Tonsils: Take ‘Em or Leave ‘Em?

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Surprisingly 60 - 80 percent of all of today’s tonsillectomies are performed because of sleep problems in kids.

Yes, a snoring child may be cute … but one who isn’t getting enough sleep and is constantly waking at night sure isn’t. In years gone by, children had their tonsils routinely removed due to repeat infections, but today, it’s more likely due to enlarged tonsils obstructing the airway and causing sleep issues. In fact, 60 – 80 percent of all tonsillectomies today are done due to sleep problems. It is the most common reason for a tonsillectomy in children ages 1 – 3.

“Although the number of tonsillectomies and adenoidectomies have declined over the past 50 years, these operations continue to be the most commonly performed procedures in the United States,” says Joseph Gigante, M.D., associate professor of general pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Obstructive sleep apnea (OSA) is the most common reason for removing tonsils and adenoids in kids today, although repeated infections due to strep throat are also still a big reason.

Children with OSA may have numerous symptoms, Gigante says, including frequent snoring, mouth breathing, restless sleep, sleep pauses where they stop breathing, bed wetting, excessive daytime fatigue or hyperactivity, and behavioral problems. After taking a careful history, if your pediatrician suspects OSA, he may order a sleep study on your child to confirm the diagnosis before discussing surgery with you.

The Procedure

“There are several different ways to perform a tonsillectomy today,” says Gigante. “The most common way is with electrocautery in which an instrument (called a Bovie) uses electricity to cut out the tonsils and stop the bleeding at the same time,” he says.

“The Bovie has the advantage of very precise cuts while minimizing the bleeding and it’s popular in many surgeries,” says Travis Cook, M.D., a physician at Capstone Pediatrics’ Specialists in Pediatric and Adolescent Health in Nashville. “There are other techniques less commonly used, so discuss with your doctor and surgeon which may be best for your child.”

Is there a “Right” Age for Tonsillectomy?

As far as “right” age, probably not, but age is sometimes a factor.

“Most pediatricians will try to avoid surgery younger than the age of 2,” says Cook.  “Bleeding and pain are the most common complications of tonsillectomy, and in an effort to reduce complications, some surgeons will perform a partial tonsillectomy in children younger than 3,” says Gigante.

For kids who have their tonsils removed due to OSA , does it really help their sleep issues? In children, the procedure appears to be successful in treating obstructive sleep apnea 75 – 100 percent of the time, doctors say. Parents have reported decreases in snoring, coughing, colds, over activity and restless sleep within six months of surgery.

Is it OSA? Symptoms include:

  • failure to thrive (weight loss or poor weight gain)
  • mouth breathing
  • enlarged tonsils and adenoids
  • problems sleeping and restless sleep
  • excessive daytime sleepiness
  • daytime cognitive and behavior problems, including problems paying attention, aggressive behavior and hyperactivity, which can lead to problems at school

 

 

Susan Swindell Day is the editor in chief of Nashville Parent and the mom of four amazing kids.

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