Many of us recall this episode of “The Brady Bunch”: Little Cindy Brady comes down with tonsillitis and is scheduled to have her tonsils removed. Soon, Mrs. Brady ends up getting the same infection, and they both end up having tonsillectomies and recovering in bed together, with neither being able to talk from sore throats.
Times were different back then (the show aired in 1971). It used to be that one kid got tonsillitis and soon, every kid on the block was having a tonsillectomy. From there, the tide shifted in the other direction, around the time I was the prime age for tonsillitis. My mom, a retired pediatrician, tells me that during the worst of it, I would have six infections every year. At that time, however, a kid had to be at death’s door to warrant the painful surgical procedure. So, mine were left in and are still in to this day.
Nowadays, we are somewhere in between – one infection doesn’t buy a kid a tonsillectomy, but five a year sure does. The newest findings show another reason that kids have their tonsils and adenoids removed (T&A): obstructive sleep apnea (OSA). In fact, OSA is now the most common reason for the procedure, surpassing recurring infections. The tonsils serve a purpose in our bodies. They are part of the lymphatic system and join the 200-some lymph nodes in the head and neck to fight infection. So, in that middle era during which tonsillectomy was avoided, the thought was that removing them would increase the risk of infection. We now know that with 200 lymph nodes in the area, there is plenty of redundancy in the immune system to pick up the slack if tonsils aren’t present. In fact, kids with recurrent infections get sick less often after having a T&A.
So, who needs to have their tonsils and adenoids removed? In kids, there are two broad categories: those who have recurrent infections, and those with OSA. Many kids have a little of both issues, as well. For those with recurrent infections, the guidelines suggest the T&A procedure for those who have more than seven infections in one year, five infections a year for two years in a row, or as few as three infections a year for three years. I will often offer T&A for kids who don’t quite meet these criteria if they have severe infections due to antibiotic resistance or abscess formation. For kids with OSA, indications for T&A include sleep disturbances that are affecting them during the day. Picture the kid who snores like an old man and wakes up tired and cranky … well, more tired and cranky than a normal kid. Kids with sleep-disordered breathing will sometimes be labelled as having ADD/ADHD because they are irritable from lack of sleep. Imagine your tendency to have a “short fuse” the morning after being up all night, and you’ll know what these kids feel like after endless nights of low oxygen levels and poor sleep. A sleep study is not necessary to make this decision; however, if there is some doubt, the results from a study can help lead us in one direction or the other.
A side note about adenoids: under a microscope, adenoids look just like tonsils and have the same function. They sit straight back in the nose. When bacteria are in the tonsils, they are in the adenoids, as well. When tonsils are big, adenoids are, too. For that reason, we usually address both at the same time to maximize the benefit of surgery. By the way, adenoid removal hurts a whole lot less than the tonsil-removal part.
So as we see in medicine, the pendulum swings from one direction to another between generations. Reasons for and frequency of tonsillectomy sure have, too.
In medicine, we see that the pendulum swings from one direction to another between generations. Reasons for and frequency of tonsillectomy sure have, too.w
