removal of tonsils for recurring sinus infections?

[Lilliahall]

Last year, I had my first sinus infection ever.  In the year since then, it was followed by 2 or 3 more.  The most recent began this past weekend, with what seemed to be a simple episode of the flu -- a fever, sore throat, and general aches and pains.  It rapidly turned into a sinus infection, laryngitis, middle ear infection, constant cough, and -- to top it all off and make things just a little more gross -- conjunctivitis.  

What makes these episodes even more unpleasant is that, after even the mildest cold or upper respiratory infection, I almost always end up with a cough that lasts for weeks or months afterward.  (It appears to be due to a post-nasal drip that exacerbates some kind of underlying allergies.  Asthma, coughing asthma, reactive airways disorder, and acid reflux have been more or less ruled out as the cause of the cough.)  

Anyway, today my ENT suggested that I consider having my tonsils removed.  She said it's helpful for people who get frequent infections that require antibiotics.  My question is simply whether that's correct.  I know of people who've had their tonsils removed for other reasons -- e.g., recurring tonsillitis -- but I've never heard of anyone doing this as a result of frequent sinus infections.

If there's a real possibility that it would help, I would definitely do it.  But I just haven't been able to find much information on tonsil removal in connection with sinus infections.  So I'd be grateful for any thoughts you might have on this.  I'm particularly interested in whether this is a generally accepted treatment for recurring sinus infections, and whether (statistically or just in your experience) it is effective.  

Thank you.

[David Tinkelman, M.D.]

Tonsillectomy is not accepted or recognized (by any guidelines or subspecialty medical organizations) as treatment for recurrent and/or chronic sinusitis.

For example, the only indication for tonsillectomy for adults, listed in the British Guidelines (Scottish Intercollegiate Guideline Network (SIGN), is recurrent severe sore throat.

This is consistent with the Guidelines developed by the  American Academy of Otolaryngology–Head and Neck Surgery Foundation.  The following is an abstract that explains those guidelines and provides information on the non-surgical diagnostic evaluation and treatment of chronic sinusitis.

I have included the information from that document, cited below, for you to have a better understanding of chronic sinusitis and to serve as a starting point for discussions with your physician(s).  I strongly suggest that you not proceed with a tonsillectomy and that you request a second opinion from either another ENT specialist or from a specialist in Internal Medicine.  While sinus surgery may be appropriate in some instances of chronic sinusitis, the treatment of this disease is, by and large, medical, including drugs, nasal irrigations and laboratory testing, including CT imaging of the sinuses, as part of the overall search for underlying or predisposing causes of chronic/recurrent sinusitis.

I hope that you and your doctors might find this to be useful information.

_______

Otolaryngology–Head and Neck Surgery (2007) 137, 365-377

EXECUTIVE SUMMARY
Clinical practice guideline on adult sinusitis
Richard M. Rosenfeld, MD, MPH, Brooklyn, NY
This executive summary will alert clinicians to key evidence-based statements in a multidisciplinary, clinical practice guideline on adult sinusitis developed by the American Academy of Otolaryngology– Head and Neck Surgery Foundation. Included in the guideline are 17 boldfaced action statements: 3 on viral rhinosinusitis, 7 on acutebacterial rhinosinusitis, and 7 on chronic rhinosinusitis and recurrent acute rhinosinusitis. Evidence profiles that accompany each statement are summarized to show why it was made and how it can be implemented. Guideline statements regarding acute rhinosinusitis focus on diagnosing presumed bacterial illness and using antibiotics appropriately.
Guideline statements regarding chronic rhinosinusitis or recurrent acute rhinosinusitis focus on appropriate use of diagnostic tests. Surgical therapy is not discussed.

© 2007 American Academy of Otolaryngology–Head and Neck Surgery
Foundation. All rights reserved.

Sinusitis affects 1 in 7 adults in the United States, resulting in diagnosis of 31 million individuals each year.1 The direct annual health care cost of $5.8 billion stems mainly from ambulatory and emergency department services,2 but also includes 500,000 surgical procedures performed on the paranasal sinuses.3 Despite the high prevalence and economic impact of sinusitis, considerable practice variations exist across and within the multiple disciplines involved in managing the condition. These variations prompted the American Academy of Otolaryngology–Head and Neck Surgery Foundation to develop the clinical practice guideline that is the basis for this executive summary.4
The target patient for the guideline is aged 18 years or older with a clinical diagnosis of uncomplicated rhinosinusitis:

● Rhinosinusitis is defined as symptomatic inflammation of the paranasal sinuses and nasal cavity. The term rhinosinusitis is preferred because sinusitis is almost always
accompanied by inflammation of the contiguous nasal mucosa.5-7 Therefore, rhinosinusitis is used instead of sinusitis in the remainder of the executive summary.

● Uncomplicated rhinosinusitis is defined as rhinosinusitis
without clinically evident extension of inflammation outside
the paranasal sinuses and nasal cavity at the time of
diagnosis (e.g., no neurological, ophthalmological, or soft
tissue involvement).
Rhinosinusitis may be further classified by duration as
acute (less than 4 weeks), subacute (4-12 weeks), or chronic
(more than 12 weeks, with or without acute exacerbations).

Acute rhinosinusitis may be classified further by symptom
pattern into acute bacterial rhinosinusitis (ABRS) or viral
rhinosinusitis (VRS). When there are 4 or more acute episodes
per year of ABRS, without persistent symptoms between episodes,
the condition is termed recurrent acute rhinosinusitis.

Most acute rhinosinusitis begins when a viral upper respiratory
infection (URI) extends into the paranasal sinuses,
which may be followed by bacterial infection. About 20
million cases of ABRS occur annually in the United States,8
rendering it one of the most common conditions encountered
by primary care clinicians. The importance of ABRS
relates not only to prevalence, but also to the potential for
rare but serious sequelae that include meningitis, brain abscess,
orbital cellulitis, and orbital abscess.9,10

Chronic rhinosinusitis (CRS) is one of the most common
chronic diseases, with prevalence as high or higher than
many other chronic conditions such as allergy and asthma.
According to The National Health Interview Survey, CRS
affects 14 percent to 16 percent of the U.S. population.11,12
Patients with CRS have a substantial negative health impact
owing to their disease, which adversely affects mood, physical
functioning, and social functioning.13,14

[hava]

Delay your decision to remove the tonsils.Do these 2 pranayam(breathing exercises) everyday, with concentration. You will start to notice the difference after you can do the pranayam for more than 15 minutes.This works gradually, so allow a few months to get better fully.
Build up your timing gradually.If you feel tired or dizzy, stop and resume after one minute.
Anulom Vilom –
Close your right nostril with thumb and deep breath-in through left nostril  
then – close left nostril with two fingers and breath-out through right nostril  
then -keeping the left nostril closed  deep breath-in through right nostril
then - close your right nostril with thumb and breath-out through left nostril.
This is one cycle of anulom vilom.
Repeat this cycle for 15 to 30  minutes twice a day.
Children under 15 years – do 5 to 10 minutes twice a day.
You can do this before breakfast/lunch/dinner or before bedtime or in bed.Remember to take deep long breaths into the lungs.You can do this while sitting on floor or chair or lying in bed.

Kapalbhati -(Do it before eating) Push air forcefully out through the nose about once per second. Stomach will itself go in(contract in). The breathing in(through the nose) will happen automatically. Establish a rhythm and do for 20 to 30 minutes twice a day. Children under 15 years – do 5 to 10 minutes twice a day.
Not for pregnant women. Seriously ill people do it gently.