The story of tonsillectomy can be traced back to antiquity. As early as 2000 BC, Ayurvedic doctors used primitive tools and herbal remedies to remove their patients’ pus-laden tonsils. In Roman times, Cornelius Celsus (25 BC–50 AD) shelled out tonsils with only his fingers, Galen of Pergamon used a wire snare (121–200 AD), and Paul of Aegina introduced a hook-like instrument (625 AD). Aetius of Amida (502–575 AD) limited himself to removing only part of the tonsils. Even this, however, would have been painful and dangerous.

In the Middle Ages, Islamic scholars preserved and expanded earlier skills and medical knowledge. The tenth-century Andalusian surgeon Al-Zahrawi (Abulcasis) described tonsillectomy in his medical texts, which later influenced European medicine. Notably, Andreas Vesalius in Padua described in 1543 the tonsils and their blood supply. In 1761, Joseph-Guichard Duverney followed through with some accuracy in his description of the anatomy of the pharyngeal region, and in the 19th century, Wilhelm Von Waldeyer published reports of his anatomical and histologic studies of the tonsils.

From the times of the great French surgeon Ambroise Paré (1564), a large number of surgeons invented instruments for tonsillectomy that functioned like a mini guillotine or modification thereof. Such models were developed by Johanni Scultetus (ca. 1645), Guilhemus Hildanus (ca. 1620), Pierre Dionis (ca. 1710), Lorenz Heister (ca. 1720), Pierre Desault (ca. 1770), Philip Physick (ca. 1827), and William Fahnestock (1832). Around 1870, Morell Mackenzie modified these instruments further and created the so-called “tonsillotome”; Mathieu invented a modified guillotine in the late 1800s, and these were followed by Eve’s tonsil snare around 1900, Brunings in 1908, and Sluder in 1911. By 1897, surgeons had begun to opt removing the entire gland after the American physician Ballenger claimed that partial removal did not completely alleviate symptoms. As ENT doctors took over tonsillectomy from the general surgeons and used a scalpel and forceps, they developed it into a safe procedure, so that by 1912, Greenfield Sluder, an ENT doctor in St. Louis, published a study in which he affirmed to have reached 99.6% success by this technique.

There were further advances when in 1915 LaForce developed his hemostatic tonsillectomy instrument; Daniels created his tonsil snare in the 1940s; and Popper developed electrocautery instruments for tonsillectomy in the 1960s. There were further new instruments, better hemostasis, better anesthesia, and minimal risk. Until the advent of the antibiotic era, surgery was the treatment of choice for all infected tonsils, perceived as an effective way of preventing future infections, and therefore indicated in most children whether they had symptoms at the time or not. It has also been legitimized by the rise of the theory of focal sepsis causing rheumatic diseases, heart disease, and other systemic diseases. In many parts of Europe and the United States, it would have been a rare experience to find a teenager who had not had his tonsils removed.

Therapeutical advances in medicine, especially the use of antibiotics, eventually contributed to a reduction of tonsil removal surgery, especially due to the lack of convincing benefits. As medical knowledge advanced, the overuse of tonsillectomy came under scrutiny and became condemned as a “dangerous fad.” One set of modern clinical guidelines emphasized the need for clear indications, such as recurrent tonsillitis, peritonsillar abscess, or obstructive sleep apnea.

Today, tonsillectomy is performed less frequently than in the 1970s. It is now usually done under general anesthesia on outpatients and takes about one hour, and the patient is usually discharged from the hospital the same day. Surgeons dissect the tonsil by cautery, sharp dissection with a scalpel, or various new techniques. In the United States, tonsillectomy is still one of the most performed surgical procedures, with over 500,000 done each year.

Further reading

Nogueira JR Júnior, Hermann DD, Ronaldo dos Reis Américo, Stamm RG, Hirata CW. “A Brief History of Tonsillectomy.” Intl. Arch. Otorhinolaryngol. 2006;10(4):314-7.