Should all kids have their tonsils removed?

Doctor Examining Girl’s Throat With Otoscope In Clinic

When I was a youngster, I knew quite a few classmates who stayed home from school to recover from having tonsils removed. In fact, it seemed so common then that I began to wonder what was wrong with me. I never came close to losing my tonsils.

I wasn’t familiar with adenoids and the problems they could cause until much later. When my firstborn, at the age of about 4, began suffering from frequent ear infections that antibiotics couldn’t control, her pediatrician recommended she have her adenoids removed and temporary tubes inserted into her ears for drainage. Those two procedures did the trick.

Today, I hear little about children having either tonsils or adenoids removed. So, I began to wonder if something had changed. Do children need to have these procedures done?

Not necessarily, explained Sunitha Gowda, MD, a pediatrician with Banner Health Clinic in Greeley, Colorado. Criteria have changed, she said. Decisions regarding elective removal of tonsils or adenoids should be individualized according to potential benefits and risks, the natural course of disease, and the values and preferences of the family and child.

That means that while years ago doctors may have treated problem tonsils and adenoids more quickly and aggressively, they now may be taking a more “watchful” approach.

What are tonsils and adenoids?

Tonsils, Dr. Gowda explained, are the two round lumps in the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth. They are the body’s first line of defense as part of the immune system. They catch bacteria and viruses that enter the body through the mouth or nose, but they sometimes become infected.

Still, for some, tonsils and adenoids can end up causing issues. According to the American Academy of Otolaryngology – Head & Neck Surgery, tonsils and adenoids can become enlarged in some children, causing blockage of airways and difficulty in breathing. Frequent infections of the throat or ears, which do not respond to antibiotics, may also be a sign of problems with tonsils and adenoids. If these problems – which could cause serious harm long-term – persist, physicians may suggest to parents that their children have tonsils removed (called tonsillectomy), adenoids removed (called adenoidectomy), or both (commonly done together).

The good news is that as children age, adenoids shrink, which may lessen the potential for them to become infected or cause obstruction.

How do I know if my child needs adenoids or tonsils removed?

According to Dr. Gowda, criteria for tonsillectomy (with or without adenoidectomy) include recurrent throat infections more than or equal to:

  • Seven episodes in one year
  • Five episodes in each of two years
  • Three episodes in each of three years

Even if these criterion are not fully met, Dr. Gowda said tonsillectomy may be an option for children who frequently get strep throat (group A streptococcal infection) complicated by other issues such as antibiotic intolerance, history of rheumatic heart disease or other ongoing infections.

Dr. Gowda said an adenoidectomy is performed when children have severe nasal obstruction due to enlarged adenoids, which causes such issues as chronic rhinosinusitis (an inflammation of the nasal passages and sinus cavities) that does not respond to medical treatment, eustachian (ear) tube dysfunction and mouth breathing. Your physician may also recommend the procedure if  tubes in the ears do not help your child. If your child has sleep apnea and is over age 2, removal of the tonsils and adenoids may be considered.

Work with your physician to weigh your options

Since removal of tonsils and adenoids involves surgery with anesthesia, Dr. Gowda recommends parents learn as much as they can before making a decision about tonsil or adenoid surgery for their children.

Factors to consider include:

  • Potential benefits and risks
  • Watchful waiting versus surgery
  • The nature of available anesthetic
  • Surgical services and facilities

For some children, such as my daughter many years ago, surgery may be the best option. However, as health care providers and their patients have learned, watching and waiting may be just the right approach. In many instances, it may help youngsters keep their tonsils and adenoids for a lifetime.

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