Having your tonsils out, also known as a tonsillectomy, to help treat a sore throat was once extremely common among young children in the United States – almost a rite of childhood passage. Now, these surgeries are declining in number.
The effectiveness of tonsillectomy for repeated throat infections instead of watchful waiting has been called into question, says a new study published in January 2017 by the American Academy of Pediatrics (AAP).
Researchers found that throat infections, health care visits and school absences improved during the first year after a tonsillectomy. However, “It is difficult to tell if the benefit persisted beyond the first year,” says Dr. Sarah Laginess, a pediatrician at Beaumont Hospital in Troy.
Reasons for surgery
Tonsils are glands at the back of the throat. Tonsillitis or enlargement of the tonsils or adenoids, can lead to repeat ear infections and frequent absences from school. Tonsillectomies are the third most common operation performed on children in the U.S., with more than 500,000 operations taking place per year (circumcision and ear tubes are the two most common procedures). Despite the fact that tonsillectomies are so common, doctors have disagreed on the usefulness of the surgery.
“The difficulty arises when there is no gold standard in diagnosing tonsillitis.” Laginess says. “Some sore throats are a result of an infection of the tonsils themselves and some are not.”
Thirty years ago, approximately 90 percent of tonsillectomies performed on children were done for repeated sore throat infections. Today, only 20 percent of tonsillectomies are done for infection and 80 percent for breathing problems while sleeping, or what doctors call “Obstructive Sleep Apnea” (OSA).
“Obstructive sleep disordered breathing ranges from snoring to actual pauses in breathing,” Laginess says. “Children would likely need to have a sleep study done to make a definitive diagnosis”
OSA carries potential health hazards. “For some children, the obstructive nature of their illness could lead to heart problems,” Laginess continues.
As with any surgical procedure, tonsillectomies come with risks. These can include bleeding, breathing problems, infections and reactions to the anesthesia used.
A study published in 2014 found that 8 percent of healthy children suffer complications and have to return to the hospital within 30 days following a tonsillectomy. About 1 in every 15,000 tonsillectomies ends in death. Bleeding complications were named in the death of a 9 year old Detroit girl following a tonsillectomy in January 2017.
You and your child’s health care provider may consider a tonsillectomy if there are frequent throat infections. “As it stands today, the definition of recurrent or severe infection is as follows: greater than or equal to seven episodes of sore throat in the preceding year. Greater than or equal to five episodes in each of the preceding two years, greater than or equal to three episodes in each of the preceding three years,” Laginess says.
Laginess adds that parents should consider the benefits and risks of the actual surgery, tolerance of the child to the illness, tolerance to the antibiotic treatments and how this affects the child’s school performance and school attendance.
According to the American Academy of Pediatrics, a period of “watchful waiting” is recommended before surgery.
“Watchful waiting in general involves the use of antibiotics to treat infection and then monitor for prolonged or further infection,” Laginess says. “For many individuals, sore throats can be due to viral causes and thus antibiotics are not warranted.”
Laginess says some home remedies to try for sore throat include lozenges as well as warm salt water gargling.
It is possible that as your child grows older, there may be fewer sore throats. “Typically, as children get older, the incidence of illnesses such as strep throat decreases. A defined age does not exist as to when it can be expected to end, however. Watchful waiting with use of antibiotics for further infections typically continues until the child reaches the criteria for severe or recurrent infection if they don’t first “outgrow” the illnesses,” Laginess says.