FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S "WINTER SORE THROAT" PROBABLY NOT DUE TO TONSILS

Question: I am a middle-aged adult who is often plagued with sore throats in the winter. I didn't have my tonsils removed in childhood and wonder if my sore throats are a consequence of this. What purpose do tonsils serve, and why is it often necessary to have them removed when we are young?

Answer: Tonsils are part of the body's immune system, and as such, help us fight off the numerous bacterial and viral illnesses that assault us, including sore throats. "Dr. Mom" has the opportunity to see what tonsils look like every time she peers into her child's mouth to check on a sore throat. The tonsils are those rounded mounds of lymph tissue located on the sidewalls of the throat just behind the teeth. In children the tonsils are quite prominent, but in adults they usually shrink down to little patches of tissue.

The surgery to remove tonsils -- called a "tonsillectomy" -- is performed frequently, but not as often as it was twenty years ago. It was previously believed that enlarged tonsils caused frequent sore throats, and surgery to remove the tonsils prevented this common malady. When I was a child, one of my sisters and I had our tonsils out at the same time. It was considered a "normal" surgery that all children should have to keep them healthy. Today, we know better. The tonsils enlarge as a response to infection. They rarely become so infected that they are actually the source of illness. However, there are still some good reasons for an adult or child to have his or her tonsils removed. In children, this operation is most commonly performed because the tonsils have become so large that they cause blockage of the throat and, thereby, produce difficulty with swallowing and breathing.

Another common reason for tonsillectomy is repeated tonsil infection, or tonsillitis. "Repeated" means having six episodes of tonsillitis in one year, or five episodes each year for the last two years. These incidents of tonsillitis must be more than just a simple scratchy, red throat. They must meet the following criteria: the tonsils are enlarged, often covered with blotches of "whitish exudate" and the test for "strep" throat is positive. In addition, the lymph nodes in the neck are usually swollen, too. Individuals suffer from sore throats more commonly in winter months for several reasons. The humidity of the air indoors is quite low. This produces drying of the lining of the nose and throat and makes it more susceptible to infection. Probably the most important cause of these respiratory illnesses, however, is that when it is cold outside we tend to spend more time indoors with others. Most colds and sore throats are caused by infections with one of several different viruses. These illnesses are spread form person-to-person, and this occurs more commonly when we are in close proximity to others. Therefore, the winter months become the season for colds and sore throats.

I suggest that you talk to your doctor about your frequent sore throats. If your tonsils are a problem, he or she will be able to tell you so. More likely, however, is that you just have the unfortunate experience of helping each "cold" virus carry on with its normal work -- making you and me miserable with a sore throat and cold.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.