August 10, 2020 | Jerry Bergman

If Your Doctor Recommends Removing Tonsils, Read This

New Research Warns of the Health Consequences of Tonsillectomies

by Jerry Bergman, PhD

Introduction

For over a century after Darwin, a major argument used to prove evolution was the claim that certain structures in humans, called ‘vestigial organs’, are useless leftovers of our evolutionary past.[1] An intelligent creator, Darwinists reasoned, would not create organs and structures that are functionless and only cause problems. These assumed rudiments of our evolutionary history included such parts as the tonsils, the appendix, and close to 100 other body structures.

The assumption that the tonsils are vestigial has been one reason for the high frequency of tonsillectomies in the past. After all, if they serve no purpose and can cause health problems, should they not be removed while the person is young to prevent problems later in life? Darwin listed a number of examples of what he claimed were human vestigial organs, which he termed rudimentary, in The Descent of Man.[2] These included the appendix, the ear muscles (see my article from 24 July 2020), wisdom teeth (30 April 2020), the tail bone, body hair, and the semilunar fold in the corner of the eye.

Research eventually changed the long-held belief about tonsils as rudimentary. Decades ago, J. D. Ratcliff wrote that “physicians once thought tonsils were simply useless evolutionary leftovers” and removed them, believing removal could not cause harm. Today “there is considerable evidence that there are often more troubles of the respiratory tract after tonsil removal than before, and doctors generally agree that simple enlargement of tonsils is hardly an indication for surgery.”[3]

It was known by physicians for over a half century that the value of tonsillectomies in preventing infection was of “little benefit after the age of eight when the child’s natural defenses have already made him immune to many infections.”[4] Dozens of studies since then have strongly supported this conclusion. Additionally, more doctors are coming to believe that there is often little benefit from tonsillectomy. In fact, there is positive evidence for problems that results from their removal. Just this year, one more large study again eloquently supported this conclusion.

Figure 1. A Diagram of the Tonsils. From Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014“. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.


The tonsil’s function

The tonsils form a ring of lymphoid tissue that guards the entrance of the alimentary [digestive] and respiratory tracts from the harm caused by pathogenic bacterial invasion. Tonsils are lymph glands that help to establish the body’s defense mechanism, including producing disease-fighting antibodies. These defense mechanisms develop during childhood. The tonsils begin to shrink in the pre-teen years to almost nothing in adults; by then, other organs eventually take over this defense function. The tonsils are not only larger in children than in adults, but are important in developing the entire immune system.[5],[6] Called “super lymph nodes”, they provide a first-line defense against bacteria and viruses that cause both sore throats and colds.[7] Although removal of the tonsils obviously eliminates tonsillitis (inflammation of the tonsils), it may increase the incidence of strep throat, Hodgkin’s disease, and other diseases.

In a tonsillectomy, the surgical procedure usually completely removes both of the palatine tonsils, including their capsules, from the back of the throat. If the adenoids are also removed the operation is called an adenotonsillectomy. Both tonsillectomies and adenotonsillectomies are far less common today for reasons we will discuss, but are still one of the most common surgical procedures in the Western world. In the United States, close to 289,000 ambulatory procedures are performed annually in children 15 and under.[8]

Common reasons for their removal include chronic obstruction of breathing and sleep apnea. Obstructive sleep-disordered breathing (oSDB) is characterized by obstructive abnormalities of the respiratory pattern that adversely affect the adequacy of oxygenation and ventilation during sleep. Signs of oSDB include snoring, mouth breathing, and breathing pauses called sleep apnea. Sleep apnea involves breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal sleep ventilation and sleep patterns.[9]

Instead of the surgery route after indications of a problem, it is now recommended to rely on watchful waiting guided by the following guidelines to reduce the incidence of tonsillectomies. The current guidelines consider

recurrent throat infection if there have been 7 episodes in the past year, 5 episodes per year in the past 2 years, or 3 episodes per year in the past 3 years…. Before performing tonsillectomy, the clinician should refer children with obstructive sleep-disordered breathing for polysomnography if they are under 2 years of age or if they exhibit any of the following: obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders, sickle cell disease, or mucopolysaccharidoses.[10]

Polysomnography, the layman’s term for a sleep study, is used to diagnose sleep disorders by recording brain waves, blood-oxygen levels, heart rate, breathing, and eye and leg movements.

Asthma found to increase with adenotonsillectomy

The new study by Kim et al. reviewed here used a nationwide representative sample of 1,025,340 subjects from the 2002–2013 South Korea National Health Insurance Service to evaluate the effects of tonsillectomy. The researchers examined the association between pediatric adenotonsillectomy and subsequent risks of specific comorbidities, whereby two or more diseases appear simultaneously in the same patient. The researchers found that adenotonsillectomy during childhood increased the incidence of asthma and had no significant impact on the number of postoperative visits for upper respiratory infections.[11] In other words, in general, the operation did not reduce upper respiratory infections—a major reason for the adenotonsillectomy operation—but increased the incidence of asthma. The statistical significance using Chi-square analyses was at the alpha .05 level, meaning that the difference found was so great that it could only be due to chance less than five times per 100.

Asthma is a serious disease

Asthma is a long-term chronic respiratory disease that causes the airways to become inflamed and narrow, making it difficult to breathe. Severe asthma can even cause difficulties in talking or being physically active. The disease often causes wheezing, coughing, or feelings of tightness in the chest. The symptoms range from mild to severe, and can occur occasionally or every day. Things that can set off or worsen asthma symptoms include cold air and stress. Other asthma triggers include anything that causes an allergic attack such as dust, pollen, molds, and pet dander. When the symptoms become severe, the condition is called an asthma attack.

Why adenotonsillectomy increases the incidence of asthma

The study reviewed here did not explain why adenotonsillectomy increases the incidence of asthma, but suggested that it is likely related to the effect of adenotonsillectomy on the immune system. As the Kim, et al. study explained, in every breath we take in antigenic materials that as a result gain entry into our bodies; some are harmless, but others can

contribute to the development of potentially dangerous conditions, requiring rapid and effective protective immune responses. Thus, from birth to adolescence, several mucosal immune systems develop in the upper and lower respiratory, gastrointestinal, and urogenital tracts. Among these, the nasopharyngeal-associated lymphoid tissues, which form the upper respiratory mucosal immune system, are arranged with a specific circular orientation around the wall of the throat called the Waldeyer’s ring. These lymphoid structures comprise the adenoid (nasopharyngeal), tubal, palatine, and lingual tonsils. During childhood, these tissues play a major role in immunity as they are the first barrier of the host’s resistance against pathogens.[12]

In short, the tonsils and adenoids are critical in the development of our immune system, and adenotonsillectomy impedes that development. This agrees with another study that found in “children with obstructive breathing during sleep, the presence of asthma is associated with an increased risk of respiratory complications after adenotonsillectomy.”[13]

Update: Tonsillectomy Increases the Rate of Irritable Bowel Syndrome

Another new study found tonsillectomy can cause or influence the development of irritable bowel syndrome (IBS). IBS affects the digestive tract causing abdominal pain, painful cramps, bloating, constipation, diarrhea, and, in serve cases, bowel obstruction which may require surgery.

The nationwide population-based cohort study found tonsillectomy was associated with a higher risk of developing IBS. The study concluded that physicians should provide appropriate monitoring of IBS in patients that have undergone a tonsillectomy.[i] The authors mentioned one reason why little is known about the harm of tonsillectomies is tonsillectomy, although a “commonly performed surgical procedure worldwide … the possible long-term consequences have not been fully explored.”[ii]

The researchers attempted to respond this lack of knowledge. They obtained a sample of 1,300 patients that had a tonsillectomy, and 2600 matched controls from the Taiwan Longitudinal Health Insurance Research Database. Matching for age, gender, comorbidities, and medications, regression analysis was used to estimate the adjusted hazard ratio of IBS and tonsillectomies. They found the IBS incidence was 3 per 1,000 person-years in tonsillectomy patients, and only 1.8 per 1,000 person-years in patients that retained their tonsils. The researchers concluded that “patients who underwent tonsillectomy had a 1.84-fold greater risk of developing IBS compared to those” who still had their tonsils, a difference which was statistically significant at the 0.05 level.[iii] This means the finding was very unlikely due to chance, but represents a real difference. Furthermore, a significantly higher risk of developing IBS existed when the follow-up period was over 3 years.

Conclusions

This is one more research study which has documented the fact that the vestigial organ theory of evolution was not only based on faulty assumptions, but has actually caused much harm to people’s health. The tonsils and adenoids are not vestigial. They play an important role in the development of our immune system. Consequently, increased susceptibility to asthma due to adenoid/tonsil removal by adenotonsillectomy is one more example of the harm that the past ‘vestigial organ’ claim has caused.

References

In chapter 3, Dr Bergman discusses whether tonsils and adenoids are vestigial.

[1]. Bergman, Jerry. 2019. Useless Organs: The Rise and Fall of the Once Major Argument for Evolution. Tulsa, OK: Bartlett Publishing.

[2]. Darwin, Charles. 1871. The Descent of Man, and Selection in Relation to Sex. London: John Murray.

[3]. Ratcliff, J. D. 1975. Your Body and How it Works. New York: Delacorte Press, p. 137.

[4]. Katz, Dolras. 1966. “Tonsillectomy: Boom or Boondoggle?” The Detroit Free Press, April 13.

[5]. Harabuchi, Y, T. Hayashi, A. Katada (Editors). 2011. Recent Advances in Tonsils and Mucosal Barriers of the Upper Airways. Advances in Oto-Rhino-Laryngology, Vol. 72. New York: Karger Publishers.

[6]. I ̇kinciog ̆ulları, Aykut. et. at., 2002.  Is immune system influenced by adenotonsillectomy in children? International Journal of Pediatric Otorhinolaryngology. 66: 251-257.

[7]. Brodsky, Linda, et al., 1988. The immunology of tonsils in children: The effect of bacterial load on the presence of b‐ and t‐cell subsets. Laryngoscope. 98(1):93-98.

[8]. Mitchell, Ron B.; et al. 2019. Clinical Practice Guideline: Tonsillectomy in Children”. Otolaryngology–Head and Neck Surgery 160(1S): S1–S42.

[9]. American Thoracic Society. 1996. Standards and indications for cardiopulmonary sleep studies in children. American Journal of Respiratory Critical Care Medicine.153:866-878.

[10]. Mitchell, Ron B.; et al., 2019, p. S1.

[11]. Kim, J.Y.; et al. 2020. Association of adenotonsillectomy with asthma and upper respiratory infection: A nationwide cohort study, PLoS One 15(7):e0236806 30 July. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236806,

[12]. Kim et al., 2020.

[13]. Kheirandish‐Gozal, Leila; et al. 2010. Obstructive sleep apnea in poorly controlled asthmatic children: Effect of adenotonsillectomy. Pediatric Pulmonology 46(9):913-918, September.

Update references:

[i]Wu, Meng-Chi. 2020 Impact of tonsillectomy on irritable bowel syndrome: A nationwide population-based cohort study. PLOS. September 1. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238242.

[ii] Wu,et al,. 2020,

[iii] Wu,et al,. 2020.


Dr. Jerry Bergman has taught biology, genetics, chemistry, biochemistry, anthropology, geology, and microbiology for over 40 years at several colleges and universities including Bowling Green State University, Medical College of Ohio where he was a research associate in experimental pathology, and The University of Toledo. He is a graduate of the Medical College of Ohio, Wayne State University in Detroit, the University of Toledo, and Bowling Green State University. He has over 1,300 publications in 12 languages and 40 books and monographs. His books and textbooks that include chapters that he authored are in over 1,500 college libraries in 27 countries. So far over 80,000 copies of the 40 books and monographs that he has authored or co-authored are in print. For more articles by Dr Bergman, see his Author Profile.

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