Tonsil surgery has been performed for more than 3,000 years. During the 19th century when
anesthesia became available, techniques were refined and the number of procedures performed increased. Repeated throat
infections often causing big tonsils was the reason why parents asked for the procedure. During the preantibiotic era,
scarlet fever was feared since potential heart or kidney complications were life-threatening. The technique used before 1900 was tonsillotomy since neither a fingernail, snare nor the later 'guillotine' were used extracapsularly.
Bleeding was small and the
surgery ambulatory. Extracapsular
tonsillectomy developed around the turn of the 20th century with the purpose of avoiding remnants - the '
focal infection theory' was prevailing. The whole tonsil was now extirpated with good visibility of the tonsillar area in a deeply anesthetized patient. During the first half of the 20th century, the two methods competed, but by 1950, total
tonsillectomy had become the only 'correct' tonsil surgery. The indication was still
recurrent infections. The risk for serious
bleeding increased; therefore large clinics arose where patients remained for at least a week after
tonsillectomy. When oral
penicillin for children became available during the 1960s, the threat of throat
infection decreased and the number of
tonsillectomies declined. The awareness of obstructive problems in children rose at the same time when
obstructive sleep apnea syndrome became a disease for adults (1970s). Tonsillotomy was revived during the 1990s and is today used increasingly in many countries. The indication is mainly
obstructive sleep apnea syndromeor
sleep-disordered breathing, especially in small children. Total
tonsillectomy is still preferred for
recurrent infections, which include periodic
fever/
adenitis/
pharyngitis/
aphthous ulcer syndrome and recurrent peritonsillitis.