Tonsillectomy Guidelines: New
Chances are, if you’re over 35, you either had your tonsils out as a child, or know someone who did. For decades, removing kids’ tonsils and adenoids was standard operating procedure in the medical community. Tonsillectomy was considered the most effective weapon against sore throats and streptococcal infections and all of their serious consequences.
A new era has dawned – one with antibiotics – and just this year, new guidelines from the American Academy of Otolaryngology with respect to the surgery today’s parents remember from childhood. Based on studies of throat infections and tonsillectomies, the guidelines recommend tonsillectomy for frequent or severe sore throats only. The Academy now recommends that the surgery be considered for children who have trouble breathing while they sleep.
Reflecting changes in clinical practice, the guidelines were developed to apply scientific evidence to the need for an operation that was almost universal in the 1950s and 1960s. While the arrival of antibiotics made tonsillectomies much less necessary, many if not most of the Baby Boomer and Generation X generations had their tonsils removed. What Ellen Wald, MD, a specialist in pediatric infectious disease and chair of the pediatrics department at the University of Wisconsin School of Medicine and Public Health told the New York Times was “was the single most common operation in the United States,” now has its necessity regularly questioned by doctors.
Jack L. Paradise, MD, professor emeritus of pediatrics at the University of Pittsburgh School of Medicine, and his colleagues published a 1984 study that looked at children with many well-documented episodes of throat infection (seven or more in the preceding year, for example). Those who got tonsillectomies had fewer infections in the first couple of years after surgery than those who didn’t, the researchers found. But the children who didn’t have surgery also had fewer and fewer infections as they got older. Dr. Paradise concluded tonsillectomies were a reasonable option for children with severe, recurrent throat infections, but so was watchful waiting.
Later, Dr. Paradise studied children with fewer infections and concluded that the benefit of tonsillectomy was too “modest” to justify the risk, the pain, and the cost of surgery in those children.
These days, many doctors are less likely to move to tonsillectomy for a smaller series of run-of-the-mill sore throats, but doctors are more willing to consider that children might need the operation if their tonsils obstruct the throat enough to affect breathing while they sleep.
Parents should also know that in a significant number of children, the breathing problems—and everything that follows from disordered sleep—might persist even after the operation and necessitate further treatment.
Bottom line: The once ubiquitous tonsillectomy requires a careful overview of each child’s condition. While tonsillectomy might improve quality of life for some children, there are limits to what it can accomplish—with sleep issues and behavior problems, and with recurrent infections.