My child gets a lot of sore throats. Should we have his tonsils removed?

By: Laura Archuleta, MD
St. Alexius Center for Family Medicine - Mandan

My child gets a lot of sore throats.   Should we have his tonsils removed?The tonsils are two large glands in the back of the throat.  They help fight off germs that enter the body through the nose and mouth.   Tonsillitis is an infection in the tonsil tissue, caused by either a virus or a bacteria.  Symptoms include sore throat, fever and swollen glands in the neck.  Most cases of tonsillitis are caused by viruses and will go away on their own.  Of the bacterial causes for sore throats, streptococcal infections (strep throat) are most common.  Usually, tonsillitis is treated symptomatically, however, when the infections are recurrent or severe, removing the tonsils may be necessary.

Before deciding on surgery, one needs to weigh the risks and benefits carefully.  The American Academy of Otolaryngology – Head and Neck Surgery recently published guidelines to help doctors and parents determine the safest and most effective treatment for children with throat illnesses.

With time and patience, many children will outgrow their recurrent throat infections.  Therefore, watchful waiting is the preferred strategy for most cases.  The guidelines recommend against tonsillectomy unless the child has had at least seven throat infections in the past year.  For children who have ongoing problems, the guidelines recommend using a cutoff of five episodes per year for two years or three episodes per year for three years.  Using this criteria can help ensure that surgery is reserved for those who are least likely to outgrow the problem.  Of course, the guidelines are not hard and fast rules.  Other factors may tip the scales in favor of tonsillectomy, such as multiple antibiotic allergies, periodic fevers or a history of abscess in the throat.

Some children have chronically enlarged tonsils.  Although it isn’t painful, enlarged tonsils can obstruct the airway and cause sleep problems.  Not all children with big tonsils need surgery, but if the tonsils are causing breathing problems during sleep, surgery may be necessary.  Signs of sleep-disordered breathing are snoring, pauses in breathing, called sleep apnea, or excessive daytime sleepiness.  In some children, sleep-disordered breathing can lead to behavior changes, concentration problems or poor weight gain.

Tonsillectomy is a routine surgical procedure performed every day in the US.  Although it is a relatively simple procedure, like every surgery, it carries risks.  The most common risk with tonsillectomy is the risk of bleeding, which can become life-threatening.  Postoperative infection is another risk to consider.  Plus, there is the possibility that tonsillectomy may not correct or reverse the underlying condition.   This is particularly true with sleep-disordered breathing.  Sometimes the obstructive symptoms can return after tonsils are removed.  If this happens, further investigation may be needed to correct the problem.

No parent wants to put their child through surgery unless it’s necessary.  In illnesses like tonsillitis, it is often difficult to say when the problem is severe enough to warrant surgical correction.  That’s why guidelines like the ones offered by the American Academy of Otolaryngology can be beneficial.  Still, guidelines only provide a general framework for decision making, and each case needs to be considered on an individual basis.  Talk to your child’s doctor for more advice.