Tonsillectomy is a procedure that can be a source of both anxiety and relief for families with children suffering from recurrent tonsillitis, tonsillar hypertrophy, obstructive sleep disordered breathing and other tonsil-related medical conditions.
The term “tonsil” is typically used to refer to the palatine tonsils, collections of extranodal lymphoid tissue that exist on each side of the pharynx (throat). The palatine tonsils have never been shown to serve a useful or beneficial purpose despite multiple research studies investigating this issue.
Tonsillectomy, a surgical procedure performed to remove tonsils, has been one of the most common surgical procedures in the United States for children younger than 15. The most common reasons for tonsillectomy in children are recurrent throat infections (recurrent acute tonsillitis) and obstructive sleep disordered breathing.
Recurrent acute tonsillitis has been decreasing as an indication for tonsillectomy since the 1970s, while obstructive sleep disordered breathing and obstructive sleep apnea have been increasing as reasons for the procedure. Obstructive sleep disordered breathing can include a spectrum of conditions that range from isolated snoring to obstructive sleep apnea. The diagnosis of obstructive sleep apnea requires a sleep study, but the diagnosis of obstructive sleep disordered breathing can be made on a clinical basis (signs and symptoms) alone. Additional symptoms associated with sleep disordered breathing include daytime tiredness, fatigue, excessive sleepiness, hyperactivity, reduced concentration, inattention, poor school performance and behavioral problems. Conditions including growth retardation, bed wetting and asthma also may be worsened or caused by obstructive sleep disordered breathing.
Tonsillectomy is known to be a simple and straightforward surgery that almost no ear, nose and throat surgeon has difficulty performing. However, tonsillectomy also has a comparatively high rate of complications. The most common serious complication of tonsillectomy is bleeding. Primary bleeding (within one day of the procedure) has been reported to range from 0.2 to 2.2% of the time. Secondary bleeding (occurring greater than one day after the procedure) has been reported to occur from 0.1 to 3% of the time.
It is also possible that a tonsillectomy procedure could be performed without the child receiving the expected benefits. Not all obstructive sleep disordered breathing and obstructive sleep apnea symptoms will respond to tonsillectomy. Recurrent throat infections also may still occur despite removal of the tonsils. It is important to have realistic expectations when considering tonsillectomy and an understanding that desired results are not always received with this or any other surgery.
For families interested in exploring the option of tonsillectomy, an excellent first step is finding an ear, nose and throat surgeon who they trust and who listens to their concerns and goals. With the exception of a few rare conditions, there is almost never a need to rush into a decision regarding tonsillectomy.
Eric Flavill, MD, is a board-certified otolaryngologist at the UT Health East Texas ENT Center in Tyler. As an otolaryngologist, Dr. Flavill specializes in treating conditions affecting the ears, nose and throat either medically or surgically.