and other complications such as food particles building up in there(i have holes in my tonsiles due to being sick all the time) and sore throats monthly etc.

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Permalink Reply by Daniel on May 9, 2009 at 3:00pm

When it comes to voluntary surgery, second and third opinions are a very good idea. I was born in 1958, when tonsillectomies for kids were the norm. When my older sister had a sore throat and her pediatrician wanted to remove her tonsils, my "Bohemian" mother went to five other doctors before she found two who agreed that it was probably unnecessary. Today, both of us still have our tonsils. By the way, both of us were also breast-fed in the 1950's. The doctors all thought she was crazy at the time. Today, neither of us have any allergies, and it would be unusual to find a pediatrician who recommends bottle-feeding. Mom was clearly ahead of her time.

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Permalink Reply by Mike on May 10, 2009 at 3:21pm

Tams, do you ever cough up pearl-like flecks of i don't know what, but that smell really bad? i was getting those for awhile, and did some research online -- turns out it was decaying food that got stuck in the pores of my tonsils, or something similar to that. gross, but true. turns out it happens to people with large tonsils. nothing to be alarmed about. for some reason, they just went away for me. even though i still have my tonsils (much to the chagrin of the sleep doctors who tried to get me to have them yanked out)

Tams said:

Daniel said:

My understanding is that tonsillectomies can be very effective for OSA in children with crowded airways, but that it seldom helps for adults.

thanks , i went to a ENT 2 days ago and he wants to remove mine but says that it might help my sleep apnea MIGHT, but i think i need a second opinion as a friend of mine said she heard it will, but he wants to remove mine due to mine are deteriating and causing bad breath and other complications such as food particles building up in there(i have holes in my tonsiles due to being sick all the time) and sore throats monthly etc.

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Permalink Reply by JoshCoop on May 10, 2009 at 5:12pm

I had a tonsillectomy when I was 21 (before I was diagnosed with sleep apnea) and it was THE worst 2 months of my life. It takes adults so long to recover from that surgery. I have a friend whose Doc recommended it for his sleep apnea and it did not help (he was 35 at the time). I would get a second opinion, for sure, before you do that.

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Permalink Reply by Tams on May 11, 2009 at 10:51am

Mike said:

Tams, do you ever cough up pearl-like flecks of i don't know what, but that smell really bad? i was getting those for awhile, and did some research online -- turns out it was decaying food that got stuck in the pores of my tonsils, or something similar to that. gross, but true. turns out it happens to people with large tonsils. nothing to be alarmed about. for some reason, they just went away for me. even though i still have my tonsils (much to the chagrin of the sleep doctors who tried to get me to have them yanked out)


tams wrote:

OMG yes they are disgusting lol and i find myself digging them out of the back of my throat too as thier irritating and he said they would keep building up and eventually iritate my stomach to where i would get really sick so i need to have my tonsils out. he said it would take up to a months time for me to heal, BUT i just seen ont he show DOCTORS where they have this new technology out called lasor surgery im gonna look into that as the girl was talking right after the surger and it was performed right in the doctors office as well and only takes a few wks recovery :O)

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Permalink Reply by Mike on May 11, 2009 at 9:16pm

Tams, I would listen to Josh, who has been through the tonsillectomy surgery, and be prepared to take that level of pain for an uncertain result. about those little white things, i think your doc is exaggerating how bad it can get. i've had them for years and don't have any problems. of course doesn't mean i'm doing the right thing. maybe i'm not. but i would want to hear it from more than just one doctor.

Tams said:

Mike said:

Tams, do you ever cough up pearl-like flecks of i don't know what, but that smell really bad? i was getting those for awhile, and did some research online -- turns out it was decaying food that got stuck in the pores of my tonsils, or something similar to that. gross, but true. turns out it happens to people with large tonsils. nothing to be alarmed about. for some reason, they just went away for me. even though i still have my tonsils (much to the chagrin of the sleep doctors who tried to get me to have them yanked out)


tams wrote:

OMG yes they are disgusting lol and i find myself digging them out of the back of my throat too as thier irritating and he said they would keep building up and eventually iritate my stomach to where i would get really sick so i need to have my tonsils out. he said it would take up to a months time for me to heal, BUT i just seen ont he show DOCTORS where they have this new technology out called lasor surgery im gonna look into that as the girl was talking right after the surger and it was performed right in the doctors office as well and only takes a few wks recovery :O)

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Permalink Reply by Steven Y. Park, MD on May 11, 2009 at 10:25pm

Tams,

What you and Mike are describing are called tonsilliths. You're right in that food particles can get trapped in your tonsil's spaces, festers and gets infected, causing bad breath and even tonsil infections. These can cause the tonsils to stay swollen and worsen sleep apnea. For most people (like Mike), it comes and goes, but for others, it can be pretty debilitating. Whether or not to get your tonsils out for this reason is an individual decision that you and your doctor must make, as it's purely elective surgery. For the very few that do elect to undergo surgery, the vast majority are very happy with the results.

As for the pain issue, there are newer ways of shaving tonsils that are much less painful than traditional techniques. There are many new ways of performing tonsillectomies, but the the one that I use is called a Coblator. It uses radio-frequency energy to vaporize tissues at relatively low temperatures, so there's less charring and thus less pain. Of course everyone has a different experience, and it also depends on the surgeon and the particular technique that's used.

Regarding tonsillectomy for obstructive sleep apnea, it depends on your anatomy. Unfortunately, most adults won't respond fully to tonsillectomy alone, since there's some or a significant degree of tongue base involvement. Yes, it does work better in children, but if you got sleep studies pre and post surgery you'll see there are a lot of children with persistent obstructive sleep apnea, despite feeling significantly better. If you follow Friedman's staging system, you need very large tonsils (3 or 4+) and a relatively small tongue (where your can see most of your tonsils without sticking your tongue out or by pressing down with a tongue depressor) to be in the "favorable" group who respond to to palatal and tonsil surgery only. Most of the positive effects of the surgery are probably due to tonsil removal.

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Permalink Reply by Mike on May 12, 2009 at 12:32am

Tonsilliths! didn't remember that term, and certainly didn't know it could be a source of infection and debilitating for some. i have to keep an eye on that i guess. how would i know if i'm having problems caused by the tonsilliths?

Steven Y. Park, MD said:

Tams,

What you and Mike are describing are called tonsilliths. You're right in that food particles can get trapped in your tonsil's spaces, festers and gets infected, causing bad breath and even tonsil infections. These can cause the tonsils to stay swollen and worsen sleep apnea. For most people (like Mike), it comes and goes, but for others, it can be pretty debilitating. Whether or not to get your tonsils out for this reason is an individual decision that you and your doctor must make, as it's purely elective surgery. For the very few that do elect to undergo surgery, the vast majority are very happy with the results.

As for the pain issue, there are newer ways of shaving tonsils that are much less painful than traditional techniques. There are many new ways of performing tonsillectomies, but the the one that I use is called a Coblator. It uses radio-frequency energy to vaporize tissues at relatively low temperatures, so there's less charring and thus less pain. Of course everyone has a different experience, and it also depends on the surgeon and the particular technique that's used.

Regarding tonsillectomy for obstructive sleep apnea, it depends on your anatomy. Unfortunately, most adults won't respond fully to tonsillectomy alone, since there's some or a significant degree of tongue base involvement. Yes, it does work better in children, but if you got sleep studies pre and post surgery you'll see there are a lot of children with persistent obstructive sleep apnea, despite feeling significantly better. If you follow Friedman's staging system, you need very large tonsils (3 or 4+) and a relatively small tongue (where your can see most of your tonsils without sticking your tongue out or by pressing down with a tongue depressor) to be in the "favorable" group who respond to to palatal and tonsil surgery only. Most of the positive effects of the surgery are probably due to tonsil removal.

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Permalink Reply by Mike on May 12, 2009 at 2:35pm

Tams, found this image of what these little tonsil stones, or tonsilliths, look like:

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Permalink Reply by Alyce G. Burriss on May 13, 2009 at 7:03am

I had my tonsils out !!! Very painful. Didn'T work for me. I was 56.

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Permalink Reply by EWL on July 31, 2009 at 8:54am

Steven Y. Park, MD said:

Tams,

What you and Mike are describing are called tonsilliths. You're right in that food particles can get trapped in your tonsil's spaces, festers and gets infected, causing bad breath and even tonsil infections. These can cause the tonsils to stay swollen and worsen sleep apnea. For most people (like Mike), it comes and goes, but for others, it can be pretty debilitating. Whether or not to get your tonsils out for this reason is an individual decision that you and your doctor must make, as it's purely elective surgery.

Hi Dr. Park and everyone:

My first post here, so fantastic to find this forum. I have had tonsillith issues for at least 25 years... I'm 43 but can remember them as far back as college. Many doctors I've seen have looked at me like I was from Mars when I asked about them and had no idea what I was talking about so I could help but respond to this thread. (Finally one ENT knew and agreed that I have many "crypts" in my tonsils from past infections, etc., and suggested hydrogen peroxide rinses, but these didn't really help much.) I'm curious about corrective surgery being purely elective-- so these are viewed as mainly an annoyance? Is there ever a medical justification?

I have also just been diagnosed with severe OSA (suspect I've had this for a long while too) and have been on CPAP for 2 weeks now-- not feeling a whole lot different yet, but I am battling a cold and (yet another) sinus infection at the same time; but I wonder if tonsils could be contributing to the problem. At the same time, I'm very leery of surgery (have not had my deviated septum corrected either!) and hear that adult tonsillectomies are very painful!

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