Tonsillectomies and Adenoidectomies for Ear Infections


My 9 year old son was referred by our pediatrician to a ear-nose-throat specialist to have ear-vent tubes inserted. After our consultation visit with the specialist, he recommended not having the tubes placed since my son is only having ear problems 2-3 times a year. The reason the pediatrician wanted the tubes was because of the infections taking so long to clear up with each episode and having to take antibiotics for 1 month to sometimes 2 months in order to get rid of the fluid behind the ear drum that seems to always remain after the infection is gone. The specialist recommended taking out his tonsils and adenoids instead. He feels getting to the root cause will have better results. This makes me wonder why I’ve never heard of this sooner. I guess my question is, should we go ahead with removing the tonsils and adenoids even though they have not given him any problems before?
Pauline Davis – Vancouver, Washington

Dr. Greene's Answer

From the 1930’s through the 1960’s, tonsillectomies and adenoidectomies were considered routine surgeries. At that time, the tonsils and adenoids were thought to be useless organs, because their function was not understood, and because they often melt away after childhood. In the late ’60’s we discovered that the tonsils and adenoids play an important role in the immune system. Once this was understood, the practice of routine tonsillectomy and adenoidectomy declined.

In 1990, a very well-designed study by Jack Paradise, M.D. (and colleagues), published in the Journal of the American Medical Association, did show a clear but modest reduction of ear infections following adenoidectomies. In 1999, the same author published another study which showed a “limited and short term” effect. Now we are faced with a decision — is the short-term benefit of removing the adenoids worth the cost?

The adenoids (also called the nasopharyngeal tonsils) are positioned at the back of the throat as defenders against bacteria and toxic substances that come into the body through the nose and mouth. When they are active — fighting infections and producing antibodies — they can become quite enlarged. In this state they can block the eustachian tube and clog the drain from the middle ear. Typically this obstruction is not complete and will still allow some of the normal secretions from the middle ear to drain.

Because the risk of adenoid surgery is greater than that of tube placement, the American Academy of Pediatrics recommends tube placement before adenoid surgery for the initial surgical treatment of most children with persistent middle ear fluid (Pediatrics 2004). However in children over 4 years old who mouth breathe chronically, snore heavily, and/or have chronic nasal congestion, the likelihood of benefit from adenoid surgery is increased. Thus, some doctors may consider adenoid surgery with tube placement or with myringotomy (hole made in the eardrum) for children over 4 years old who have the above symptoms of problematic adenoids.

Tonsillectomies are another story.

In 1983, the British Medical Journal reported a controlled study performed by A.R. Maw. The authors compared those who had their adenoids taken out with those who had their adenoids and tonsils removed. They found that adenoidectomy did result in improvement in middle ear disease. However, there was no additional benefit from having the tonsils removed. At present, there is no evidence that tonsillectomy alone is of any benefit in the treatment or prevention of otitis media. If a child were suffering from some other concurrent condition, such as obstruction of the airway or sleep apnea, however, I would consider tonsillectomy in addition to adenoidectomy as a possible solution.

For your son, Pauline, it’s not really a question of antibiotics versus surgery (the long courses of antibiotics may not be necessary — they may not be speeding up the disappearance of the fluid). The question is fluid in the ear versus surgery. Surgery may well be the better option for your son. His 2 or 3 infections per year — each with 1 or 2 months of fluid — mean that his hearing may be decreased for up to 6 months each year. A formal hearing test and thoughtful assessment of his school performance may help you to reach a decision. The information here can be used as a starting point for discussion with your doctors about the best course of treatment for your son.

November 7, 2008
Published on: November 08, 1996
About the Author
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Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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Recent Comments

I underwent removal of tonsils and adnoids when I was a child because I keep getting ear infections. now I’m an adult, I realized that nothing has changed.


That is tragic. What do doctors tell you to do now?

Best, @MsGreene
Note: I am the co-founder of, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Dr. Greene, my grandson suffered from obstructive breathing and chronic ear infections with notable hearing loss. He underwent removal of tonsils and adnoids last fall at age 7. Surgery went well but now 8 months out he still says he still has the popping and fluid stopping up his ears. Frequently he will tell us to repeat ourselves saying he is not hearing very well. Why?

Dr. Greene, please help. My son has terrible allergies during March and April. We are in coronavirus times, but i know i need to see an ear, nose and throat doctor. Pediatrician mentioned my sons large tonsils. I’ve seen them. I know he probably has Osas. My ques: does their throat expand as they get older? I read your article a min ago on Osas vs Ps. I see you stated they could outgrow OSas in several years. He does have heavy breathing, drooling, bad allergy issues in Spring. Has not had issues with continual ear infections yet. He just turned 4. If i remove his tonsils, can I only get 1 removed? To just free some space for better breathing purposes. Thank you. Please respond.

My daughter had tubes put in her ears and got her adenoids taken out this morning. When I went into the recovery room to see her after surgery I noticed a good amount of blood filling the inside of her ear opening to the point it was starting to run down her face. I’ve had tubes myself 6 times thru out my life and never once even saw a dot of blood afterwards, so I was really wanting another opinion about the situation. Cause the nurse said it was completely normal for the ears to bleed afterwards, but if it’s SO normal how come in the 6 times I had the procedure done I never experienced any bleeding. I’ve spoke with a couple friends also that have children that had tubes put in and none of them experienced any bleeding either. Would you please give me your opinion and advice with my situation! Thanks so much

Hi Jessica. I still remember seeing my son in the recovery room after getting ear tubes placed – it was a great feeling when the surgery was over. But I can imagine how disconcerting it would be to see blood streaming down your daughter’s face!

There are a number of blood vessels in the eardrum. When the eardrum looks red and inflamed during an ear infection, it is these blood vessels dilated.

Placing an ear tube is a bit like piercing an ear, except the little grommet goes in the eardrum rather than the earlobe. Sometimes this happens to nick one of the larger vessels in the eardrum – and this can bleed. It may take a while to stop bleeding, but typically the amount of blood loss isn’t significant, even if it looks like a lot in the stripe going down their face.

This might happen about 15% of the time an ear tube is placed – so it’s not too unusual that your experience and your friends’ would fall in the other 85%.

I do suggest that whenever there is bleeding after ear tube placement that an ENT take a look before sending the child home, and if the bleeding recurs or continues.

All the best to you and your daughter – DrGreene

My six-year-old grandson is anemic and they want to do a tonsillectomy and tubes in his ears is it safe when someone is anemic to be put to sleep and have surgery

I was 6 when I had all three of them removed in 2000. Up until then I had had 42 ear infections and doctors were afraid for my hearing. Never had an ear infection after, and the rate of me becoming sick went down drastically too. Today I catch a cold or flu maybe once every three to four years. So if your kid is in the same situation, I would recommend getting them out because it will probably help them.

My son is 4 years old and has chronic ear infections. His ENT suggested and A&T removal with a second set of tubes. I’m perfectly fine with getting his adenoids removed and a new set of tubes, but I’m struggling with having his tonsils removed. He has never been previously diagnosed with tonsillitis, strep throat or even bad soar throat by his pediatrician who sees us every time he has an ear infection. He did have a spout of sleep apnea, but I think it was caused by the sinus infection that he had, because he has never had issues with it before and it has not been an issue since his infection cleared up. Should he really have his tonsils removed?

My granddaughter is scheduled for a T& A following several bouts of strep throat being diagnosed without actual cultures being taken and several bouts of antibiotics over the last 9 mos. she also has fluid in her ears which hasn’t cleared up in spite of the antibiotics so she isn’t hearing well because of that. Her parents have Kaiser Permanente insurance and I’m wondering if this is a hasty recommendation since they have not tried ear tubes yet which after reading your article seems more appropriate for a first step? Also is it necessary to also remove the tonsils since they don’t seem to improve the hearing? Would the bouts of sore throats make this necessary or is this normal to just always do both T&A together and not really necessary? She does snore a tiny bit at times but no airway impairment or sleep apnea. Her surgery is scheduled in less than 2 weeks so I would appreciate your input beforehand.
Thank You, a concerned Grandma

A second opinion is likely a good idea. The parents of the child can request one from another Kaiser doctor, but they may get more information if they go outside the system. The problem with that is, of course, they will need to pay for the consult out-of-pocket.