Does My Child Need a Tonsillectomy?

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 530,000 per year in 2006, due to growing skepticism in the medical community about the utility of tonsillectomy for infection control. Despite a reduction in the number of tonsillectomies performed for repeated infections, there may be an increase in the number of tonsillectomies performed for airway or alimentary tract obstruction.

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. Most cases are done as same-day ambulatory procedures. 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.

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, malignant tumor of the tonsils, 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.