I’ve had a few parents in my office recently, bringing their children for evaluation of their throat and tonsils.
The question most often asked: “Should my child have his or her tonsils removed?” The answer to that question can be complicated, since there is more than one reason to recommend a tonsillectomy. Years ago, it wasn’t unusual for the tonsils to be removed by a surgeon for general sore throat problems. That is not the routine anymore.
The tonsils are collections of tissue on either side of the throat. The tissue is made up of lymphoid tissue. Lymphocytes are white blood cells that are responsible for identifying and dealing with foreign proteins or infecting agents. In other words, they help us build immunity.
Along with the tonsils, the adenoids make up another collection of lymphoid tissue in the back of the nose. While the tonsils and adenoids make up a large part of the lymphoid tissue of the throat, there is more present in the back of the throat in smaller and less conspicuous areas. Therefore, it is impossible to remove enough tissue to affect a person’s ability to mount an immune response.
The tonsils are most active in childhood. Both the tonsils and adenoids tend to seem larger and be more prominent between the ages of 1 and 10. After that, they tend to spontaneously regress and in the case of adenoids, completely disappear.
Here are the accepted reasons to consider tonsillectomy and adenoidectomy in children:
Multiple episodes of tonsillitis. The single occurrence of a throat infection is not an indication to consider tonsillectomy. In fact, recent research and statistical analysis has shown that until the child has had documented tonsillitis seven times in one year, five times a year for two years or three times a year for three years, recommendation for surgery is withheld.
If a child is known to carry streptococcus bacteria between bouts of sore throat, there is an indication for surgery.
If there is a problem with antibiotic intolerance or allergy complicating the treatment of sore throat.
The child who is struggling in school because of recurrent throat infections may require special consideration for tonsillectomy.
If an abscess is present in the throat caused by tonsil infection (peritonsillar abscess).
The presence of middle ear infection or fluid is often relieved by removing the adenoids.
A dentist or orthodontist may recommend consideration of tonsillectomy and adenoidectomy for certain types of dental malocclusions.
Obligate mouth breathing and obstructive sleep apnea.
Mouth breathing and sleep apnea have recently been identified as a prominent problem. Sleep apnea is obstruction of the upper airway, which prevents a person from getting into the deeper stages of sleep. The result is non-refreshing sleep. This causes abnormal sleepiness during the day.
Children who have sleep apnea tend to snore, stop breathing during sleep or sleep poorly; they are often fussy or unruly. Children with sleep apnea often have trouble in school, have difficulty learning and are many times singled out as discipline problems. In many cases there are other related problems such as nightmares and enuresis (bedwetting).
The source of sleep apnea in children is associated with tonsils and adenoids that obstruct the air passages and prevent a child’s ability to breathe through his nose when he eats, drinks, or sleeps. When this occurs, tonsillectomy and adenoidectomy are performed. Adenoidectomy alone is not considered curative.
Even though surgery for tonsillectomy is safe and effective, ear, nose and throat specialists follow the above guidelines to assure that unnecessary surgery is not performed. Every child needs to be evaluated individually in order to ensure the best outcome of treatment.
An assessment of related problems such as allergy is important to consider before planning surgery. Complications such as bleeding tendencies or medication allergy as well as general medical histories are important in making the proper decision about your child’s surgery.
In conclusion, the decision to perform surgery takes several factors into account. Tonsillectomy is performed when there is an obvious need and the result will lead to a better outcome than any other treatment.
Fortunately, with paediatric tonsillectomy being such a commonly performed procedure, we have ample statistics and experience from which to make an educated decision for each individual.
Dr. Robert Glatz is an ear, nose and throat specialist based in the Cayman Islands.