Not Your Grandma’s Tonsillectomy

Richmond Family Magazine

Explore Treatment and Prevention

Why It May Be Right for Some Kids

By Rajanya Petersson
Richmond Family Magazine
July 2013

Remember when it seemed like every other kid on the block was having his tonsils removed? Lots of adults recall being promised ice cream after the procedure and then, sadly, being too sore to eat it. Today, however, tonsil removal is far less common – at least for the reasons we might remember.

Tonsils and adenoids are small collections of tissue that make a partial ring around your throat. They are specialized organs that play a small role in protecting you from infection, but they sometimes become infected themselves, as in strep throat. Most of the time, infected tonsils and adenoids clear up quickly with the help of antibiotics. Since they are part of the protective immune system, doctors usually don’t remove them unless it is absolutely necessary.

These days, the most common reason to perform surgery to remove tonsils and adenoids, called tonsillectomy and adenoidectomy (T&A), is problems that can arise with breathing at night. Enlarged tonsils and adenoids can block the airway during sleep, causing loud snoring, breathing pauses, and/or nightwaking with choking and gasping for air. These children may be diagnosed with what’s called obstructive sleep apnea.

It’s important for parents to monitor their child’s symptoms. Of course, loud snoring and enlarged tonsils by themselves may not be enough of a reason to remove tonsils, but if your child has breathing pauses or problems during the day, such as fatigue, hyperactivity, or trouble with focusing, these may be signs of poor sleep and indicative of the obstructive sleep apnea that may improve after T&A.

Tonsils and adenoids are part of the lymphatic system, which helps fight infections. The tonsils and adenoids do this by trapping germs coming through your mouth and nose. Your tonsils are the balls of tissue you see in the back of the throat, and adenoids are higher up, behind your nose. As noted, we prefer not to remove them unless the child has real and persistent problems with snoring, breathing problems at night (possible obstructive sleep apnea), and/or recurrent infections.

Tonsillitis, or infection of the tonsils, causes them to become red and swollen, and sometimes a white or yellowish coating will be present. There is usually a fever, and the child complains of a sore throat and painful swallowing. You can’t see the adenoids through the nose or mouth, but breathing problems and abnormal voice quality can be clues to infection. Recurrent strep throat infections used to indicate surgical removal of the tonsils or adenoids, but doctors now feel that unless a child has more than seven strep throat infections in one year, a very unusual event, T&A usually is not performed. Some doctors may try a long course of antibiotics before finally deciding to remove tonsils and adenoids; this treatment sometimes eliminates the need for surgery. However, in addition to the above, if the child has had five or more strep infections in the past two years, or three or more in the past three years, they may benefit from T&A.

A severe tonsil infection might cause so much swelling that the child complains that swallowing is too painful, and he or she will stop eating solid foods. This should trigger a trip to the doctor to see if more treatment is necessary, usually with a course of antibiotics. Sometimes a tonsil infection can spread to the surrounding tissues, causing a peritonsillar abscess. This may need to be treated with surgery, especially if it happens a second time.

Surgery to remove tonsils and adenoids is performed under general anesthesia.It is a relatively simple operation, but requires considerable skill because of the small spaces involved. No matter the reason behind the procedure, your child can still have ice cream and popsicles after T&A, as the cold seems to help with the pain.