back to top
Sunday, 16 February, 2025
HomeOtolaryngologyRare case of stubborn tonsils twice removed

Rare case of stubborn tonsils twice removed

In an unusual case, an American woman has just had her tonsils removed – 40 years after they were first taken out when she was five-years-old.

CNN reports Katy Golden's procedure in 1983 seemed to go well; her recovery was similar to that of many other children, and she was back to her talkative self in what felt like no time.

But just a few weeks ago, Golden had the procedure repeated all over again.

They had grown back over the past 40 years – the left tonsil nearly to full size – and were causing trouble once more.

Golden has had dozens of surgeries throughout her life to address inner ear issues and is no stranger to sore throats, but it had been years since she had seen an otolaryngologist, also known as an ear, nose and throat or ENT physician.

“I knew that there was some sort of little flap or something that’s been there for years, but I didn’t realise what it was,” she said. “Yet whenever I got sick or had a sore throat or something, then of course the back of my mouth would be super inflamed, and it was hard to swallow. And I thought, ‘Well, obviously it’s not my tonsils. I had those taken out. It’s just a sore throat’.”

In September, she developed a particularly painful sore throat and made an appointment with Dr Cynthia Hayes, an ENT.

While examining Golden’s throat, Hayes explained what she was seeing so a medical scribe could take notes. And when Hayes mentioned the size of the tonsils, Golden said, the disbelief and shock “hit me like a ton of bricks”.

“I said, ‘no, I don’t have tonsils’. I looked at her thinking, ‘Maybe I picked a dud’,” she recalled.

But Hayes told her she was looking at inflamed tonsils.

“I didn’t think it was possible. I was in disbelief and shock that tonsils that I thought had been removed were causing my pain,” Golden said. “She told me, ‘Well, they must have grown back’.”

Tonsil regrowth is rare. The few studies that have attempted to quantify the risk put it somewhere between 1% and 6% of those who have an intracapsular tonsillectomy, a procedure that removes most of the tonsil tissue.

Practices around tonsil removal are not very standardised, experts say, which can make it difficult to understand all of the nuances.

Several methods can be used to remove tonsils. The most common include microdebridement, which uses a tool to suction and shave off tissue, and coblation, a “hot technique” that involves the use of radiofrequency to remove tissue.

Some doctors, especially those who were trained decades ago, prefer a “cold technique” that uses only a scalpel or other bladed instruments.

“In addition, the amount of tissue removed can greatly vary from surgeon to surgeon and is hard to control for in studies,” Dr Adva Buzi, an attending physician in the Division of Otolaryngology (ENT) at Children’s Hospital of Philadelphia, said. She was not involved in Golden's case.

“Tonsillar regrowth probably occurs when residual tonsillar tissue is subject to new inflammation. If performed correctly, tonsillectomy aims to remove all tonsillar tissue, making regrowth rare.”

In eight years of practice, Hayes said, Golden was only the second patient she’d seen whose tonsils had grown back.

“It was pretty apparent when I looked back there,” she said. “In the back of the throat, there’s an anterior to posterior pillar, and that’s where the tonsil sits. When someone has had their tonsil removed, it should be very smooth. But with hers, it was very bumpy…it looked just like tonsil tissue, just as a regrowth, sitting right there.”

Hayes believes Golden was more prone to tonsil regrowth because of the technique used when she was a child.

“Cold techniques” were more common when Golden had her initial surgery decades ago, including the use of a guillotine instrument that cut the tonsil off with two blades.

But Hayes says “hot techniques”, like the coblation she used for Golden’s second surgery, allow for more precision.

“I actually dissected down to the tonsil capsule and removed that whole tissue,” she said. “Obviously, I don’t have a magic ball, but I don’t expect her to have a reoccurrence again.”

Neither Golden nor Hayes can be sure when the tonsil regrowth started or how long it took, but Hayes’ best guess is that they had been there for at least a decade.

Tonsillectomy recovery is often longer and more difficult for adults because children tend to heal faster in general, experts say. In the two weeks since her procedure, Golden said she has been surprised by just how brutal recovery has been.

“I haven’t experienced any bleeding, but the area is way more painful than I expected. It’s taking far longer than I thought it would.”

Still, she’s optimistic that the payoff – no longer getting run down with sore throats that “feel like swallowing a cactus for a few days” – will be worth it.

 

CNN article – More Popsicles, please: Your tonsils can grow back (Open access)

 

See more from MedicalBrief archives:

 

GPs overwhelmingly incorrect in deciding on tonsillectomies

 

The long-term risks of having your tonsils out

 

Young girl loses leg to necrotising fasciitis

MedicalBrief — our free weekly e-newsletter

We'd appreciate as much information as possible, however only an email address is required.