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70 or so years ago, kids all got their tonsils out. I have a family member who, when perfectly healthy, had them out (75 or more years ago) because his twin was having his out, and it would be too hard on his mother to have only one twin in the hospital, and she would likely have to go through that again eventually, so get it over with. I have another who had them out about 55 years ago because "I got sick all the time."

Yet nobody under 40 (who I know, in North America) has stories like these about themselves or their children. Infants these days get ear infections, which generally clear up before school age one way or another. Some get tubes. But these tales of 4-10 year olds getting their tonsils out and getting to eat ice cream (in various picture books I own) just don't seem to match present-day reality.

Why? Do tonsils not get infected any more? Have doctors decided removing them is a bad strategy?

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    Wow! Thanks for this question because I have often wondered the same thing!! Did they figure out better solutions to treating ailments associated with tonsillitis? Realize the benefits of tonsils? I'm not sure why it is supposedly less common, but I had my tonsils removed like 3 years ago when I was 24..... (because I kept getting sore throats). I remember thinking, "they still do this?" It's a lot more painful to get a tonsillectomy as an adult. See my question here: health.stackexchange.com/questions/9639/… – Pills N Pillows Jul 24 '17 at 17:28
  • I look forward to the answers!!! (By the way, I still get a lot of sore throats... so I'm not sure it was effective for me......) – Pills N Pillows Jul 24 '17 at 17:29
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    Interesting question. I had a number of bouts of tonsillitis as a child in the early 1960s, and I came close to having them taken out, but it never happened because I stopped having tonsillitis. My two older sisters, however, both had them out and they had fewer episodes than I did. So it seems the change in thinking was at least beginning to occur by the early 60s. – Carey Gregory Jul 24 '17 at 23:30
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    The simplified version is that alternative short-term treatments got better, and long-term studies showed that the long-term benefits mostly didn't exist. Still looking for sources. – Mark Jul 25 '17 at 20:49
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There is an excellent wikipedia page about the the procedure called tonsillectomy: "Although tonsillectomy is performed less frequently than in the 1950s, it remains one of the most common surgical procedures in children in the United States and many other western countries."

That WP page is amply sourced with research papers, the following box is just a shortened excerpt.

Complications

A recent study states that tonsillectomies in young children (0 to 7 years) are correlated with weight gain in the years following surgery.

The morbidity rate associated with tonsillectomy is 2% to 4% due to post-operative bleeding; the mortality rate is 1 in 15,000, due to bleeding, airway obstruction, or anesthesia complications.

Impact on immune system

It remains controversial whether tonsillectomy may negatively affect the immune system. However, multiple studies have confirmed correlation between a previous history of tonsillectomy and a wide range of diseases, such as:

Hodgkin's disease, Non-hodgkin's lymphoma, Laryngeal cancer, Esophageal cancer, Thyroid cancer, Breast cancer, Prostate cancer, Base of tongue cancer, Leukemia, Asthma, Hay fever, Irritable bowel syndrome, Crohn's disease, Appendicitis, Heart attack, Sarcoidosis, Rheumatoid arthritis, Multiple sclerosis, Deep neck infection, Poliomyelitis, Recurrent cellulitis, Primary biliary cholangitis, Chronic rhinosinusitis, Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.

Moreover, other studies have found that tonsillectomy may lead to:

  • a decrease in levels of serum immunoglobulin
  • a decrease in levels of secretory Immunoglobulin A
  • an increased risk of autoimmune disease
  • an increase in mortality between the age of 18 and 44
  • an increased risk of chronic disease
  • an increase in overall cancer risk

Mark's comment is basically right:

"The simplified version is that alternative short-term treatments got better, and long-term studies showed that the long-term benefits mostly didn't exist. Still looking for sources."

But this is also actually a very prominent example of very widespread bad practice that once was the standard. One study shedding some light on this can be found in the historian David Wootton's "Bad Medicine: Doctors Doing Harm Since Hippocrates":

Moreover Lister’s innovations made possible new types of bad medicine. For the first time it was possible to operate on the abdomen, and some surgeons proceeded to happily chop out bits and pieces (an appendix here, a colon there) not because they were infected, but because they might one day become infected––the historian Ann Dally has called this ‘fantasy surgery’. These operations never became the norm, but tonsillectomies did, and we now know they did more harm than good. Worse still, the decision as to whose tonsils should be removed was not remotely rational. Of 1,000 11-year-old children in New York in 1934, 61 per cent had had tonsillectomies.

The remaining 39 percent were subjected to examination by a group of physicians, who selected 45 percent of these for tonsillectomy and rejected the rest. The rejected children were re-examined by another group of physicians, who recommended tonsillectomy for 46 per cent of those remaining after the first examination. When the rejected children were examined a third time, a similar percentage was selected for tonsillectomy so that after three examinations only sixty-five children remained who had not been recommended for tonsillectomy. These subjects were not further examined because the supply of examining physicians ran out.

Clearly the decision as to who should have a tonsillectomy was entirely arbitrary. This was bad medicine alive and well in the 1930s.

First: do no harm. Since tonsillitis is still a common problem, the actual illness may be differently classified or diagnosed today. There may be other treatments available. But just cutting it out was of questionable effectiveness in the first place, could and did lead to a number of side effects and unwanted complications or long term effects. Together with the observation that most of the time not even the official guidelines were able to ensure a good practice, and many doctors were apparently unable to follow them, it is a good thing that this tonsillectomy fad is further falling out of fashion.

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    Wow, that is spooky, the healthy twin who had a tonsillectomy because the doctors thought it would be more convenient ... died of esophageal cancer in his 60s despite having none of the listed risk factors. – Kate Gregory Sep 10 '17 at 16:44

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