pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Tonsillectomy – possibly hastily recommended

[A 31-year-old writes wondering if the tonsillectomy she had recommended to her was a bit “rushed.”]

I am a 31 yr old generally healthy female. I have had sore throats occasionally and it has bothered me to the point that I finally went to talk to an ENT to see what they recommended. I didn’t take to kindly to the fact that he seemed very rushed. He also didn’t seem very professional. He immediately performed a direct endoscopy on me and told me my nasal cavity was too kinked and asked me if I had ever had my tonsils removed (tonsillectomy). I hadn’t. Without talking to me about why or giving me any other options he suggested we schedule a tonsillectomy and also have my nasal cavity straightened. I agreed at first but after discussing this with an instructor in the music dept at my local university whom him and his wife sing and so also have loss of voice as well, I was attending he suggested voice hygiene and vocal rest. Which I have been doing since March 8th. I am on state Medicaid so I have to get referrals for each visit. Do you think I should go see another ENT or get a physical from my doctor as recommended in an article on the website? Thank you for responding to my email ahead of time…. Tiffany S., Shelley, Idaho
Thank you for perusing my site. As you know, I am a pediatrician and so my experience is limited pretty much to those under 21; but, as a managed care medical director responsible for credentialing and quality improvement – physicians, I DO know. And from what you describe, you didn’t get a very satisfying exam or deliberation. Having a “too kinked” nasal passage does not, in itself, cause frequent sore throats- which you said was why you went to the doctor in the first place. If you have chronic sinusitis as a result of the “crookedness” that might be a different story. Also, you didn’t say that he found any abnormality in your tonsils (which at your age shouldn’t be of substantial size- as they decrease with age.) and you didn’t mention that you had problem with recurrent TONSILLITIS (not just a sore throat). So the information you gave didn’t really indicate rational for tonsillectomy. And, although infrequent, there could be a voice change following the procedure.

As you can tell, I’m not able to diagnose or recommend via the Internet on the problem you described. HOWEVER, it is a primary rule that no-one should undergo a surgical procedure, including a tonsillectomy, without complete faith that the doctor has spent enough of their time and talent to correctly diagnose the problem, has explored and explained alternatives at all levels short of invasive surgery AND that they have rapport and trust enough that they have the skills and expertise to do the best job possible. Doesn’t sound like you have that confidence so should either go back to the same doctor loaded with questions about the benefits and risks of tonsillectomy and make it so you do, or see another physician. A physician board certified in internal medicine might be a good place to start, one who has no bias toward surgery, realizing that would only cover part of the issue. You still need to have faith in the surgeon performing the procedure so need to either work it out with the one you’ve seen or see a new one – explaining your situation to the internist might result in a referral to one with a bit better perceived “people skills”… Hope this helps a little. Statistics show that the tonsillectomy procedure is overused and that there are a lot of surgeons who can perform them well.

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