Having a tonsillectomy was once a pretty common milestone for children. Doctors would perform the surgery on children who had repeated sore throats, even if the problem was not always an infection or enlargement of the tonsils. In some cases, the tonsillar tissue can be so swollen that it impairs breathing, sleeping or eating, and that is cause for removal, but that likely isn’t what’s happening in every child.
In the United States, approximately 530,000 operations to remove tonsils (and adenoids as well) are performed each year on children under the age of 15. It remains the second most common non-circumcision pediatric surgery, behind appendectomies.
Tonsils do have a function. Sitting at the back of the throat, the two masses of tissue prevent germs and bacteria from entering the respiratory tract. They also produce antibodies, so they aren’t just merely roadblocks. When they don’t function properly, they can cause frequent infections, sore throats and breathing or sleep issues. A recent study of the procedure showed an increased risk for very young patients and could be a turning point in deciding whether or not to perform the surgery in patients under the age of three.
The guidelines from The American Academy of Otolaryngology-Head and Neck Surgery recommend that children younger than three be hospitalized overnight after a tonsillectomy. This group also has a higher risk of complications including bleeding and respiratory issues. The study review conducted looked at the medical records of 1817 patients under the age of six who underwent tonsillectomies at five different medical facilities in or around New Orleans between 2005 and 2015. In these patients, there was a significantly higher risk of complications in patients under three, with higher numbers of post-op bleeding, dehydration, and respiratory distress. There were more complications in children over three who were hospitalized after surgery, but that is likely because patients who stay overnight are already in a higher risk category, having been classified as such by their providers.
The study also looked at the weight of the children at the time of surgery. Previous research suggested that children who weighed more would have a harder time with the procedure, but the team did not find this to be a factor in predicting outcomes. The authors wrote, “To our knowledge, this is the first study to determine if an association exists between weight and complications. We did not find weight to be a useful predictor of complications in our group. Comparing children who weigh 10 kg or less with children who weigh more than 10 kg at the time of surgery was also not a useful predictor of complications.” They did add, however, that there were not many children in the study who weighed more than 10kg (22 pounds) and that a larger pool of data might show different results.
While it’s not as routine as it once was, there will always be children who need to have their tonsils removed. This study could help doctors and families decide what is best for their situations. Age, medical issues and what kind of facility the surgery is performed in are all factors that should be carefully considered.
Sources: JAMA Network, UPI, AAO-HNSF, KNEB News
