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Why don’t doctors remove kids’ tonsils anymore?

 In Ask an Expert, Ear Nose & Throat (Otolaryngology), Pulse Blog

Q: Why are tonsillectomies less common now?

Doctors actually do a lot of tonsillectomy surgeries for children—more than half a million a year. However, compared with the old days, physicians are more selective about who needs to have tonsil surgery.

It may be surprising, but sleep apnea is the number one reason kids under 10 undergo a tonsillectomy. Large tonsils can obstruct breathing. Removing them can improve a child’s ability to sleep soundly. Better sleep can improve a child’s behavior, memory, and school performance.

Of course, tonsils may also be removed due to severe and chronic throat infections (for example, strep throat and tonsillitis). In these cases, a tonsillectomy can decrease the frequency and severity of a child’s illnesses.

Compared with kids, teenagers and adults are more likely to get a tonsillectomy for recurrent infections than for sleep apnea. Sore throats are uncomfortable, missing school and work can be disruptive, and the antibiotics used for treatment can have side effects. Getting chronically infected tonsils out can be a relief.

It’s important to remember that surgery really only helps individuals who are severely affected by throat infections. According to American Academy of Otolaryngology guidelines, surgery is not recommended for children with fewer than seven episodes in the past year, fewer than five episodes in the past two years, and fewer than three episodes in the last three years. Most children, even if they have had multiple throat infections, get better on their own.

Like any surgery, this one carries risks. Patients generally have a sore throat for at least a week following surgery. There’s a less than 5 percent risk of bleeding, which could lead to another surgery. Doctors always strive to balance the risks of surgery with the benefits of removing the tonsils.

—Jonathan Zwart, MD

Otolaryngologist Dr. Jonathan Zwart sees patients in Vancouver Clinic’s Ear, Nose & Throat Department. He treats most general ENT issues, including nasal obstruction, sinus problems, and tonsillitis.

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