New Guidelines on When Kids Need Tonsillectomies
Most Children With Sore Throats Don’t Need Tonsillectomies, but Bed-wetters Might
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.
The new guideline, however, says that kids should have at least seven episodes of throat infection, such as tonsillitis or strep throat in a year, or at least five episodes each year for two years, or three episodes annually for three years, before they become candidates for surgery, and that those infections should be documented by a doctor, rather than just reported by parents.
The idea, experts said, was to reserve surgery only for the most severely affected, because the surgery can rarely have serious complications including infections and serious bleeding.
“Children who have fewer episodes really aren’t going to see a lot of benefit,” says Jack L. Paradise, MD, professor emeritus of pediatrics at the University of Pittsburgh School of Medicine.
“There aren’t many kids, overall, who meet those stringent criteria,” Paradise says.
What’s more, Paradise and other experts stress that even children who satisfy the guidelines shouldn’t get an automatic green light for surgery.
“I’m not sure, if I had a child that met all the criteria, that I’d automatically subject the child to the consequences of that,” Paradise says, “Post-operatively, it’s a very painful procedure.”
Changing Attitutes to Tonsillectomies
The tonsils are cone-shaped lumps of tissue embedded in the throat, and they are believed to play a role in how the body responds to infections, though experts aren’t exactly sure how.
But in the early part of the 20th century, the tonsils were blamed as the “focus of infection” in the body, and doctors began taking them out as a way to promote good health.
The operation became so routine, for example, that entire classrooms of youngsters would get their tonsils taken out at school.
But by the 1970s, many experts were questioning how effective and appropriate it was to subject kids to a painful operation that could have rare but serious complications -- all for what new research suggested had begun to suggest were minimal improvements in the risk of sore throats.
At the same time, however, doctors were starting to become more aware of the myriad problems tied to sleep disordered breathing in children, a spectrum of problems that can range from snoring to obstructive sleep apnea.
And more tonsils began to be taken out as a way to open up the airway and improve sleep.
As sleep improves, research suggests behavior, growth, school performance, and even bed-wetting does, too.
“I’ve seen kids like this,” says Drake. “Kids are so tired that their brains can’t hear the signal from their bladders that it’s time to go, and you take the tonsils out and the problem resolves.”