Does my child need a tonsillectomy?
This is a very common reason why your doctor may send your child to see an otolaryngologist.
First, what are the tonsils?
Tonsils are tissues in the back of the throat that are part of the immune system. They respond to environmental antigens in the upper aero-digestive tract and activate immune responses. The Palatine tonsils are what most people are familiar with and are the tonsils that can be seen in the back of the throat. The Pharyngeal tonsils are better known as the Adenoids and are located behind the nasal cavity. The Lingual tonsils are located in the back of the tongue.
The term Tonsillectomy usually refers to the removal of the palatine tonsils.
Is there an impact on the immune system if the tonsils are removed?
There have been no studies to date that have shown that individuals who have their tonsils removed have any impact on their immunity. In fact, diseased tonsils have been shown to not to be functioning normally.
What about the Adenoids?
The Adenoids are the tonsillar tissue that is present in the back of the nose. When there is significant enlargement, there is blockage of the air passage through the nasal cavity and children tend to breathe through their mouths. Additionally they can block the function of the Eustachian tube and increase the risk for ear infections and fluid buildup causing hearing loss. The adenoids can also harbor bacteria and viruses and contribute to constant runny nose and possible sinus infections.
Here are reasons why tonsillectomy may be recommended for your child:
Does your child have loud snoring that sounds very concerning to you? Can you hear it from outside the room? Have you noticed any pauses in breathing or choking sounds while sleeping? Does your child mostly breath through the mouth while sleeping? If so, your child may have pediatric obstructive sleep apnea.
Children may have different symptoms of sleep apnea than adults. Adults often can feel sleepy during the day. Children on the other hand may exhibit poor attention, have hyperactivity, or be irritable during the day. This could lead to poorer performance in school.
In adults, the first line treatment option for obstructive sleep apnea is CPAP therapy. In children, the most common cause of sleep apnea is enlarged tonsils and adenoids that block the airway during sleep.
Some children have very large tonsils and adenoids from overstimulation by the immune system, which cause them to enlarge and block the nasal or oral airways causing obstructive sleep apnea in children. In cases of pediatric sleep apnea, both tonsils and adenoids are removed to help relieve the obstructed breathing.
Recurrent bacterial throat infections.
Recurrent strep throat or bacterial tonsillitis are another indication for removal of the tonsils. Removing the tonsils help to decrease the number and severity of throat infections. It may decrease the need for antibiotics and therefore the possible associated side effects.
Tonsillectomy can be recommended when there are more than 7 documented throat infections in the past year, 5 or more infections per year in the past 2 years, or 3 or more infections per year in the past 3 years. If your child does not meet these criteria, tonsillectomy may still be recommended if there are issues with antibiotic allergies or intolerance or other comorbid medical issues.
Other indications for tonsillectomy and/or adenoidectomy include: swallowing difficulties due to enlarged tonsils, abnormal growth of the jaw and face due to enlarged tonsils and adenoids, recurrent peritonsillar abscesses, significant asymmetry of the tonsils with concerns for possible malignancy, and chronic bad breath due to chronic tonsillitis
Much of the information summarized on this page may be reviewed in full detail on our Academy website.
How is Tonsillectomy performed?
Tonsillectomy is done under general anesthesia and is usually a same day surgery. This means that your child comes to the operating room for surgery and then goes home the same day. If your child is very young, has severe obstructive sleep apnea, or has other medical conditions, your surgeon may keep your child in the hospital overnight for observation.
Surgery is done entirely through the mouth. There are no external incisions. The tonsils are usually removed with an electrocautery device, which helps to control bleeding as it is removed.
How is Adenoidectomy performed?
The adenoids are also removed through the mouth. A mirror is used to look indirectly at the adenoids. The tissues are then reduced by various methods including sharply removing them, coagulating, or vaporizing the tissues with specialized instruments.
If you or your child is having a tonsillectomy and/or adenoidectomy click here to review our post-operative instructions.