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Tonsillectomy and Adenoidectomy Overview
The tonsils and adenoids are lymphoid tissues that play a role in the immune system. The tonsils are a pair of round lumps located in the back of the throat, while the adenoids are found in the back of the nasal cavity. These tissues are sometimes respectively called palatine tonsils and pharyngeal tonsils.
Tonsillectomy, the removal of the tonsils, is one of the most common surgical procedures performed on children. Adenoidectomy is a related surgery in which the adenoids are removed. Sometimes the procedures are performed together in an operation called tonsillectomy-adenoidectomy.
Because of their role in the immune system, the tonsils and adenoids are prone to becoming infected with bacteria. Frequent bouts of tonsillitis (infected tonsils) can lead surgeons to perform a tonsillectomy. Tonsillectomy and/or adenoidectomy may also be performed if the tissue is enlarged and interfering with breathing.
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Trends in Tonsillectomy and Adenoidectomy in the U.S.
Tonsillectomy and adenoidectomy rates in the United States have varied over the last fifty years, following a general pattern of decline. In hospitals in 1965, the tonsillectomy rate in the U.S. was 63.4 per 10,000 for all age groups, and 165.6 per 10,000 for children under 15 . Two decades later (1986), these rates had dropped to 11.7 per 10,000 for all age groups and 33.9 per 10,000 for children under 15 .
Between 1990-91 and 2000, the hospital tonsillectomy rate for children under 18 dropped from 10.7 per 10,000 to 2.1 per 10,000 .
Although the data do not give a crystal-clear picture (see "Confusing Data") below), the trend has been a decline in both tonsillectomies and adenoidectomies. This decline is due to the increasing use of antibiotics to treat tonsillitis, decreasing the need to treat the condition surgically .
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The data are confusing because tonsillectomy has increasingly become an outpatient procedure, and the statistics were collected separately for inpatient and outpatient surgeries.
In the mid-1990s, a survey that examined only rates of ambulatory (outpatient) surgery, as opposed to hospital inpatient surgery, found a rate of 45.9 per 10,000 for children under 15. The apparent increase over the approximately 10-year period from 1986 to the mid-1990s may not reflect a real increase in tonsillectomy rates; instead, it may reflect the difference in where the procedure was performed. Also, the rates for 1990-91 and 2000 are for children under 18, not children under 15 as with the other data. Since children 15-17 years old probably have fewer tonsillectomies than younger children, including them in the statistic probably skews it.
Though the data available do not paint a perfect picture, there is no doubt that tonsillectomy and adenoidectomy rates have fallen in the United States over the past 50 years, as treatment for tonsillitis has shifted from a surgical approach to a medical approach.
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1. Trends in Hospital Utilization: United States, 1965-1986 (PDF). U.S. Dept. of Health and Human Services, 1989.
2. Health Care in America: Trends in Utilization (PDF). U.S. Dept. of Health and Human Services, 2004.