New Guidelines on When Kids Need Tonsillectomies
Most Children With Sore Throats Don’t Need Tonsillectomies, but Bed-wetters Might
Jan. 3, 2011 -- Most children who get repeated throat infections probably don’t need surgery to remove their tonsils and would improve in time with careful monitoring, according to new clinical guidelines on tonsillectomies in children.
The new guidelines also suggest, however, that removal of the tonsils, or tonsillectomy, may improve problems tied to poor sleep, including bed-wetting, slow growth, hyperactive behavior, and poor school performance.
In fact, sleep-disordered breathing -- a set of problems that range from snoring to obstructive sleep apnea -- is now the most common reason for tonsil removal in kids younger than 15.
“We used to think that only if you were an air traffic controller did it matter if you slept well or not, and now we know that’s not the case,” says Amelia F. Drake, MD, chief of the division of pediatric otolaryngology at the University of North Carolina School of Medicine in Chapel Hill.
More than half a million tonsillectomies are performed each year on children in the U.S., making it the second most common surgery in this age group, just behind procedures to place tubes in the ears to relieve recurrent ear infections.
Despite the fact that it is a mainstay of American medicine, experts have long disagreed about how useful or appropriate tonsillectomies may be.
The new guidelines, published Monday by the American Academy of Otolaryngology - Head and Neck Surgery, are the first set of official recommendations on tonsillectomy published in the U.S. The guidelines aim to give doctors and parents more information about when tonsillectomy may be warranted and to help minimize the risks and pain of this procedure in young patients.
“I thought they were very comprehensive,” says Drake, who reviewed the new recommendations but was not involved in drafting them. “This is an area where improvements and refinements can have a huge impact. This is medicine at its core.”
New Criteria for Removing Tonsils
The guidelines update a set of clinical indicators for tonsillectomies published in 2000 by the American Academy of Otolaryngology, which suggested that doctors could consider taking out the tonsils if a child had at least three cases of swollen and infected tonsils in a year.