If you are of a certain age, you probably remember the jealousy induced when another young classmate announced he or she was having his tonsils removed. From the vantage point of an elementary-school student, this meant a few days off and lots of post-surgical ice cream. And several decades ago, tonsillectomy seemed a routine part of childhood.

These days, tonsils are not so casually removed. Physicians carefully consider the severity and frequency of infection before deciding on tonsillectomy. Clinical guidelines include at least several episodes of tonsillitis in the past three years.

“Other considerations include whether bouts of tonsillitis are affecting normal functioning. For example, they are severe enough to need time off from school or work. They may also cause trouble sleeping because of enlarged tonsils blocking the airway,” explains Dr. Divya Chauhan, a family physician at Creve Coeur Family Medicine and on staff at St. Luke’s Hospital.

Many people assume the tonsils are akin to the appendix in terms of being seemingly unnecessary but potentially troublesome. So why bother keeping them?

“Tonsils and adenoids are part of the lymphatic system, which helps to fight off infection,” says Dr. Ken Haller, a pediatrician at SSM Cardinal Glennon Children's Medical Center and associate professor of pediatrics at Saint Louis University School of Medicine. “We have lymphatic glands and lymph nodes all over the body. Whenever there’s an infection somewhere in the body, the lymph glands nearby will often swell up to fight off the infection. The tonsils and adenoids are generally an important part of the lymphatic system, and they’re right at the entrance of the body.”

Tonsils in the throat and adenoids, which sit at the back of the nasal passages, catch germs that enter through the mouth and nose. Because they are exposed to so much, it’s no wonder they tend to get infected. Sore throat, fever, enlarged lymph nodes in the neck and enlarged tonsils are symptoms of infection.

“If this occurs, the patient should be seen by a health care provider and may have the tonsils swabbed to determine if the infecting organism is streptococcus, or strep throat,” says Dr. James Forsen, a specialist in pediatric otolaryngology with Mercy Children’s Hospital. “If the child has strep throat, an antibiotic is prescribed. But the concern is not just the throat infection.”

Strep can migrate to other organs, in particular the heart, where it can cause serious complications in a small but significant number of cases. “Strep is one of those things that’s just out there,” Haller says. “There’s no way to really prevent it.” However, he emphasizes the importance of a strep test to make a definitive diagnosis and cautions parents against antibiotic use unless there is a positive test result.

Chauhan agrees, adding: “If antibiotics are prescribed, take them exactly as directed by your doctor. Antibiotics not taken correctly can lead to bacterial resistance.”

Kids today may be more likely to keep their tonsils—but they’ll still want the ice cream.

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