How patients are being left in agony as the NHS restricts tonsillectomies: It used to be a routine operation... now it's being rationed - but the treatment ends up costing more

Mandy George gave little thought to the sore throat she felt coming. With young children and a husband who worked nights as a computer engineer, she had no choice but to tough it out.

“It just felt a bit ‘scratchy’ and I didn’t feel it at first with the weather,” says Mandy, 43, a carer from Jarrow, Newcastle upon Tyne.

"But over the next 24 hours or so it got much, much worse. My tonsils were really swollen and I felt tired to the bone. I couldn't swallow properly and my throat was visibly swollen.

“Then suddenly I grabbed my throat, turned to my husband Sam and gasped, “I can’t breathe.”

Mandy's tonsils had become so enlarged that they were blocking airflow through her throat.

Sam, 43, called 111 and was told to take Mandy to A&E. There she was given an intravenous drip containing strong antibiotics, and over the next few hours the drugs took effect.

The swelling subsided and Mandy's breathing returned to normal.

But then the results of a blood test checking for signs of a bacterial infection showed something worrying.

Mandy's levels of platelets - cell fragments that help blood clot - had plummeted. That meant she was at risk of bleeding to death from the slightest scratch.

The mother of three had developed immune thrombocytopenia, where the immune system attacks and destroys platelets, often as a result of a viral or bacterial infection such as tonsillitis.

Mandy, who was then living in Livingston, West Lothian, was transferred in the middle of the night to a specialist center at the Western General Hospital in Edinburgh, where she was given intravenous immunoglobulin, a blood product enriched with antibodies that stop the immune system from attacking platelets.

After five days, she had fully recovered but will need annual blood tests to check her platelet levels for the rest of her life.

While Mandy's story may sound unusual, recent studies indicate a steep increase in hospitalizations for severe tonsillitis.

A study published last year in the European Archives of Otorhinolaryngology found that between 2015 and 2019 there was a 25% increase in admissions to four NHS trusts for peritonsillar abscesses, a potentially fatal complication of tonsillitis where an abscess forms between the tonsils and the wall of the throat.

In addition to high doses of intravenous antibiotics, this requires emergency treatment to drain pus from the area, often under local or general anesthesia.

A second study by doctors at Rotherham Foundation NHS Trust, published last March in the journal Annals of the Royal College of Surgeons, found that since the late 1990s, cases of "deep neck space" infections - a serious complication of tonsillitis where the infection takes hold around the tissue that covers the neck and neck - had increased almost fivefold lined.

These two studies support previous reports showing that the number of Brits ending up in hospital due to tonsillitis has been increasing for years.

The most likely explanation for this increase? Cuts to NHS tonsillectomy operations.

In the 1950s and 60s, around 250,000 patients had tonsil surgery each year in the UK.

However, large-scale studies began to question the value of routine surgery and suggested that, at least in children, many cases of recurrent tonsillitis gradually resolve.

And although they were once considered of little value, scientists discovered that tonsils are made of lymphatic tissue, which makes proteins to fight infections.

However, these same proteins are also released by other tissues in the body, so removing the tonsils won't have much impact.

According to NHS guidelines, tonsillectomies should only be carried out under the '357 rule'. This states that a child or adult must have had at least three attacks of severe tonsillitis per year for three consecutive years, five attacks per year for two years, or seven attacks in 12 months to qualify for surgery.

As a result, tonsillectomies in England have fallen to just 40,000 to 50,000 a year, a fraction of the number at the peak. So has the pendulum swung too far?

The Rotherham study showed that before cuts to surgery, the NHS spent around £71 million a year on tonsil removal and just £8 million on treating severe tonsillitis.

Now the trend has gone in the other direction, with £73 million a year being spent on treating complicated cases of tonsillitis and just £56 million a year on surgery.

This means that any savings from fewer surgeries will be more than overshadowed by the bill for treating sick patients.

“These figures show that measures to control the number of tonsillectomies in the NHS have gone too far over the last 15 years,” says Professor Tony Narula, a retired ear, nose and throat (ENT) surgeon and former president of ENT UK.

“The aim of not operating unless absolutely necessary is a noble goal, but when you take into account all recurrent infections, these studies may actually underestimate the overall cost to the NHS.

Many cases of tonsillitis, the Rotherham team warned, end up requiring “long intensive care stays and a lengthy course of rehabilitation”.

Professor Nirmal Kumar, consultant ENT specialist at Wrightington, Wigan and Leigh NHS Trust and president of ENT UK, added: “We know that if you do too few tonsillectomies, hospital admissions for acute infections increase, and we see that every day with patients admitted with these types of infections.

"Tonsillectomies are still an important operation; but we cannot continue to operate on hundreds of thousands of people every year, often unnecessarily."

From a young age, Mandy had suffered at least two bouts of tonsillitis a year, with long periods away from school.

The attacks continued into adulthood. “They last five or six days each and can be really debilitating,” she recalls.

“Every time I asked my GP about having my tonsils removed I was told there wasn’t enough evidence to do so or that I wasn’t sick enough.

"The irony is that my parents often treated me at home because they didn't want to bother the GP any further, but if they had then I would probably have been referred for surgery."

The Department of Health did not respond to a request for comment from Good Health.