Tonsils: to yank or not to yank

It was either strep throat or tonsillitis that kept me from having a birthday party until I was ten years old. Finally, I had my tonsils — and adenoids — removed. Until then, I had no idea that most people breathe through the nose- not just the mouth.

That was ages ago. Now, experts say that most children with frequent throat infections do not need tonsillectomy surgery, according to new guidelines issued by the American Academy of Otolaryngology — Head and Neck Surgery (AAO-HNS).

Thirty years ago, recurrent infection was the reason  for approximately 90% of tonsillectomies in children; now it is about 20% for infection and 80% for obstructive sleep problems (OSA). Read more about kids and sleep.

The guidelines, which follow, were developed by panel members chosen to represent the fields of sleep medicine, advanced practice nursing, anesthesiology, infectious disease, family medicine, otolaryngology–head and neck surgery,  and pediatrics.

1.        Most children with frequent throat infection get better on their own; watchful waiting is best for most children with less than seven episodes in the past year, five a year in the past two years, or three a year in the past three years.

2.         Severe throat infections are those with fever of 101 or higher, swollen or tender neck glands, coating (exudate) on the tonsils, or a positive test for strep throat.

3.         Tonsillectomy can improve quality of life and reduce the frequency of severe throat infection when there are at least seven well-documented episodes in the past year, five a year in the past two years, or three a year in the past three years.

4.         Children with less frequent or severe throat infections may still benefit from tonsillectomy if there are modifying factors, including antibiotic allergy/intolerance, a history of peritonsillar abscess (collection of pus behind the tonsil), or PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and adenitis).

5.         Snoring is never normal in children. Large tonsils can obstruct breathing at night, causing sleep-disordered breathing (SDB), with snoring, mouth breathing, pauses in breathing, and sometimes sleep apnea (pauses more than 10 seconds).

6.         Doctors should ask parents of children with SDB and large tonsils about problems that might improve after tonsillectomy, including growth delay, poor school performance, bedwetting, and behavioral problems.

7.         Although most children with SDB improve after tonsillectomy, some children, especially those who are obese or have syndromes affecting the head and neck (e.g., Down syndrome), may require further management.

Know a child who has a tough time sleeping? Take a look at how sleep medicine experts at Cardon Children’s diagnose and treat children with sleep disorders.

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