Tonsillectomy

     Tonsillectomy has gone through many phases. In the 1950’s it was almost done routinely. It then fell out of favor and was rarely done. Now there are new reasons to do it and it is being done more often.

     There have always been good reasons not to do tonsillectomy. First, the anesthesia needs to be very deep to overcome the gag reflex. This can lead to more post-operative problems in the recovery room. The area around the tonsils has lots of blood vessels and there is danger of serious bleeding during and immediately after the surgery along with a risk of bleeding seven to ten days later. Finally, the throat is very sore immediately after the procedure and can remain sore for 2 weeks. The pain is bad enough that a child may simply refuse to eat or drink after the operation and need to get IV rehydration.

     Tonsillectomy has always been used to decrease the number of sore throats in children who have frequent, recurring sore throats, especially strep throat infections. If the child has a deep infection in the tonsils that never gets totally resolved and continues to reoccur, tonsillectomy will certainly help. However, for routine sore throats or strep throats, the evidence is less clear that it helps.The child certainly won’t get a tonsil infection (they are gone!) but the rest of the child’s throat can get infected. With or without tonsils, if a child shares a sucker with a child who has strep throat, that first child will probably get strep throat.

     The reason tonsillectomy is being done more frequently is to correct sleep apnea. Some children have tonsils so large that they cause obstruction to the child’s breathing while the child is asleep. This is more than just snoring. The child may have periods where he stops moving air in and out even though his chest is moving and he is trying to breathe. Children who are obese have even more problems with sleep obstruction. Having large tonsils is common between the ages of 3 and 6. Tonsils normally shrink in size as a child gets older, so the sleep problem may go away by itself.  But severe blockage can cause a child to be sleep deprived and start to fail in school. It can also cause poor growth and contribute to behavior problems. When the sleep disturbance is causing other problems, it is time to consider tonsillectomy. There are centers that study children’s breathing patterns when they are sleeping and can give parents the information they need to help them make the decision about whether to do surgery.