For the past few years, I have had chronic throat infections, both viral and bacterial, sometimes as often as once a month, for months at a time. My doctor wants me to see a specialist about a possible tonsillectomy. Are they commonly performed to alleviate both types of infections, or usually just bacterial infections?

Amy

Either. Both. It doesn't matter.

What matters is that your tonsils have joined forces with the Dark Side. (Apologies to Bill Cosby, whose comedy skit on tonsillectomy is MUCH funnier than anything I might write!) Even though tonsillectomy is a painful operation for adults, it really sounds like your tonsils are ruining your quality of life. Your doctor is right -- you need to talk to a specialist so that you can at least THINK about having your tonsils removed. A specialist (usually an ear, nose and throat doctor, or ENT) can answer all of your questions about this operation. Only then can you make an informed decision to have (or not have) surgery. Right now, you don't even have the option.

Most cases of chronic tonsillitis (or recurrent acute tonsillitis) are due to bacterial infection. In contrast, sporadic sore throat (the "occasional" sore throat) may be viral. I suspect you think some of these infections have been viral because you tested negative for strep throat. But the test for strep throat tests only for Streptococcus, and misses all other bacterial infections. Why is strep throat such a big deal? Because a small percentage of untreated strep infections turn very ugly, leading either to severe kidney damage or rheumatic heart disease. For this reason, prompt antibiotic treatment of strep throat is essential.
In cases such as yours, how does an ENT decide whether to offer tonsillectomy as an option? Recurrent strep throat is certainly worrisome enough to justify tonsillectomy. However, I do not think strep throat is a necessary prerequisite to justify a tonsillectomy. Here are the other factors I weigh in making this decision:

Frequency. One sore throat a year, no matter how nasty, does not warrant tonsillectomy. If the patient has had six infections in one year, then I begin to think about recommending tonsillectomy. If the patient has had this problem for several years, then fewer infections per year may, nevertheless, warrant tonsillectomy (e.g., three or four per year for three years).

Severity. Let's say the patient has an occasional sore throat ... sore enough to register on her radar, perhaps even sore enough that she uses an over-the-counter pain medication. Yet she never sees the doctor about it, never misses school/work, never requires antibiotics. Even if this occurred more than six times per year, I would still hesitate to recommend a tonsillectomy. On the other hand, if she has only three infections per year, and if they have been whoppers (high fever, dehydration, one or two weeks of missed school/work), then tonsillectomy is probably worth considering.
Complications. It is possible for the infection to spread behind the tonsil -- this is known as a peritonsillar abscess, and it's a dangerous condition. If the patient has had one peritonsillar abscess, tonsillectomy is an option. If the patient has had two abscesses, tonsillectomy should STRONGLY be considered -- in other words, you'd be a fool not to have the tonsillectomy.

Please notice, I have not told you that you need your tonsils removed. I rarely tell people this (except in the case of recurrent peritonsillar abscess, severe obstructive sleep apnea or suspicion for tonsil cancer). All I am saying is that you should consider tonsillectomy as an option along with other options (such as living with it, treating each infection with a short course of antibiotics, or taking a lengthy course of antibiotics to try to prevent reinfection).