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Long-term health risks after having adenoids or tonsils removed in childhood (jamanetwork.com)
291 points by tankerslay 10 months ago | hide | past | web | favorite | 206 comments

Thank you so much for posting this. Really, THANK YOU, kind stranger. Here in the Czech Republic we're always forced by doctors to do AE/TE to our son despite being mildly affected by strep as we are fighting PANDAS. The latest research converges on that AE/TE is not effective, and that we're doing the right thing by not doing the operation. It looks like doctors even in the most advanced medical institutions are blindly following old books here and still recommend to take the tonsils out at every occasion and eat bags of antibiotics "just for any case." The level of medicine here is so abysmal (except, probably, surgery) that we now have to rely mostly on our own heads and collect the latest research. Thank you.

We went to a really good Ear nose throat doctor in San Diego hospital because our son had a long lasting runny nose, and they also told us to remove his tonsils and adenoids. I did not want to have them removed because of the involvement of sleep drugs necessary for operation, so we tried multiple ways to find the issue of the running nose, turned out it was something to do with the oil vaporizer they used in his preschool class, as soon as they removed it - his runny nose poeblem went away.

Heh, you can do it the Russian way and yank them out while you are awake with just a topical, until your kid passes out from the pain :). That’s how my adenoids came out. Do not recommend.

There's a scene in Roald Dahl's autobiography part one, Boy, that describes the process of getting his adenoids removed without anaesthesia. Sounded terrifying enough that I'm glad we knock people out for that sort of surgery.

I had mine removed with only mild anaesthetics and I still have nightmares about that. It also didn't help with various nose and throat infection at all. In fact I had pneumonia couple years later so not much respect for the butchers that did this to me.

I still have, let's call them interesting, memories of Soviet dental procedures. I think that if I were to put them on film, modern audiences would call them "torture porn".

Hmm, my wife had them removed when she was a kid in Russia and says it was not that bad.

People have wildly varying sensitivity to pain.

A lot of those ENT problems are related to allergies and irritants. The problem is that very often it's extremely hard to figure out what is causing the reaction and if it's an external element of the environment that can be modified. But the consensus of the medical community that formed in the last decade is that removing adenoids and tonsils should be a last-line of defense for chronic cases that affect your life significantly. That's because the solution is almost never permanent.

I had years of doctors saying my nose and throat problems were caused by "allergies and irritants" - eventually one had a look up my nose and diagnosed a deviated septum (and my tonsils were already a mess).

NHS surgery to fix the deviated septum, whip out my tonsils and a couple of other things and I was much better - and that was nearly 30 years ago.

You've piqued my curiosity. Why would a preschool have an oil vaporizer?

For smell. You can get Glade plugins or on the essential oils side a diffuser. We have used both in our family.

Don't they also have female hormones in them?

Not female hormones per se, but things that are so similar as to have similar effects. This is not great for children, particularly developing boys. I've read some links between synthetic estrogen and changes in male behavior. I'd hate to think that a school might be naively using these things because they tend to calm boys down.

Lavender oil can increase estrogen when used topically.

That is beyond retarded...and a school is supposed to instruct kids in the truthful ways of life? Spraying oil does NOT eliminate aromatic odor molecules. All it does is dilute their presence. In addition, all of these essential oils are from plants, which many people are randomly allergic or inflamed by. Essential oils are for a home. Spraying essential oils into public airspace is such a dick move. Sorry about your kid, sucks when people spray biologically active drugs into the air that other people have to breathe.

The school is looking forward to your job application to be a preschool teacher. You'll have the following benefits:

* $32k annual salary

You'll have the responsibility to take care of the most precious little things that have every walked the earth. Your management are the parents, or as they like to call themselves "the people who pay your salary". These management want you to know they would do nearly everything you attempt to do differently than you do it. They want you to know they would do it differently, but they would never actually do it.

You'll need to show up at 7:15am sharp. You'll be able to leave as soon as the last parent picks up their child, which is sometime around 6:15pm. We are happy to have you on the team.

Edit: in education, there is asymmetry of requirements (similar to the asymmetry of bullshit). The boots-on-the-ground educator has 70-years worth of legal duties to be performed. This educator is working with a wide variety of incoming supplies (i.e. the little humans). Additionally, nearly everyone thinks they are capable of being a teacher, and their own recommendations and their own requirements.

The flippant demand that we should prevent $3.50 Glade plugins in a classroom in the scope of all the other things that matter is asymmetrical bullshit. A kid had a runny nose. Medical advice was to remove tonsils. The parents pushed back and found the real problem.

Maybe the $3.50 Glade plugin covered for another kid who was being bullied because of body odor? Or, maybe it cut down on distractions from nearby human pollution odors? Perhaps, the preschool is the lowest cost preschool around because the parents are cheap and do not want to pay market-rate for childcare. Thus, to be able to break even, the preschool uses a building used has a mold and water problem.

Of all the things that can be improved with education in the US, we decide on an internet forum that a $3.50 Glade plugin is the root of all evil for education because it masks instead of removes odors.

"Of all the things that can be improved with education in the US, we decide on an internet forum that a $3.50 Glade plugin is the root of all evil for education because it masks instead of removes odors."

You need to work on your straw man game. Start with something they actually said and work your way into something they didn't actually say. But just straight up putting fake words into their mouth is far too blatant.

This makes me think. Could there be an opportunity for remote babysitting or remote education for the earlier grades. We can elimate the not so qualified 32k person.

Socialization matters much more than education at that age.

Hell, let's just put the children in pods with feeding tubes. Then they won't require any labor.

Don't forget the waste removal tubes, and for god's sake, don't mix the two up.

No, but we need IT to stop enabling high land prices that force both parents to work.

So sad but true

What does any of this have to do with forcing an oil vaporizer on everyone? Are you arguing that teachers need essential oils in the air to get through the day; or is this just about the fact, that parents always have different ideas? In that case you should still err on the side of not putting random substances in the air everyone at the school has to breathe.

I think they're providing contrast against the hilarious suggestion that "a school is supposed to instruct kids in the truthful ways of life".

Ah, I see. I probably misinterpreted the intention behind that comment.

Are you trying to tell me that someone starting a post with "That is beyond retarded..." isn't a source I should be citing on what is/isn't proper human behavior?

That said, "Truthful way of life" and "Glad plugins don't eliminate the cause of odor, just mask it which has a value all its own" seem to both be able to exist in the same space right? I haven't been to this school, but it seems most teachers aren't actively indoctrinating children to believe the "Big Scent" lie that candles/oil diffusion/whatever actually fix the cause of their problem rather than addressing the symptoms

It would be better if most scent diffusers used essential oils, but unfortunately, most are made with VOCs and synthetic fragrance compounds that are known or suspected to cause many health problems, like Glade plugins. Febreze and Lysol are the same but with more VOCs.

I have severe sensitivity to fragrance and cannot tolerate synthetic fragrances, incense, or essential oils. Simply being near people who use artificial deodorant, shampoo, laundry detergent, dryer sheets or any other mainstream product that leaves them covered in synthetic fragrance is very uncomfortable. Essential oils are less problematic.

With essential oils, many of the chemicals present (such as linalool and d-limonene) break down as they oxidize after diffusion, and the oxidation products have different health effects than the original chemical, such as allergy sensitization and irritation.

My mother-in-law visited for two months, and left one of the rooms in my house saturated with Young Living essential oils from a diffuser. Six months later, I still can't go in there.

Same—I can’t tolerate most artificial fragrances, as they make my sinuses block up and irritate my eyes & skin. Sadly they’re everywhere—between perfumes, deodorants, lotions, laundry detergents, fabric softeners, air fresheners, odour removers, shampoos, body washes, hand soaps, household cleaners, &c., a lot of people and their homes are just covered in them.

I’ve been trying to figure out the specific compounds that give me trouble and why, but there are many, and for a lot of these products, it seems like the ingredients are rarely published in full—or they use obscured chemical names—I guess because companies have some right to maintain their “secret sauce”.

I’m not chemophobic in the slightest, but I have to wonder if this wild mix of VOCs is affecting people in ways that they just don’t notice because they don’t have any allergy or irritation—such as endocrine disruption. And it will be hard to pinpoint if they do cause health problems because there are so many different compounds and they’re so common and assumed safe.

Well it's already known that even natural extracts like lavender oil are estrogen amplifiers. And the thermal receipt paper used for years, contained BPA, also an endocrine disruptor. There are tons of chemicals that we use willy nilly without any knowledge on their real and complex outcomes on life. I'd mostly prefer natural but its somewhat specious because having artificial additives means usually the whole mixture will have 10 or 15 chemicals instead of the 103485 in a plant extract. But I'd trust mother nature's 100000000000 years and human civilizations' many years of trials over an Ames test.


Great! It's very rare to meet other people with this issue.

Manufacturers are allowed, as I'm sure you know, to list all scent component ingredients glommed together as 'fragrance'. This is supposedly because they're proprietary - they wouldn't someone to make an exact knock-off of a new perfume too easily, right? It also has the effect of making the health aspects of the formulations very difficult to analyze. It's a lot like a properietary black box in computing... EWG judges 'fragrance' as its own separate ingredient, giving it a (bad) rating of 8/10.

I have noticed 5-6 different main scent 'flavors' on all the disgusting consumer products out there, which probably correspond to specific chemicals. There's the one like fake grapes, the one that's spicy and powdery, the one I call old lady underwear, the fake fruit, the 'manly' scents, and more.

Johnson Wax (SC Johnson?) actually lists the full fragrance ingredients to products like Windex in their site - I was amazed.

I agree that these products highly likely cause widespread harm of different types, including to people who do not perceive a problem.

Try running an ozone generator in there. It will break down the compounds much more quickly. The ozone itself breaks down pretty quickly, but don't run it when people or pets are in the house.

> school is supposed to instruct kids in the truthful ways of life?

If only that was true...

Cut carb intake right down and the levels of catarrh drop right off. Observational study in the 40's or 50's by a chap called Paton.

They already said it was due to an oil vaporizer, I don't think carbohydrates have anything to do with it.

Ah, good point - I misread the comment. I would reassert, though: a HC diet can leave you prone to very snotty episodes, compared to the alternative ;)

It's been one of the two most obvious beneficial changes of my LCHF foray, the other being a substantial reduction in inflammation (and no longer suffering with chronic Achilles tendonitis). N=1, IANADr, etc.

Certain food can produce bateria that increases ones reactions. By cutting the carbs you may see other benefits.

Can confirm that. Recently visited an otorhinolaryngologist with my 3 y.o. daughter having a blocked nose for too long after being sick, and the conversation started with typical "Why you even bothered to come here with such insignificant issue" and ended with "She have an enlarged adenoids, you need to remove them". And all of that been said only after short visual check of a crying child's nose. What you even able see there, with such tools and conditions? Of course I didn't trust the doctor at all, after that quick check-up and bold statements. And this is not a single doctor, after a many encounters with other doctors I can say that the whole health care system here, in the Czech Republic, is screwed up. Doctors are too ignorant and unprofessional to have so big self-confidence (often replaced by just being rude) as they have here.

Everything is based on population averages and fealty to academic research guidelines. But, like any population wide conclusions, it is a tricky move to apply them back to any given individual in the population.

From a personal experience, the public health care in Czech Republic is way much better than NHS or what you can afford as a middle-income family in US. The equation changes when you can afford private care.

A middle income family in the US usually has insurance that covers just about any specialist they want to see. MD Anderson, likely the best cancer institute in the world, accepts almost everyone's insurance (and also does about $100,000,000 of free work for those without).

The only people really limited in who they can see are those on public insurance like state coverage Medicaid for the poor or federal Medicare for the elderly. Those programs usually only pay a percentage of market value, and thus many doctors won't take them because they often lose money on the transaction.

As someone living in the US with far better medical coverage than average I am awestruck by how wrong this statement is. Have you ever had to deal with a serious illness in the US?

Yes, with several family members. With middling insurance in Oklahoma. I'm quite well versed in how Blue Cross Blue Shield's tiered policies work with several types of specialists. If you are awestruck, perhaps it is you who needs to learn a bit more.

What was exactly incorrect? I would agree that "you can see any specialist you want" is an exaggeration, but as someone with good insurance, I have about 100+ different ENTs in the bay area I could bring my daughter to, Stanford and UCSF included.

Most of America is not like the Bay Area with its overabundance of specialists.

There are many places in the US where the closest doctor is a few hundred miles away, and many more where the only doctors within a few hours are primary care physicians.

> many places in the US where the closest doctor is a few hundred miles away

Although this statement may be true, it may also be irrelevant if there are no people in those places. That said, I'm not just being pedantic: my point is that lack of availability is far more likely to be a result of low population density than of being in the US.

Moreover, your comment fails to respond to the original point, which is that of affordability/availability to families with middle income. Poverty combined with low population density would likely result in even less availability, but, then, poverty is incompatible with "middle income".

The NHS stopped the entire tonsil removal thing decades ago.

Not knowing what PANDAS is made for an interesting first read.

You're right to be cautious and fact check everything you're told. I apologise if my response becomes overly ranty. This isn't to scare you, just to encourage you that you're doing the right thing by taking such an active role in your child's care.

I have views on this that would seem to most people to be seriously conflicted.

I'm militantly pro-science, and I argue constantly in the face of anti-science and pseudo-scientific bullshit anywhere I hear it. It makes me no fun at all at parties, and even some family members groan whenever someone brings up "alternative views" to the scientific consensus on much of anything as they know I'm about to start lecturing, whether it's climate change, vaccination, flat earth (<- seriously) or most of anything else.

On the other hand, my personal experiences of how medical science is applied locally by doctors and surgeons has made me entirely disillusioned with their whole industry, and I never trust anything I'm told without confirming it for myself.

To explain, I'm based in Northern Ireland, and a debate has gone on for a long time as to whether our National Health Service (NHS) is struggling or in trouble. In reality, it has already imploded.

This isn't hyperbole. Here's an exact quote from the BBC:

"Northern Ireland has some of the worst performance figures in the UK.

During the Christmas period, the number of patients seen in four hours in A&E departments dropped to 63%.

Exactly the same proportion started their cancer treatment within 62 days, according to the latest statistics, while the numbers waiting longer than they should for a routine operation have almost doubled in the past four years."

This hits home for me really hard. In the last six years my extended family has experienced:

- Two missed cancer diagnoses. - A potentially serious (and time-sensitive) diagnosis requiring specialist follow up that was missed on two seperate occasions. - Delayed treatments for potentially life-threatening cancer of over 100% of the recommended waiting period.

Our local hospital has become known as a place more likely to kill you than help you, due to how abysmal the standard of care is. Here's a link from a couple of months ago:


Life threatening emergencies that arrive by ambulance are often left unattended for over four hours (this is recorded in the public record thanks to open data laws).

I sincerely hope the circumstances in the Czech Republic are better and that the doctors are much less overworked and much more capable of helping you, my intention here is just to give you encouragement that you're right in not just assuming that your child's in safe hands without you being involved.

> I sincerely hope the circumstances in the Czech Republic are better and that the doctors are much less overworked and much more capable of helping you

I'm not an author of the parent comment, but i also live in the Czech Republic and can say that no, It's not any better. And based on a stories which my friends living in other countries telling me, I starting to suspect that the whole world health care system "made a wrong turn" some time ago. Looks like it's screwed everywhere, or at least for majority of the population.

I am very happy about the professionalism and the humanity of Italian doctors and the Italian national healthcare service.

Of course there are problems, waiting lists, lack of funding. But damn, it's good and (mostly) free. I feel lucky.

Perhaps there are regional differences, but in my city, it's really good.

What do you base your judgment on? I think it heavily depends on what you needed services for thus far. I know people who thought just like you - until they themselves or a relative really needed them. Then they changed their opinion. But even then it depends on what exactly the issue is, I know at least one serious cancer case who got everything they could and then some for free - and they had money and shopped around, incl. specialists in the US checking out if it was worth going there for private consultations paid out of their own pocket, who told them they had top specialists right in front of them near where they lived (in Germany, a university clinic).

I think variance is big and individual examples are useless unless you have the exact same problem in the exact same locality as someone else. But I think it's safe to say that anything falling outside standardized diagnosis may not work out so great. I had to do my own research myself and beat a professor's (of medicine) prediction and amazed a few other doctors with "miracles", but I did not actually do anything special, just what I thought was kind of obvious after some research. When you fall into one of the many blind spots your experience will be bad, if you fall into one of the categories which are "standard" you'll probably be one of those people who are very satisfied by what the system provides.

One has to understand how doctors are trained and what the system they work in forces them to do (and what not to do). Once you understand that you may get more satisfaction. For example, doctors prefer treating immediate problems. If you come with a long and varied history, they don't have a time for that, and often they would not know what conclusions to draw anyway - the body is complex and even if they had a hunch, the more possibilities there are the harder it is to diagnose. Also, expectations of expectations: Doctors know (sometimes learned the hard way) that people expect miracles or at least solutions from them when in reality they themselves often don't know.

Finding the cause of a problem may take months or even years of commitment (in retrospect, after a diagnosis, it's always clear of course, "why didn't we think of that sooner"). Few patients have the resources, the patience(!) and will to slowly and iteratively work on a problem, especially when success is highly uncertain. I only solved the one I myself had because I took some very radical steps that set me back income-wise for a decade at least and cost me a few social connections. The majority of people would have gone with "placebos", symptom-covering "solutions" for immediate problems, instead of choosing the great uncertainty (and when I started it was very uncertain indeed and everybody advised me to be "reasonable" and not throw my life away to chase ghosts but listen to the doctors). If I was a doctor I would never treat someone like me - because it would be highly unlikely that the person would be as extreme as I was and give up so much of their current life for very uncertain future benefit. So what doctors offer also is a mirror of what patients expect and are willing to invest (and I don 't mean money, the time and effort under uncertainty is much harder to bear).


By the way, my tonsils disappeared by themselves! I went to nose and throat specialists a few times during the last decade because during my long recovery I had plenty of throat issues. At some point they wondered why my tonsils where so tiny, and during the last appointment last year or so I was asked when they had been removed - they weer gone. I never had surgery, and I'm sure I still had them a decade ago. No use asking, nobody knows what happened. They were definitely never removed (or the doctor three years ago would not still have found them to be unusually small, and the next one three years later that they were not there at all).

> What do you base your judgment on?

The experience of various family members at different stage of their life (we had to deal with childbirth, cancers, complex surgeries, broken bones, and simply old age, etc) and my experience in living in different countries. I am happy of my city hospital.

> childbirth, cancers, complex surgeries, broken bones

That's all pretty standard, all of those I'd trust most modern hospitals with. Yes there can be big differences, but at least all of those are part of the standard things modern medicine excels at. Anything ER, surgery, child birth. Cancer treatment is more variable but there's standards, they know what the problem is, they know what to do for diagnosis, and treatment is pretty standardized and most variance is how much they are willing to experiment with the latest (and most expensive) treatments.

Try having anything that is systemic and not easy to see (or invisible to any biomedical imaging). Each time you have a clear diagnosis for which doctors can go to their catalog of appropriate treatments you are lucky. Anything obviously and visibly broken (incl. by using imaging tech) is "the easy stuff".

Your satisfaction also depends on how willing you are to accept whatever the doctors tell you!

If I had accepted the verdict some ten years ago I would never have found that there actually was a relatively easy to identify and treatable cause for my issues. If I had accepted the endocrinologist's recommendation for surgery to remove the nodule in my thyroid, and part of the enlarged thyroid too, I would have had a happy surgery experience, because they are good at hat. But I didn't - and the nodule disappeared and the thyroid shrank back to normal to the great amazement of the endocrinologist. I don't mean to criticize your assessment, I'm happy myself too - but I had to do all the heavy lifting myself, it's just that I know how to use "the system" and how to get what I want from it and not asking for things they are bad at delivering. If you always accept what they tell you psychologically you will be a satisfied customer and life is easy (even if the problems persist, but if you accept them as inevitable your mind learns to ignore them pretty well). If you don't know and never assume that things could be better you'll always give top-rates.

I was extremely satisfied (no exaggeration) and full of unshaken trust in all doctors for almost 40 years, and I had things like jaw surgery to correct an under-bite. I went into this surgery as if it was an appointment for a hair cut, they did not even give me anything to lower anxiety even though they had planned to - my trust was complete, and for things like surgery it still is. Only when I had a problem where there were symptoms but no known cause did I hit a wall and had a very rude awakening.

What was the issue in the end? And how did you solve it?

There is a huge backstory, but there was a point when a lot of tiny problems that I had ignored for decades as "part of life", "stress", "everybody has small problems", "too much computer work" or attributed to external factors like "the cold viruses have gotten worse over the last twenty years" reached a crisis point in the form of problems with the digestive system so bad I had it checked out, from both above and from below. At the end of it all was the prediction by the professor of gastroenterology whom I had consulted (yeah, I thought the grand title would not hurt and it was almost within waling distance from where I live) that I would have to take PPIs for the rest of my life.

I looked it all up and read a lot online afterwards, his procedures were immaculate and complete including all the blood work he had ordered, beyond a normal checkup, left nothing left to ask for given the symptoms I had presented. His diagnoses was 100% correct and according to all guidelines in the modern medical world, whether you are in Europe or the US.

Except that nothing made sense.

He completely ignored when I told him that I had never in my life had so many issues as with the PPIs. He asked me to be patient, just a few more weeks and we could lower the dose. But in addition, I felt that 99.9% of all my problems were "unaccounted for" in that diagnosis, that it only was about one tiny issue, but I felt it was much more systemic and that the recommendations would do nothing whatsoever towards finding a solution. It was putting buckets under the leak instead of finding the leak in the roof and fixing it. But I found that it was perfectly normal not to look for the deeper explanation, the cause of problems such as I had had!

First thing I found after a few weeks was that I had a huge candida outbreak. The professor had ignored the symptoms, I found the description on some website that I thought was entirely bonkers and esoteric, which is why I ignored it at first. But after weeks of no solution, and it got worse, I went back to that website and checked other ones too. I thought, it must be candida! I got an oral anti-fungal (cheap, no recipe required) - and within 15 minutes I had confirmation that it was a fungal infection. I went to a doctor with the diagnosis and got it confirmed, and I even got systemic anti-fungals (fluconazole based), all of it with huge success.

HOWEVER - I soon learned that a fungal infection isn't a cause, it is itself only a symptom. The only thing I found that was a remote possibility was: heavy metal poisoning. I did a test, I searched for specialists, I had to go travel a few hundred kilometers to an environmental medicine doctor at a university clinic, he said I'm a gray area case and I must have something else but that I should start chelation. He never found anything else, and ALL problems I ever had slowly disappeared, including miracles such as the thyroid thing. The prediction about "PPIs forever"? I have not taken one since 5 weeks after the professors prediction and my gut health now is PERFECT, like I never knew it, not even in childhood.

Which heavy metals did you test for? And what do you think was the source?

I had significant levels of mercury in hair but also in urine. That was a "fortunate" exception - with chronic poisoning you may end up - no, you usally do end up always testing with very low levels that don't raise any alarms.

Growing up as a child in East Germany we had lead pipes at home, but they had a thick layer of mineral build-up and even though I also heavily used DMSA, a prime chelator for lead, no significant amounts of lead ever showed up. Given that health came back - to levels not seen in decades - without us ever seeing much of lead, only mercury, I guess it must have been mostly mercury.

The only possible source is amalgam fillings in teeth, which I got in childhood in East Germany. I found a document that indicates that the kind of mixture they used there was different and was abandoned elsewhere long before, so that may be a contributing factor. Nevertheless, my jaw bones had lost their trabecular structure and were in a bad state in exactly the places where the amalgam fillings had been. This was found by the doctor who just wanted to do a regular injection into the buccal mucosa - and ended up deep inside the bone. Ooops, that's bad, he said. He injected DMPS, mercury chelator, and in the following months my jaw bones "came alive". In a positive sense. A year later he found the bone impenetrable everywhere he tried, it was penetrable by a simple needle without pressure in all four quadrants before that (I had had fillings in all quadrants, fortunately none very deep).

I also remembered that my East German dentist, after reunification asked me if she should replace some of the amalgam fillings with plastic fillings. I had no idea why and what and did not care, I always said "yes" to every suggestion a doctor ever made to me, I was completely unaware of any "amalgam controversy" until I had to do my desperate research of what was wrong with me. But now I remember that at exactly that time, just a year after I had started studying, I had suddenly and out of the blue developed severe, almost asthma-like allergy, had inexplicable problems in various joints, had terrible sleep issues, and a lot of other stuff. And I barely managed to pass the math classes (CS study) - I had always been a top math person and we had high-level math instruction at high-school (in year 3 of the CS study I discovered that the lecture was exactly about the same stuff that we had had in high-school from our over-achieving teacher). I had gotten "stupid", but I only realized it when everything cleared up under the chelation treatment and I've taken over 60 mostly STEM courses on Coursera and edX and now my brain works again. My dentist had removed the amalgam fillings with a normal drill and without any protection. When I did the research eight years ago even a fresh doctor in residency warned me not to have my remaining amalgam fillings removed - because of the danger of mercury being freed ("this is dangerous" was what she said), the drill creates vapor no matter how much water you use to cool it, and mercury vapor is the worst since it can penetrate all the surrounding tissues. When I had the remaining fillings removed it was done with special equipment and a chelating agent to wash the mouth after each removed filling.

There's a lot more - A LOT... after all, all those years of (essentially) experiments that hardly anyone ever performs. I've taken waaayyyy more chelators than even the doctors who think amalgam fillings cause poisoning and offer chelation treatments usually do, but since I have had success that could be clinically proven, and since I seem to be handling the whole thing very reasonably the doctor keeps filling my prescription. My conclusion, based on actual, sort of, "experiments" - on and off chelators, is that heavy metals have effects given FAR lower amounts than are clinically relevant today. I feel my conclusion is in line with science, given that we have reached the official conclusion for lead that the amount with zero effects is zero lead - and mercury is worse than lead (according to an NIH document I found). But you won't be able to detect those effects unless you try. The slow decline of health and mind is very subtle, I was "lucky" that I hit an extreme. I see soooo many people with issues I had, such as psoriasis, warts on the feet, colds that won't end, issues with eyes, etc. etc. - a looong list, that I have to wonder.... I DID take bio-chemistry, physiology, anatomy, etc etc. - at least a thousand ours of medical lectures and courses if not more over the last few years, so I am aware of the complexity. I just think that heavy metals contribute much more than is currently accepted. All you have to do to get (what I now think is) a significant amount of mercury is to eat lots of sea fish, especially the predators.

> By the way, my tonsils disappeared by themselves!

You're not alone there: my partner's tonsils "dissolved" when she was younger. I've never heard of this anywhere else until now.

I believe you find this article interesting: https://www.nytimes.com/2015/08/11/upshot/labels-like-altern...

"My friends who believe in homeopathy don’t really care. Those who favor conventional medicine, though, can be just as blinded. Too often, when confronted with evidence that advanced technology might not be providing benefits, the medical community refuses to change its behavior."

He goes on to argue that the distinction between conventional and alternative medicine is misleading. The only distinction should be between what is proven and what is disproven.

"By definition, Alternative Medicine has either not been proved to work, or been proved not to work. Do you know what they call Alternative medicine that's been proved to work? Medicine." --Tim Minchin


And how would you call medicine that has been proven not to work? This is what the original discussion is about: the medical system can be too slow to recognize and stop harmful practices.

There are many examples: Thalidomide, operating on babies without anesthesia [0], intensive glucose control [1], adenoid removal (the topic here) etc.

[0] http://www.nocirc.org/symposia/second/chamberlain.html [1] https://www.nejm.org/doi/full/10.1056/NEJMoa0810625

"Alternative" means "unproven or disproven", doesn't it?

To pro-alternative folks like myself it just means "not in the medical textbooks yet". Most 'alternative' approaches do have rigorous studies backing them up, just recent and ignored by a lot of people.

Homeopathy doesn't work. Acupunture doesn't work. Traditional Chinese Medicine doesn't work. Faith healing doesn't work. These rigorous studies you're mentioning do not exist.

This meta-study supports the use of acupuncture to treat chronic pain: https://jamanetwork.com/journals/jamainternalmedicine/fullar...

The practice seems to have a (very small) effect compared to placebo or "fake" acupuncture, but the "traditonal" theory of it has no explanatory value whatsoever.

What about getting allergy shots? Do you know that it was considered 'quack science' just as recently as a few decades ago? Now it's been adopted by mainstream medicine as one of the most effective ways to help deal with allergies.

Believe it or not, western medicine doesn't have all the answers, especially when it comes to chronic conditions. Thinking that steroids and antibiotics will cure IBS is quack science, and that's what's being practiced in western medicine.

You have a distorted view of the methods and procedures of "western" (evidence based) medicine. It is obviously not perfect (and I'm pretty sure that you don't actually know the worst of it - the current obsession with having universal prescriptive protocols for everything is a rather clear local minimum that medical practice is stuck into), but everything else generally doesn't rise above the "not even wrong" bar.

"Western" medicine dramatically improved in the last few decades. "Alternative" medicines do not have the intellectual framework or the ability to improve.

I don't know, it's a matter of definition. What I know is that the article makes a good point.

My son had adenoids removed last year because his hearing was VERY bad because of some kind of mucus blockage. Doctors explained to us that he would hear perfectly without the adenoids, because inner ear measurements were very good.

So during the OP they cut away the adenoids, and made a hole into each eardrum, so fluids could exit. After the OP his hearing was so good that he told us not to scream at him when we barely whispered - for 2 weeks. As soon as the holes in the eardrums healed up, the blockage developed again and his hearing was exactly the same as before the OP.

We tried alternative treatments for a year, strange juices with corticosteroids and stuff (which worked well for his hearing, but he couldn't really sleep while on them), near-infrared radiation through the nose (our favorite so far, but does not work that well because adenoids are too far in)... so he's soon have his second OP where they will likely remove adenoids again (they regrow sometimes) and insert little tubes into his eardrums such that fluids can regularly exit the ears.

Distant relatives of mine have the same issue, but worse (delayed speech development due to near-deafness), and for them the OP worked for 1,5 years and now its positive effects are going away; perhaps requiring another OP.

I'm not thrilled about all this.

BTW here is advice a very expensive doc gave me regarding hearing and speech development: If your kid understands what you are saying while you whisper from a distance of ~1 meter, then her speech development should not be negatively affected, or not that much.

Sorry to hear you're going through this. I can't imagine how frustrating it must be. Are you concerned about side effects from all these interventions? Do you have a hypothetical point at which you would simply choose to accept your child's hearing impairment?

I'm trying to be a stoic, and I will deliberately try to accept anything that I cannot influence in this very moment. Approaching medial issues, I think that the only thing you have to accept (until your death) is that your previous attempts at improving have failed; so as long my son's hearing is not good, I'll keep on looking for things to try out. There are time and cost constraints of course; sometimes I go for weeks without researching anything to improve the situation. But the motivation to do something returns naturally when he's in pain again, or is misbehaving very badly because of this.

My heart breaks for you. Wishing you the best.

Reading your comment made me want to share my own experience--I had the same issues/surgeries as your son when I was a kid. Was very blocked up/nasally all the time and prone to ear infections, had some problems hearing, breathing, etc. Except in my case, when they removed my adenoids they also put the tubes in my ears on the first surgery, and I didn't have any follow-up operations. Not sure why they didn't use the tubes on your son the first time, but in my case I think it helped in the long run.

Initially I experienced the same effect on my hearing--everything was unbelievably loud to me all of the sudden. I asked everyone to quiet down, the TV was always too loud, the phone ringing scared the crap out of me. Eventually, I adjusted and it didn't seem so bad. I'm not sure if my actual hearing got less sensitive or if I just "got used to it", neurologically or otherwise.

However, I can tell you that to this day I still have a pretty bad sensitivity to noise. Don't get me wrong, it's not nearly as bad as it was right after the surgery, but I sometimes feel like I can hear people whispering from across the room. Certain noises (especially high-pitched ones) seem to bother me way more than other people. I have been accused many, many times of having a ridiculously low speaking voice (I think these are somehow related). Like my overly-sensitive hearing made me think I was speaking much louder than I really was--or that everyone else's hearing just sucked. I still haven't figured that one out, I might just be a low-talker for unrelated reasons :).

Anyway, I do think this surgery had significant long-term effects, and oddly enough, some days it seems like my emotional state plays a big role. If I'm feeling really upset about something, all the external noises of the world seem that much louder. I get overwhelmed and even angry and feel the urge to tell everyone to shut up. I think this is exacerbated somewhat by living in a busy city in a poorly sound-proofed apartment.

Even with the side-effects, I do think I'm better off having had the tubes/adenoids removed because I no longer have the constant feeling of being stuffed up, or the painful ear infections along with hearing loss and breathing difficulty. Though I admit some days, I wish I didn't hear so damn much, but I'm trying to just find a more peaceful living space to cope. I do wonder if there were better treatment paths, especially given this study and the other comments I'm seeing in this thread!

Just anecdotal, but I think this simple study supports the idea that it is worth exploring the cause of non-critical health issues before we start slicing and cutting.

I grew up with the worst ear infections. Tonsils were removed, and various drugs and treatments. I even needed a speech therapist because of hearing problems that were caused. My family doctor was very opposed to putting holes in the eardrums though, so they didn't try that.

I continued to get ear infections regularly until I left home, but I didn't really realize the stopped. About 8 years later I had another one, and finally isolated it to whey protein (protein supplement started using when going to the gym).

It has now been another 10 years without an ear infection.

Funnily, I have the same reaction to whey protein, and also if I eat very (!) large amounts of swiss cheese or even joghurt. I anecdotally found out that drinking a small amount of apple cider vinegar mostly resolves my stuffy ears after that. Forgot to mention that I also had my adenoids removed as a kid.

So are his eustachian tubes chronically obstructed?

My younger brother had chronic ear infections as a kid, and as best I know he basically had tubes in his eardrums for a while, and then when he was older his eustachian tubes started draining more reliabily. He's been fine since.

Docs did not tell me what exactly is obstructed - yes they said he might soon be fine without an operation because his head will grow.

In that case, it sounds possibly similar. Tubes are pretty non-invasive, although they can come out which is annoying and you have to wear earplugs when you swim.

I had tubes put in my ears when I was little for drainage. Eventually they were removed and I don't have the problems.

Did they only put in the tubes, or also take out the adenoids?

Just tubes in.

Only barely related but I have a personal story about this!

I had my tonsils removed at eleven years old. I didn't know why then, and I still don't now.

I suffer quite a bit now from allergies (I'm not sure how related to this it is, and I guess I've no way of knowing really).

I remember being really scared, and the surgeon playfully telling me that I'd be fine, I'd be asleep through the whole thing and would wake up back on the ward (with ice cream!) and barely even know it was over. I was told that I should count to ten while they issue the anaesthetic. I was unconcious by seven.

The next thing I remember is waking up really disorientated, in a different room, and could only see blurred grey shapes. I've never been in such pain before or since. I shut my eyes and bit down hard into the white hospital pillow while screaming.

An unfamiliar voice shouted angrily at me that I wasn't supposed to be awake yet. I opened my eyes as the pillow felt wet only to realise that it had turned completely red. It felt like someone had cut my throat out.

My mother (having been advised that I'd be asleep for hours) had gone to get a coffee and was completely unaware that any of this had happened. For reasons that were never explained, the nurse wouldn't take me out of the room and my mum wasn't informed until a couple of hours later when I was wheeled back out onto the ward.

I had to stay in hospital for another two days as a result of what went wrong (haven't a clue to this day what that was exactly), and was bloody terrified.

Anyway, long story short is that when the bleeding eventually stopped I finally got some ice cream. It was warm, it tasted bad, and it was entirely not worth it.

In summary, surgery could well be correct for you and/or your child if a competent professional has analysed and considered your case and health outcomes, but I don't recommend that anyone allow themselves or their children to be mutilated without any explanation at all in exchange for sweet treats.

I feel sorry for your experiences.

I had my adenoids removed, twice actually, but my first surgery was quite memorable.

Post-soviet Estonia, 90's. I was nine, my nose was pretty much constantly blocked or snotty. The Doc said I had my adenoids enlarged, and advised my mom to agree to an operation. And so, couple months later, I remember sitting in the Doc's reception room, while nurse was slowly screwing long (half the size of knitting) needles with local anesthesia really deep into both of my nostrils. I had no clue about lobotomy back then, he-he, however this part alone was enough to injure my childhood psyche. And I didn't yet image what kind of fun will come next.

Two hours later they came for me. I was taken to the operating room, in the middle of which stood a red faux-leather (torture) chair. My hands were strapped to the armrests. I was kindly told to sit still and open my mouth. Long story short, I was operated with huge weird scissors inserted deep into my throat, cutting off pieces of my flesh, while I was in full consciousness that whole time.

Couple years later, I was repeated this operation in a regional hospital of Kyiv, this time under general anesthesia (I echo OP's counting up to 7 max). The chief surgeon said that my first operation was an act of inhumanity.

Twenty years later, I don't blame anyone. Nowadays we have much better NHS (better than in Ukraine so far). I understand that this was a confluence of unfortunate circumstances—it happens and it could be much worse. Today, thanks to science, I know this episode a) should have never happened, and b) will affect my future life. I was already wondering why I got allergic symptoms several years ago. Let's hope that scientific and technology progress will catch up and fix all the mistakes that we had to go through :-).

Very unpleasant! I recall spitting up blood afterwards, but it wasn't that bad at all. Although, I was never supposed to have my tonsils removed. I was in hospital for another reason but got mixed up with someone else and the wrong operation was performed.

Yikes! How on earth does this even happen?

I'd at least expect some Cherry Garcia or Chunky Monkey after a quagmire of this magnitude.

I'm not exactly sure (it was rather a long time ago), but IIRC everyone else in the ward was there for tonsillectomy and someone must have got it wrong when the surgeon called for "next, please".

No Ben & Jerry's back in those days!

"No Ben & Jerry's back in those days!"

That's the real scandal in all of this! :-)

In seriousness, I'm sorry for your experience.

Thanks. I think that your experience sounds worse; I hope it hasn't left any lasting impression.

Me too post...

Tonsils and Adenoids out when I was 3, so I don't remember it as vividly as you do, but I also woke up hours before I was expected to. They'd strapped me to the bed so that 3-year-old me couldn't mess with the IV they'd put in my arm. My throat was in searing pain, but was too sore to make a noise loud enough to alert any of the nurses, so I lay there in pain for almost an hour with no way to do anything about it. They sent me home a couple of days later, but it was weeks before I could eat solid foods and I had to go back to the ER to get IV fluids multiple times or I would've died.

I try to tell my story whenever it's relevant because I believe doctors and parents severely underestimate how traumatizing this kind of procedure can be for children.

My sympathies.

Had adenoids removed at the age 6 or 7 with only local anaesthesia. It was fucking terrifying.

They told me it was space air. I began to protest that there was no air in space, and before the count of 10 the nurses began spinning around me as I fell into my first psychedelic trip. Didn't have an experience like that again until I tried salvia. I was 6-8. Weird.

Had general anesthesia as a kid/pre-teen. Broke my nose, went to the hospital, doctor didn't want me to be awake when fixing it.

Felt very sick and disorientated afterwards. Had swallowed what I at the time perceived to be a lot of blood, which I vomited for one or two days. Couldn't eat, tasted the ice cream twice.

Pretty sure my nose could've been pulled into place without general anesthesia, but maybe that would've been scary too.

I'm really sorry you had to experience this.

I appreciate that. It really was atrocious ice cream.

Wow... it sounds like you were tested by the Gom Jabbar.

Let me provide you an alternative perspective worth considering. Depending on the seriousness of your condition, having adenoids can result in having problems breathing normally( aka through the nose). Now obviously breathing is very important for your organism, and it will find ways to adapt, and you will find yourself breathing through your mouth.

Breathing through the mouth will encourage the development of a long face, cus tongue is not in its natural position, at the top of the palate. Your posture will change since having the mouth open is not the default position of the body for long periods of time. You might find your neck lunging forward. And these are just second and third order effects for not being to breathe properly during early childhood.

Jaws might not develop properly, teeth as well. And that is all the effects I know about.

Yes, I've had both my adenoids and tonsils removed, in the end. Not early enough though.

My daughter couldn't breathe easily when she was young--when sleeping you could literally hear her breathing from a room or two away. Like having Darth Vader sleeping in the next room. After tonsil/adenoidectomy at about 3 years old she could finally breathe properly and her sleep become much better. It made a HUGE difference to her quality of life.

I had my tonsils removed when I was 19 because of sleep apnea. Even after reading this piece I'm reasonably confident, though not certain, that it was a net-positive.

Is there a causal link between the surgery and the increase in long-term disease risk, or were patients who were more likely to get the surgery (because of more severe symptoms or more frequent occurrence of infections) at greater long-term disease risk (whether they had surgery or not)? Without some functional mechanism, I'd be very wary of these kinds of data analyses.

> Without some functional mechanism, I'd be very wary of these kinds of data analyses.

Kind of a tangent, but dumb question: wouldn't the sensible default assumption be that messing with your body is likely to be harmful unless proven harmless? Rather than the other way around? So if you're skeptical, shouldn't you be skeptical that it's harmless?

It has not been until recent times that any form of messing around the body was for any reason other than self preservation or the improvement of quality of life. I am talking post-enlightenment/age of reason medicine here, not dark ages blood letting. And we still get it wrong, and still do things without enough of an evidence base, but when it comes to removal of adenoids, the reason it is done is because in those it is affecting it is having a harmful effect on.

Whether that be the formation of peritonsilar abscesses (potentially fatal), difficulty breathing (watching a 6 yo struggle to get air into their lungs due to enormous tonsils is not a sight I enjoy seeing) or just missing large numbers of days of school due to repeated illness, with knock on effects to child wellbeing and performance, there is a firm reason why we do this procedure

That isn't true - body modification has been a facet of human culture for a long, long time.

Weird to hear tonsilectomies being spoken of in thw present tense. It stopped being routine in Australia in the 80s.

There are more than 35,000 tonsillectomies done in Australia every year (and more than half a million in the US). This is a highly routine procedure. In fact there is very clear guidelines on when GPS should refer for tonsillectomy:

Tonsillectomy is indicated When young children have had >7 episodes in one year or >5 episodes in either of the last 2 years, or quinsys, or obstructive sleep apnoea.

Tcj_pcx for some reason I can’t reply to your comment, but there’s almost nothing in it that actually makes sense:

I'll just pass straight over the emotional comments.

Massage doesn’t cure tonsillectomy; and frankly this thing that people say, that ‘doctors treat the symptoms not the cause’ is actually a vein of deep ignorance in the general populace.

The treatment cures (in around 97% of cases) tonsilitis. Which may have lead to (in the above scenarios) a 6-10 year old child missing up to 30-40 days of school a year. And therefore having a severe impact on that child’s learning and progression. It is not treating a symptom: giving analgesia or an ice cream would be an example of that. Is modifying the mechanism by which the condition unfolds and therefore preventing the condition from occurring again.

[0] https://www.safetyandquality.gov.au/wp-content/uploads/2015/...

> Tonsillectomy is indicated when young children have had >7 episodes in one year or >5 episodes in either of the last 2 years, or quinsys, or obstructive sleep apnoea.

Yes. I'm not sure why you're replying to me, as you're essentially agreeing with that I wrote.

As another poster already pointed out, it used to be done on the first or second episode, with the general view that the tonsils were a 'useless' organ (people held/hold similar ideas about the appendix and penile hood). Now it's only done, ad you mention, when the child has had > 7 episodes in one year or > 5 episodes in either of the last 2 years

> Massage doesn’t cure tonsillectomy

Tonsillectomy is prevented by figuring out why the tonsils are becoming inflamed in the first place.

I said "bodywork (massage/etc)" because most people aren't familiar with the different kinds of bodywork that were developed over the course of the 20th century. I would place the emphasis on "etc". Massage is a general treatment, while other forms of manual therapy are more specific in their beneficial effects. You might know some "physical therapists" who can work magic with their techniques.

> The treatment cures (in around 97% of cases) tonsilitis.

Removing the tonsils will prevent the tonsils from becoming inflamed, on account of their removal. But certainly you would agree that if the cause of the inflammation could be determined, it would be better to address that factor than to just remove the part?

The girlfriend I mentioned in the post was born with her umbilical cord around her neck, which is how I knew that she'd probably benefit from "bodywork". When she came back from a class trip to Mexico, a few weeks after we'd met, the lymph glands on her neck were rather puffed out. I'd already made her an appointment with the good "physical therapist" (to hopefully deal with the unresolved somatic problems associated with her tonsil extraction ~15 years before). The "physical therapist" found that one of her ribs was out of place (certainly due to carrying a heavy bag over her shoulder while stomping around the border cities). This displaced rib was pinching on the lymphatic channel (maybe not the correct terminology). After releasing the rib to its proper location, the therapist said the lymph glands would probably go down over the next 1-3 days, and that if they didn't normalize she should seek further medical care (x-ray/etc, to rule out conditions she could have caught in Mexico). The swollen lymph glands entirely went away over the following week.

I recently took a new friend to an actual physical therapist with similar training. This woman sprained her ankle ~6 to 10 years ago. The post-injury surgery made her ankle problem worse (I understand the surgeon accidentally cut a nerve that shouldn't have been cut)... This woman was just trying to hold herself together, but was collapsing. The physical therapist helped this woman out quite a bit, and she was surprised at being able to make several trips to unload her car a few days after the appointment.

My point is simply that people's conditions usually have a broader context than their presenting symptom.

that would not be an obvious bow to draw from your comments, and frankly, and medical practitioners who are not looking at holistic health when presented with a patient are missing the point.

However, you are so far off point on the tonsillectomy.

Let's take a slightly different condition. A patient has gallstones, causing ascending colangitis. The treatment (which you would describe as treating only the symptoms) is to remove the gallbladder, a cholecystectomy.

The cause in this instance is being a mid 50's woman, slightly overweight, genetic predisposition, high fat diet.

Your implication is that because the Doctor is treating the symptom, they are doing a disservice to the patient?

The reason I am defending this so strongly, is because it is only a stone's throw from the implication you initially started with - 'that doctors treat symptoms, not causes', to 'Doctors/The medical-industrial complex is with-holding the cure for cancer, because if they fix it they don't make any money'.

As though no doctor, or scientist in the field, has ever died or watched a family member suffer through that or some other insidious disease.

Doctors are human, they make mistakes, they act on evidence that is only partially formed (and have to in order to act in a timely manner), and their actions are often not fully explained to those who they are treating.

We can and should do better. But slinging mud on my profession I can not sit idly by and abide.

My mother had to have her gallbladder taken out ... maybe 6 months ago. IIRC she was diagnosed with acute pancreatitis at that time too. If she'd been taking better care of herself, she might not have deteriorated to the point that gallbladder removal was necessary. Hindsight being 20/20, the signs of a developing gallbladder condition were all there... (Adult children generally have very little ability to influence their parents' habits.)

> 'Doctors/The medical-industrial complex is with-holding the cure for cancer, because if they fix it they don't make any money'.

Progressive cancer doctors are coming around to the idea that Otto Warburg (who theorized that cancer is a metabolic condition, rather than genetic in origin) might've been on the right track: https://www.nytimes.com/2016/05/15/magazine/warburg-effect-a...

> But slinging mud on my profession I can not sit idly by and abide.

My goal is to help the profession clean up. Sometimes doctors do good work, but frequently the evidence to support an intervention never actually existed: https://www.propublica.org/article/when-evidence-says-no-but...

> slinging mud on my profession I can not sit idly by and abide

Now I know why you thought the parent's comments were emotional. The world would be a better place if we all tried to stop seeing personal attacks where they don't exist.

For the record, your disagreement could likely be bridged by removing absoluteness. You could likely agree that "some doctors sometimes treat symptoms, not causes". And we all agree that's a problem to be solved.

Seconded. Not to mention patients lying or involuntarily withholding pertinent information (because embarrassed or would reveal unwholesome behaviour/activities).

> Tonsillectomy is indicated When young children have had >7 episodes in one year or >5 episodes in either of the last 2 years, or quinsys, or obstructive sleep apnoea.

But it used to be a lot more common. It used to happen after the first or second episode.

Back in the 60s, in some areas of the US, all kids had their tonsils out, even if they never had an infection. They'd do multiple siblings in a single day.

>The treatment cures (in around 97% of cases) tonsilitis.

I feel like this is a kind of doublespeak and a rather misleading way of phrasing things. It of course stands to reason that excising an organ in toto will be very effective at preventing a person from having continued inflammation of that organ, as it is no longer part of their body, in the same way that toenail fungus can almost certainly be "cured" by amputating the affected toe.

The latter rarely happens, because people understand the value of their toes and realize that having toenail fungus is typically better than having no toe at all. But for organs inside the body, whose function is less plain to the lay person, patients are largely at the mercy of doctors to give them an honest appraisal of the life-long risk of removing them, and whether it might be warranted in a particular situation.

It seems that in many of these cases, it would be far more straightforward and honest to simply say "If [organ X] is really bothering you, I can cut it out," rather than cite some pseudo-scientific percentage purporting to describe how often surgery can "cure" some abstracted set of symptoms or "chief complaint." Doctors (especially specialists!) seem reluctant to move beyond this rather myopic way of conceptualizing health care. The idea that medicine is simply a game of "complaint whack-a-mole" might be psychologically comforting to a doctor (as well as financially lucrative in fee-for-service jurisdictions), but, from the perspective of the patient, it makes little sense to fix one symptom only to acquire five more of greater severity.

The question people really want answered is: "If I cut out [organ X], is it going to cause me other problems down the road?" But this is the very thing that doctors/surgeons so often seem so curiously (willfully?) ignorant of, even for "routine" procedures. Isn't it rather bizarre that, despite tonsillectomies and adenoidectomies being performed on millions of children over many decades, often for the most trivial of justifications, the analysis described in the linked paper took until 2018 to be completed, by a trio of PhDs no less?

Is it just too psychologically burdensome for surgeons to worry about the long term health of their patients or the long-term consequences of their procedures?

I think tcj_phx certainly does have a point, that people are not so much interested in "treating symptoms" as they are in doing what will preserve their whole-body health well into old age. If doctors can't say what will best achieve that, either because they don't know or haven't bothered to look into it carefully, they need to be very upfront about their ignorance and inability to provide a well-considered recommendation.


Any relation between tonsils and your ex's gender/personality ("She was an emotional wreck") is nonsense. Don't post sexist stuff like that here.

The commenter is saying that a particular person, who happens to be female, is / was an emotional wreck. How is that sexist?

It's not, unless you somehow associate being an emotional wreck with having a specific gender. Ironically saying it's sexist is probably the sexist statement here.

OP should have just said "my friend" and you wouldn't call him sexist then. Did you really react like that only because a woman was mentioned in the post? Do you realize that it makes you sexist, and not OP? Don't post sexist stuff like that here.

There's nothing sexist about it. She was a mess, I helped her deal with her problems, she greatly appreciates the help.

My point was that people's presentations have a context. She was an emotional wreck because of all the different kinds of "stress" that she was dealing with -- unresolved "birth trauma" (umbilical cord wrapped around her neck), "adverse childhood experiences", etc.

Her tonsils were extracted because her doctors didn't know what else to do. If they'd known to look deeper than the presenting symptom, she might still have her tonsils.

I responded to robbiep's comment edit above, please look for that too.

Do you're saying bad childhood experiences caused emotional trauma caused her tonsils to be inflamed?

I'm looking for a better explanation but can't find one. I don't think your comments are sexist, but they do seem illogical.

No, I'm saying that birth trauma (related to a Nuchal Cord [0], and possibly a breech birth [edit: just confirmed she was born breech; doctor tried pulling her out with forceps and the nuchal cord wrapped around her neck made her birth more traumatic than usual) was one of the factors behind her later development of inflamed tonsils. Bad childhood experiences contributed to her being unable to cope with life when we met.

  In no study was it possible by ultrasound to 
  distinguish between a loose or a tight cord, 
  although at least 3 attempted to do so.[citation 
  needed] Peregrine[2] concludes that ultrasound 
  diagnosis of nuchal cords will only be useful if 
  doctors are able to do so reliably and predict 
  which of those fetuses are likely to have a 
[0] https://en.wikipedia.org/wiki/Nuchal_cord

> but they do seem illogical.

I typed my first comment in this thread out on my phone. Subsequent comments were done using a keyboard. I suppose when challenging conventional wisdom I should restrict myself to using an actual keyboard to develop my post more.

Who said it was harmless? I'm sure any surgery isn't without risk. The mechanism for the most obvious short-term risk is very well known - infection. For that reason alone one has to weigh the benefits and really consider whether surgery is worth it.

Anyway, my skepticism is not so much with this particular result, it's the experimental design generally. How do we know the sample represents the population when it's not randomly selected? At best, it's the starting point of a possibly interesting research tangent, not something I'd be publishing as a stand alone paper.

Yes, because walking into a hospital filled with sick people to be cut open is default a dangerous thing to do. Even visiting a hospital is a terrible idea for anyone even remotely at risk (older, immune compromised, etc) due to infections.

> "cases were no less healthy than controls presurgery in the first 9 years of life"

Looks like they addressed that (heading: Testing for Biases in General Health Before Surgery)

And elsewhere, a bit more explicitly:

> Participants in the case and control groups were selected such that their health did not differ significantly prior to surgery.

> Participants in the case and control groups were selected such that their health did not differ significantly prior to surgery.

And yet some of them got the surgeries and some didn’t, so it’s unclear if the control was adequate.

>And yet some of them got the surgeries and some didn’t, so it’s unclear if the control was adequate.

It is what it is. The documented evidence suggests that the medical histories of the two groups diverged strongly at the moment of surgery.

It is possible that the decision to have surgery depended primarily upon an arbitrary judgment of the surgeon, in which case the randomization is adequate.

It is also possible that the pre-surgery health of the two groups diverged in a way that was not well-documented in the medical record, in which case the control is inadequate.

However, this latter possibility is still not flattering to the medical community. If the conclusion of the study is even possibly correct, it raises a serious question of why such a flimsy paper trail accompanied such a momentous cost-benefit decision in the lives of these children.

Andenoids/Tonsils are organs of the immune system. This is not mechanistically surprising to those in the field

I had my adenoids and tonsils removed as a kid in the early 1970s. Had bad allergies all the way into my thirties, but I have no way of telling if they were the reason I needed to have my adenoids removed in the first place. However, I simply grew out of my allergies in my late 30s.

These days I rarely get sick, despite living in London and travelling on public transport all the time. And when everyone else in my family has a terrible sore throat, I never have a problem, so that's definitely a plus side for me right now.

I'd be really interested in whether there's a downside heading into old age, but I've not seen any data on that.

Like everything in life and medicine, it is all risk-benefit analysis. I'm underwhelmed by the absolute risk reduction for most of these findings. Most people get some sort of upper respiratory infection, is increasing URIs rate from say 65% to 70% clinically meaningful? Sure its statistically significant here given the large sample size, but I'm not sure it helps us know what will happen.

But if a child is suffering now, and we have the chance to help, what should we do with this data? I'm definitely against unnecessary surgery, especially in children. I just don't think this pushes my definition of necessary very much.

My daughter's adenoids were removed after their size caused her ear canals to remain closed, which was causing fluid buildup behind her ear and affecting her ability to hear clearly.

When a child cannot hear, they cannot learn important nuances to speech. Additionally, prolonged exposure to those fluids, if I understood the ENT doctor correctly, her hearing could have been permanently damaged had we left it. We were also taking intercontinental flights at the time and the closed canal could have caused a rupture, further limiting her hearing.

None of these things were associated with an ear infection. We only identified the adenoid issue because she was having trouble hearing and the ENT identified the large adenoids at that point. There was no pain associated with it, and I suspect many parents may not even realize that their kids have this issue.

What are the long term speech and hearing risks compared to the long term health risks?

I strongly caution anyone against a knee-jerk response to a study like this. It could be another anti-vaccination study all over again.

Reading stories like yours does make me wonder if the bigger issue here is variance in standards of care.

Clearly you've been advised, based on your specific circumstances, of why it would be in your daughter's best interests to have this surgery done (there's no sarcasm here - it's great that so much consideration has gone into it and clearly it's been the right thing to do in your case).

It does seem like based on my own anecdotal experience, and from other comments in the thread, as if "tonsils out" is an automatically triggered decision in much of the world for certain ailments in cases where it may or may not be appropriate or warranted.

For the record, I hate even being anywhere near the fence on an issue like this, as I'm very much pro-vaccination (for example) and my position on this comes across as anti-science which I'm anything but.

You have to pay to have them removed in the UK now, it's no longer free on the NHS, unless you suffer from 3x serious infections in a one year period.

I suffer from frequent sore throughs, infections and even tonsillitis. My Auntie, who is a doctor, strongly advised me not having them removed. Which at the time is not what I wanted to hear but it seems, unsurprisingly, was great advice.

I seem to recall that a "tonsils out" subplot was commonplace in the American sitcoms of the 60s and 70s, but completely disappeared soon after that. I was born in the late 70s and I don't think I know a single peer who had tonsils or adenoids removed.

Having your tonsils out in the 60s and 70s was a much more painful procedure with a longer recovery time so people were more aware when someone had them removed.

My daughter had her tonsils and adenoids removed 6 years ago. She had it done on Friday morning and was running around feeling fine on Saturday. No significant pain and she was back to school on Monday. Unless she mentioned it none of her friends knew.

Since everyone is joining in with anecdotes, I’ll share mine. During second grade I had strep at least four consecutive times. One of those times I developed an ear infection with pain so intense my parents took me to the emergency room. On doctor’s orders, I had my tonsils removed. While the procedure was not pleasant (I had severe nausea from the anesthesia), the effects were immediate and permanent. In nearly three decades since I’ve yet to develop strep again.

Could there be a correlation between people needing to get their tonsils out and their higher rate of infection from some other factor and not necessarily as a result of the tonsils getting removed?

> "cases were no less healthy than controls presurgery in the first 9 years of life"

Looks like they addressed that (heading: Testing for Biases in General Health Before Surgery)

Just to add to the anecdotes in here. I had my tonsils removed at about the age of three and never suffered any particular consequences.

For perspective. I had horrible health that plagued me until I was about 20. Whether that's got anything to do with the butchering, I have no idea.

Had adenoids removed, and suffer from runny nose and (fortunately relatively mild) allergies all my life. Never occurred to me before it could be related.

Same here, I had them removed at the same age and never had an issue related to allergies or anything serious.

I am skeptical of the findings. I imagine that people who get their Tonsils and Adenoids removed are probably more predisposed to allergies to begin with.

My brother got both removed when he was 10 as he was suffering from ear infections and other problems, I didn't.

Now as an adult, my allergies are worse and I get sore throats more frequently with more irritating symptoms.

Allergies are also common in my family.

So my experience is that this surgery can have a very positive effect on one's quality of life.

From the abstract:

> Increases in long-term absolute disease risks were considerably larger than changes in risk for the disorders these surgeries aim to treat.

Presumably specifics are discussed in the paper. They followed 1.2 million children. Perhaps they were able to get an apples-to-apples comparison of children with similar issues and who did and did not get these surgeries.

When my father was a child, there was a craze in town (India) that tonsils are bad and removing them will only do good. My grandma fell for it, among hordes of other mothers, and got my fathers tonsils removed. My father is a Gen X cohort, and now whenever the pollen season arrives (he is in USA now), he is totally helpless.

I had my tonsils and adenoids removed due to recurring severe infection. Well, actually, the tonsils were removed due to infection, and my adenoids were an "afterthought" because my dad has a history of sleep apnea. I don't have any allergies, and I definitely don't get sick as often as when I was younger-- during which time I was getting all sorts of infections (ear, kidney, eyes, etc.) recurrently.

Anyways. Just another anecdote on the pile.

My daughter was 3 when they removed her tonsils. Recurring infections and swelling were making it difficult for her to breath. She still has the occasional cold but nothing like before they were removed. They were huge for a tiny 3 year old.

I have bad allergies and still have my tonsils. The pollen season in the US can be very different than other places especially in the South. For me it also came with age and my allergies started in my 20s.

I’d bet your father is not used to the pollen in his region. Doubt it because of his tonsils.

It was the same in the UK in the 80’s - I remember pretty much my entire year at school going for surgery over the course of a year.

Despite having had repeated tonsillitis as a kid (and bronchitis at the same time - unheated boarding school with abysmal hygiene and dozens of boys to a room is quite the disease incubator), my mother, a nurse, dug her heels in, and said no. She'd had to deal first-hand with the outcomes of botched tonsillectomies a few times too many.

They did my brother seven years later without their permission - and he suffers from severe allergies to this day. I have none.

I’ve always been extremely sceptical of “its vestigial” or “that body part is bad for you”. I mean, surely if either were true, selection would have done away with it. If having tonsils were a dysgenic trait, nobody would have them.

I can tell you why it remains such persistent practice - it’s a quick and easy surgery in most cases, and it’s billable at a decent rate in most places. A surgeon in the UK can do ten or more in a day, at £3k a pop. You have an endless supply of patients, and parents who’ll consent because after all they had theirs done when they were kids.

Play your cards right and you’ll make millions a year.

> I can tell you why it remains such persistent practice -

It's strongly recommended against in the UK now. We do less than 1 operation per 1000 population.

> A surgeon in the UK can do ten or more in a day, at £3k a pop.

That's not how English surgeons are paid, is it?


> It's very rare that someone needs to have their tonsils taken out. This is usually only the case if you have severe tonsillitis that keeps coming back.

My son had his tonsils taken our in a private UK hospital 6 years ago (my job at the time had private health care) and the total bill the insurer paid was rather less than £3.

So the idea that consultants were getting £3K for individual private operations in the 1980s seems unlikely - and as far as I know that's definitely not how they are paid for NHS work.

>They did my brother seven years later without their permission

In the UK, in the late 80s or 90s? I'm not saying it didn't happen, but HOW?! Did your family attempt to complain or sue?

Boarding school, loco parentis. Without an explicit intervention from a parent they can do as they please, and they’re under no obligation to inform the parents of anything. I wrote letters home, telling my parents of the day-to-day, my brother did not.


> I’ve always been extremely sceptical of “its vestigial” or “that body part is bad for you”. I mean, surely if either were true, selection would have done away with it.

That's not necessarily true - if something is vestigial it is no longer affected by positive selection pressures; it won't be selected against until it is harmful. [0]

[0]: https://en.wikipedia.org/wiki/Vestigiality

They probably aren't related; I have my tonsils and also have bad pollen allergies.

I’ve begged my doctor to remove my tonsils and they refuse due to studies like this.

I get tonsil stones every single month and at least one severe case of tonsilitis per year (usually closer to 3-4.)

Anyone have strategies that worked to convince their GP to allow them to be removed? At this point I’m considering just paying out of pocket to get it done.

You probably know this, but note that removal doesn't necessarily end the stones.

Had mine removed as a kid. Then had a peritonsular abcess around age 20. Then had tonsil stones for a few years.

After a change in diet (no wheat, little packaged food) they stopped. Can't be sure of the exact cause.

Also, I've heard waterpik devices can help.

I had my tonsils out as an adult and it's been great. I'm much healthier now. YMMV.

Are you in the US? Get an opinion from a different ENT.

Not in the US? Try these guys:


A lot of people fly in from other countries where they lack medical choice.

I had my tonsils removed at age 24 after horrible problems with tonsilitis and tonsil stones.

Wish I'd had the ghastly things removed much earlier - my son had his out at 12.

Never had any problems afterwords - indeed only times I suffered from any allergies were before I had them removed but I suspect that is coincidence.

You can do a tonsillotimoy instead of a tonsillectomy.

It's a much less invasive surgery and they only burn down your tonsils bit by bit and you can leave the next day.

Get a second opinion?

This sort of thing is just a matter of doctor shopping. Keep asking different doctors until you get an answer you like.

Whoa I never knew what those were, thanks for mentioning tonsil stones! I also get them, but mine are typically not very large based on some of these images that showed up on google.

This is entirely anecdotal, but for me they seem to show up when I do a poor job of keeping myself hydrated.

Have you tried using a water pick? I recently discovered there was such a thing as tonsil stones.

It's pretty simple to remove tonsil stones. Just get a lighted tongue depressor and a tonsil stone tool.

Think of it as another maintenance task. Like brushing your teeth.

Simple for you, sure.

It's not always that simple to remove them for everyone, depending on a number of factors; the topography of your tonsils, the location and depth of the stones, shape of your mouth, your gag reflex, etc., etc.

You're also forgetting the fact that digging around in your tonsils causes irritation.

Can you use a water pik?

Not sure. Never tried. It would probably work less than 50% of the time at best.

I've had my tonsils removed at age 6, no allergies at all. My appetite increased quite a bit they tell me, but my parents were in their twenties back then, who knows. Anyway, wanted to throw in my data point in here.

I had my tonsils removed last year (so at age 33) due to having a peritonsillar abscess multiple times in a couple of years - which implies that the first time I was infected it likely became a "chronic" risk. So far no allergies, so I hope my immune system is already "properly trained" from before or something.

Anyway, if anyone ever needs to have their tonsils removed for health reasons: only drink isotonic water[0] when you're thirsty. For some reason my surgeon forgot to tell me that, but I discovered this on my own by accident. After the surgery I felt very dehydrated, so made some ORS at home. To my surprise, drinking it did not hurt at all, even though drinking plain water earlier had felt like getting thousands of paper-cuts in an open wound.

I was eating regular food within a week (it took a bit longer to fully heal up of course), and didn't even need to use the heavy duty painkillers that I was prescribed (only over-the-counter painkillers for sleeping, really). I suspect that instead of being a pain-killer, drinking isowater avoided the irritation that caused the pain in the first place, which means I also avoided inflammation and healed up faster than expected due to that.

[0] Take this recipe for home-made rehydration solution and tweak to your liking http://rehydrate.org/solutions/homemade.htm

Mine were removed when I was 2 because they were huge! Like all surgery, it comes with risks and tradeoffs. It's great that we have a better idea of what the risks are now but that's not a reason not to do the surgery. Let's not forget that it's still a well tolerated procedure that confers some benefit to the right patients. We're not removing them for fun.

What benefit is that? Large tonsils occlude the airway, causing sleep breathing disruptions. The impact of those disruptions isn't visible but we know it is very harmful, particularly to children since they're still developing. We can avoid those developmental problems by removing the tonsils. I don't want to go into it here in too much detail but "developmental problems" is not a small thing, we're talking about structural changes to the skull, learning difficulties, behavior problems, etc.

An open question is how bad does the occlusion need to be before it justifies removing the tonsils. I don't know the answer to that question. I'd say bad. And that happens increasingly often because large tonsils have a strong correlation with allergies to begin with. Chronic infections are more a complication of the original problem, not the cause of it. And that's not even touching the damage these infections can do to the sinus cavities.

I have to point out the obvious confounder here. The kids who get their tonsils and adenoids out are the ones with recurrent respiratory infections to begin with. Really the only way to control for this is to randomize kids to surgery or not and then follow for 20 years or more. This in contrast is an observational study, albeit with a very large number of subjects. They said they tried to control for confounding factors, but it's hard to see how effective that can be after the fact.

Tonsils can cause miserable life to suferrers and while they might have negative long term effect, the research does not include the mental issues that recurring tonsils cause.

I wonder if it’s really the other way around — people who tend to get infections often have this surgery because, well, they often get infections?

I had my tonsils out at around age 8 due to chronic ear infections. I don't know how bad it was before the operation, but my respiratory health has been abysmal since the operation. I've recently begun to wonder if oral probiotics could be a missing part of the equation. Tonsils literally have "crypts" - the quality of your oral bacteria must play a huge role in how they function. http://www.blisk12.com/what-is-blis-k12/

I can't find it now, but two or three months ago I read a story in the news about a teenage girl who bled to death after her surgeon accidentally cut in to her aorta during her tonsilectomy. The saddest thing was that it was a slow, completely preventable death, and that the doctors did not take her symptoms at all seriously, despite her coughing up copious amounts of blood, telling her and her mother that it was all perfectly normal. Very sad story.

This does not tie in with my experience as someone who had those removed at age 6. This winter for example, everyone in our household had nasty chest infections except me.

Anecdotal data is not a good source of medical advice.

When treating a patient, using the results of a study is a good starting point, but it may really have nothing to do with treating the specific patient. The patient may fall outside of the distribution of normal occurrences, as indicated by the study. They may be an outlier.

This is one reason why medicine is challenging - you're not treating a population, you're treating a patient.

If you are the patient, you want the doctor who is guided by science, but also not blinded by "well, the studies say to do X, but that's not working. I guess there's nothing I can do for you".

In my case, I had my tonsils removed as an adult and it is one of the best medical decisions I've ever made. Prior, I had all kinds of health problems. They are now gone, and while I used to get sick a few times a year to the extent of missing work, that no longer happens.

While I generally agree, treating a patient is also not as simple. For example, I never had my tonsils removed and in the past 5 years I have not been sick a single time. Plus, this doesn't invalidate the study itself, as the results merely lay out a chance, the probability that you will suffer long term effects.

People can smoke cigarettes their entire life and never get lung cancer or they smoke once and get a diagnosis for lung cancer next year.

It think their entire study is based on the collection of such 'anecdotes'.

With some good statistics you can make fairly certain assumptions that the anecdotal data you collect is a good sample of the broader population.

A single data point as presented by OP is less valuable than that of a study, which contains multiple data points.

It's not anecdotal because I was giving own experience.

Also I wasn't offering any advice.

Your own experience is anecdotal.

Your own experience cannot be anecdotal

Anecdotal evidence is evidence from anecdotes, i.e., evidence collected in a casual or informal manner and relying heavily or entirely on personal testimony. When compared to other types of evidence, anecdotal evidence is generally regarded as limited in value due to a number of potential weaknesses, but may be considered within the scope of scientific method as some anecdotal evidence can be both empirical and verifiable, e.g. in the use of case studies in medicine. Other anecdotal evidence, however, does not qualify as scientific evidence, because its nature prevents it from being investigated by the scientific method.

[Wikipedia/Anecdotal Evidence]

This does not contradict the point I made in my post previous to this one.

Interesting that however advanced medical science is, we still don't know about everything the lymphatic system does.

I used to get a lot of throat infections when I was a kid and had the discussion with my doctor to whether I should get my tonsils removed. My doctor was heavily opposed.

recently, I've been having allergies and more throat issues and wished I would have got them taken out. Pretty glad I didn't now.

What if enlarged tonsils/adenoids is a allergic response of immune system? These people are prone to allergic reactions in first place. Correct way of testing this hypothesis would be to cancel OP to 50% of control group and compare long-term health risks after 30 years.

I had frequent tonsil infections as a kid and was given the option to have them out but declined.

Now I have two very small and pitted tonsils due to frequent infections which asides from the odd tonsil stone don’t bother me at all.

I don’t get hay fever or any allergies.

Think I made the right decision

If you have your tonsils removed you most probably have not a very strong immune system, originally. So it's OK to expect that you're less healthy during the life. I don't think that tonsils removal is causing this, the root of the problem is deeper I think. I have my tonsils removed a year ago when I was 32 because of problems with my joints. They are better now actually. So I would say, you need to remove your tonsils when it's absolutely necessary.

Would love similar study on circumcision...

It was amazing to have the tonsils removed as a kid. For a couple of days we were only allowed to eat ice-cream :)

Too late, my 3 kids had the adenoids removed. Anything that i should look out for?

Thanks for this post. I have tonsil problem from years but i am always afraid to get that removed from my body. The general treatment which i do when feel problem is hot water gargle.

In my generation, 100% of us had our tonslis/adenoids removed as children, but we have no significant differences in health issues whatsoever.

this practice (along with getting appendix removed when not necessary) seems like some distant relative of bloodletting.

In 20 years HN will have a front page top post about the long term health risks of male circumcision. Sometimes it take time for common sense to become.. common.

And those are?

Mutilated genitals

I dont know if that qualifies for a “long term health risk”.

We aren't lizards. We can't magically grow back lost portions of out body.

Right, but if you survive the procedure, are the side-effects going to kill you, or leave you more likely to contract diseases, and so on? That's more the question. And the answer appears to be no. Plenty of reasons why it's a bad idea, just not this one...

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