In the United States, surgeons perform over 500,000 tonsillectomies each year, including more than 530,000 in children and adolescents to improve breathing while sleeping or reduce recurrent infection. While tonsillitis can be a reason for tonsil surgery, it's usually only done in extreme cases.

A recent study by an international team of researchers, published in JAMA Network Open, suggests this relatively common procedure could increase a patient's risk of developing an anxiety-related disorder later in life.


What does the study say?

Scientists Guangxi Medical University in China and the Karolinska Institute in Sweden analyzed data on over a million people held in a Swedish health registry, finding that a tonsillectomy was linked to a 43% increased risk of developing conditions such as post-traumatic stress disorder (PTSD), depression, or anxiety.

Being an observational study, the research can't determine the cause of this outcome. However, the increased risk was present even after accounting for the sex of the participants, the age at which they had their tonsils out, any family history of stress-related disorders, and the education level of the parents (an indicator of socioeconomic status).


The researchers wrote in the published paper, "These findings suggest a potential role of adenotonsillar diseases or associated health conditions in the development of stress-related disorders."

The researchers compared siblings in some families to control for certain genetic and environmental factors. Even among this sample, there was a 34% greater risk of anxiety disorders for those family members who had their tonsils removed.

As per the researchers, "We found that although the risk increase appeared to be greatest during the first years following surgery, an increased risk of stress-related disorders was still noted more than 20 years after the surgery."


What’s the reason behind the association between the surgery and the decline in mental health?

As experts say, while we can live without our tonsils, they help fight infection, so our bodies are more vulnerable without them. It's also possible that in some cases the reason for the tonsillectomy – like persistent inflammation – might also be the reason for the anxieties later in life. While previous studies have linked the removal of the tonsils to increases in other health problems, including autoimmune diseases and cancer, thanks to the study, we now have another important consideration to weigh up.

According to the researchers, "If our findings here are validated in future studies of independent study populations, mechanistic studies would be needed to disentangle the role of human tonsils and their diseases, via inflammation or other associated health conditions, in the development of psychiatric disorders in general and stress-related disorders specifically."


What is tonsillitis?

Tonsillitis is an infection of the tonsils, two oval-shaped tissue pads located at the back of the throat. Tonsillitis can feel like a bad cold or flu and can be caused by a bacterial or viral infection:

Symptoms: Red and swollen tonsils, sore throat, difficulty swallowing, tender lymph nodes in the neck, fever, headache, earache, feeling tired, coughing, and feeling and being sick.

Causes: Most cases are caused by a common virus, but bacterial infections like strep throat can also cause tonsillitis.

Treatment: Treatment depends on the cause, and surgery to remove the tonsils is usually only performed when tonsillitis occurs frequently, doesn't respond to other treatments, or causes serious complications.


Is tonsil removal surgery the only way to treat tonsilitis?

Tonsil removal surgery, also known as a tonsillectomy, is usually only recommended if you have severe tonsillitis that keeps coming back. If tonsillitis is caused by bacteria, like Streptococcus (strep) bacteria, it can be treated with antibiotics. Over-the-counter painkillers like ibuprofen or paracetamol can help ease tonsillitis symptoms.

However, if you have chronic or severe tonsillitis that keeps coming back, you might need to have your tonsils removed. If tonsillitis causes complications that are hard to manage like breathing or swallowing difficulties, and if your tonsils are so big that they cause breathing problems or sleep disorders - you might need to opt for the surgery.