Tonsils have been the source of interest and controversy for years, and not just for singers. Tonsils, however, are of more than passing interest for singers. American slang has even somehow equated them with the voice: a “great set of tonsils” has, in Damon Runyonesque parlance, come to mean a good voice.
Of course, tonsils have almost nothing to do with the voice. They are two almond-shaped masses sitting at the junction of the soft palate and the base of the tongue that help us acquire our immunity. Along with other areas of lymphoid tissue in the back of the nose, pharynx and tongue, they sample everything that normally comes into the body, take a snapshot, and then signal the immune system to make appropriate antibodies.
It’s an important task, and the tonsils do it well. By age 4, however, the body has usually acquired most of its immunity, thanks to these sentinels—and the tonsils’ job is done. After that, a period of less intense activity follows, and in our teens, tonsils normally begin to atrophy. In healthy young adults, they have shrunk away to inactive nubbins of tissue—except when the tonsils themselves become infected.
Infection of the tonsils means that foci of bacteria have gotten trapped within the deep pockets (so-called crypts) on the surface of the tonsil. When the infection is acute, a severe sore throat develops, which usually resolves with a course of antibiotics. The tonsils become large, red, and often covered with an exudate. In acute cases, such infections usually respond well to treatment.
Chronic tonsillitis is a different matter. Here, bacteria have taken up permanent residence within the tonsil, and often are walled off by scar tissue. This scar tissue, part of the body’s defense against chronic infection, means that the bacteria can’t be eradicated with antibiotics, since the surrounding fibrosis prevents adequate tissue levels of the drug. The patient gets temporarily better, then relapses.
With chronic tonsillitis, the battle between the bacteria and your immune system is one neither side can win. As long as your immune system is strong, you are symptom-free. As soon as it is weakened, the bacteria gain the upper hand, and a sore throat recurs.
What can weaken your immune system? First and foremost, stress. Stress can be physical (like an unrelated viral infection or inadequate rest), or psychological—worry about exams, auditions, money, a fight with your significant other, the list goes on. It is quite common for young college students to get recurrent tonsillitis: being away from home, studying, exam pressures, late nights, etc.
Should you have your tonsils out? The exact indications for this vary, but in general, we take tonsils out for two reasons. One is when they are massively enlarged, and interfering with breathing. In such cases, the young patient has a specific voice that sounds like he’s juggling something in the back of the throat. Secondly, in cases of chronic tonsillitis, where frequent infections result in ill health, lost time from school or work, and general debilitation.
For singers, the doctor who performs the tonsillectomy should be familiar with the anatomy and physiology of singing. This really means performing the procedure with minimum trauma, taking care not to injure the soft palate. A newer technique, shaving away the surface of the tonsil with a laser rather than complete removal, further assures that the palate will not be traumatized, although it is certainly not indicated for every case.
The question singers commonly ask is: “After a tonsillectomy, will my voice change?”
After the initial healing period, the voice should be normal. Many patients tell me they actually feel more room in the back of the throat, which makes sense in cases where the tonsils were larger and obstructive. You should put off singing for about three weeks, but I encourage patients to begin moving the palate, lifting it, as well as moving the larynx up and down, to assure good mobility. This can be started one week after surgery.
In general, tonsillectomy is a safe and simple procedure, and, performed for the proper indications, can be of great benefit. As always with any surgery, get a second opinion. In most cases, the indication is chronic infection, and you are not dealing with an emergency. Talk with your doctors until you are comfortable.
