To a singer, the voice is perhaps the most prized part of the body. It is, literally, an instrument few singers wish to alter, particularly through surgery. Because singers’ livelihood depends on a healthy, clear, reliable voice, they tend to bristle at any procedure that might affect that voice.

When the issue of tonsils – especially removing them by surgery (tonsillectomy) – arises, many singers want to change the subject. While the tonsils can be important elements of our immune system, they also can hurt quite a lot when they become infected; and when infections occur repeatedly, they can cause both pain and regular disruption to a singer’s routine and livelihood. Let’s address some basic questions that we, at the Chicago Institute for Voice Care, commonly get from singers regarding issues related to their tonsils.

What do the tonsils do? Are they necessary?

As a part of the immune system, tonsils can be quite useful, helping to fight infections in the throat. Unfortunately, while they’re fighting infections, sometimes tonsils become infected, enlarging and causing pain. And while tonsils are part of the fight the immune system wages against infection, the immune system still fights infections just fine without them.

The issue for many patients is when tonsils interfere with or become centers of discomfort, from any number of causes:

• Repeated infections (as often as every other month)
• Strep throat – not just a cold or sore throat
• Problems relating to sleep/snoring, often from oversized tonsils
• General inflammation of tonsils and related complications (abscesses)
• Tonsils of unequal size
• Tonsil “stones” of bacteria and cellular material that collect and become painful
• Tonsils that interfere with oral cavity resonance

When patients face these symptoms on a too-regular basis, the question of removing the tonsils is a good one to consider. For someone whose voice is his or her livelihood and is affected by these symptoms repeatedly, you should know that removing tonsils actually makes you LESS SUSCEPTIBLE to throat infections. It doesn’t guarantee you won’t have ANY throat problems, but significantly reduces the risk.

How do the tonsils affect the voice?

The tonsils are not directly related to the vocal cords (folds). However, they affect how a singer/actor places a note as well as the resonance or “ping.” To consider how oversized or infected tonsils can affect the voice, think about trying to talk or sing with marbles in your mouth and how that changes the way you use your voice and what comes out as a result. Large or oversized tonsils can create unwanted pressure and force you to “push” when you sing. They can even contribute to formation of nodules.

Should I have my tonsils removed?

Obviously, this is a question for each person to answer by talking with doctors, family, and friends. A good way to consider this question is to ask yourself: “Am I missing work, school, or professional gigs because of problems with my tonsils? Is my voice already changing or strained because of problems with my tonsils?” If the answer is yes, then having them removed offers the possibility you won’t have these problems again – or at least they will be significantly less common once you recover from the procedure

Are there risks?

All surgery has risks and complications, but those associated with tonsillectomy are rare and overwhelmingly minor. Tonsillectomy, particularly when performed by a surgeon who is trained in and sensitive to vocal health, is generally very safe. The most common, but still atypical, risk, bleeding of the tonsil bed, may occur in the first week or so after surgery as scabs diminish, but that is not typical for most patients. In the first week or two after surgery, there may also be come sensitivity in the part of throat where the tonsils used to rest, but that goes away as part of normal postsurgical healing. And for some, scar tissue is a worry, but we are also particularly sensitive to what kind of scar may result from surgery to each patient and align the surgery accordingly to avoid or minimize these effects.

How do we minimize risks at CIVC?

Having worked with a lot of singers and those who make a living with their voice, we are highly experienced and particularly sensitive to how the tonsils and tonsillectomy affect the voice, so we pursue many steps with patients to minimize risks:

• We talk with you about how anesthesiology will be used to best protect your vocal cords. For example, in cases where a tube must be inserted between the vocal folds during surgery, we use the smallest tube possible and make sure an experienced clinician inserts the tube.
• We minimize the use of heat energy during surgery to preserve vocal tract muscles and reduce the risks of scarring and pain afterwards.
• We carefully separate the tonsils from surrounding muscles to maintain the muscles in the back of throat you use to help place and shape notes afterwards.
• The exercises to address these are highly individualized and designed in a way that they fit with your everyday life
• We closely monitor your healing to address any issue or concerns throughout the process and answer any questions you might have at any time