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When a Child’s Tonsils Need to Come Out

It doesn't take long—about 20 to 30 minutes—for an ear, nose and throat specialist like me to remove your child's tonsils. Still, I recommend a tonsillectomy only after careful consideration.

Most children I examine have been referred by their pediatrician because their tonsils are very swollen, causing breathing problems, or they're experiencing repeated infections that keep them from school and other activities. When antibiotics and time don't seem to help as much as we'd like and when your child's ability to breathe and function normally is impaired, it may be time to consider surgery.

Healthy tonsils are small, rounded lumps at the back of the throat on each side, visible just above the tongue. They are part of a ring of lymphoid tissue in the back of the throat that includes the adenoids. The adenoids must be checked with an angled mirror since they lie between the back of the nose and the throat.

Blocking the airway

Swollen tonsils are easier to see, forming a reddish, oval mass. Occasionally they are large enough to actually touch in the middle. The severity and frequency of tonsillitis must be taken into account when considering a tonsillectomy. Massively enlarged tonsils and adenoids may obstruct the airway and cause sleep apnea and breathing difficulty during the daytime.

Fortunately, the size of the tonsils and adenoids generally begins to decrease after age 9 and shrinks rapidly during the teen years. Also, the incidence of tonsillitis peaks between ages 4 and 7, then begins to decrease; tonsillitis becomes relatively uncommon after age 15. Getting your child past these critical years with antibiotics and conservative treatment may eliminate the need for a tonsillectomy.

As part of the immune system, tonsils and adenoids are part of the overall lymphatic system and help to fight infection by filtering bacteria and viruses from the air and food. Some parents worry their child will become ill more frequently after the tonsils and adenoids are removed, but this is not true. The human body offers a lot of protection. For example, about 250 infection-fighting lymph nodes lie between the collarbone and cheekbone.

The frequency of tonsillectomies or tonsillectomies combined with adenoidectomies has slowly been increasing over the past 40 years. However, the reasons for performing the surgeries have been changing.

Criteria for surgery

Few absolute criteria for tonsillectomy exist other than blockage severe enough to cause a lack of oxygen in the body and cardiopulmonary changes. The following may indicate the need for a tonsillectomy:

  • The child has a severe sore throat seven times in one year, or five in each of two years, or three in each of three years.

  • The child has a throat infection severe enough to cause an abscess, or an area of pus and swelling, behind the tonsils.

  • The child has a case of tonsillitis not helped by antibiotics.

  • The child's swollen tonsils and adenoids impair normal breathing.

As with all elective surgeries, the risks of surgery, including the risks of general anesthesia, hemorrhage, postoperative nausea and vomiting, as well as school absence for the child and work absence for the parent, must be weighed against the benefits. Any decision regarding tonsillectomy should be made in collaboration with the family, surgeon and pediatrician. Tonsillectomies are usually same-day surgery, but doctors may suggest an overnight stay for very young patients. Your child will miss about a week of school, then resume a normal routine.

Source:Bruce R. Maddern, M.D., member of the American Academy of Pediatrics and a Florida pediatric otolaryngologist