Does My Child Need a Tonsillectomy?

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Medical Author: Melissa Stöppler, M.D.
Medical Editor: William C. Shiel, Jr, MD, FACP, FACR

Tonsillectomy, the surgical removal of masses of lymphoid tissue located in the back of the mouth, may have seemed like a childhood rite of passage for many children of previous generations. Tonsillectomy became a popular treatment for recurrent sore throats and respiratory infections as early as the 1800s, and its frequency peaked in the United States in the late 1950s to the 1970s. Today, doctors are more conservative in recommending tonsillectomy. The number of tonsillectomies performed in the United States has declined from over 1 million per year in the 1970s, to about 250,000 per year, due to growing skepticism in the medical community about the utility of tonsillectomy for infection control.

Often performed in conjunction with removal of the adenoid (a mass of lymphoid tissue located behind the nasal passages), tonsillectomy is a minor surgical procedure that is generally well-tolerated. Nevertheless, rare complications such as infection or bleeding may occur following surgery, and an absence from school for seven to ten days is usually required.

In September 2004 a study by Dutch researchers published in the British Medical Journal showed that most tonsillectomies might be unnecessary, with tonsillectomy having no major clinical benefits over "watchful waiting" in children aged two to eight with mild symptoms of throat infections, or mild breathing difficulties due to enlarged tonsils.

However, there are instances in which tonsillectomy is recommended, including sleep apnea, in which the tonsils are so large they interfere with breathing at night, causing heavy snoring and interrupted sleep. Other indications in which tonsillectomy is absolutely necessary include airway obstruction or difficulty swallowing. A high frequency of throat infections (five to six per year or more) or the occurrence of unusually severe infections may also be indications for tonsillectomy in children, and the frequency and severity of these infections as well as their response to antibiotic therapy are important factors to consider in each case when deciding whether tonsillectomy is appropriate.

REFERENCE: MedscapeReference. Tonsillectomy.