Tonsillectomies: not as common, but still an option
I can still remember having my tonsils out when I was a child in the 1950s. The bad sore throat and the vanilla ice cream I ate to help relieve some of the pain are the two highlights that stick in my memory.
“The heyday of tonsillectomies was in the pre-antibiotic era when physicians removed the tonsils because they were concerned about the possibility of strep throat and rheumatic fever,” said Douglas Mann, MD, an otolaryngologist at Falmouth Hospital.
When strep throat, which is caused by Group A Streptococcus, goes untreated, it can lead to rheumatic fever and cause heart valve disease, according to the National Heart, Blood and Lung Institute (NHLBI). As the body tries to fight the strep infection, the heart valves can become damaged or scarred.
Tonsillectomies have been declining since the 1970s according to the American Academy of Otolaryngology-Head and Neck Surgery (AAOO-HNS). Thirty years ago, 90 percent of the tonsillectomies were done for recurrent throat infections. Now, about 20 percent are for throat infections and 80 percent for obstructive sleep problem, such as sleep apnea.
While Dr. Mann has performed thousands of tonsillectomies in his 35-year career, he now does 50-100 per year.
There are two reasons children have a tonsillectomy, according to Dr. Mann. They are:
- Tonsil hypertrophy– very large tonsils that obstruct breathing especially while asleep and can cause sleep apnea, brief periods when breathing stops. The most common and highly effective way to treat sleep apnea in children is to do a tonsillectomy and adenoidectomy, according to the American Academy of Pediatrics (AAP).
- Recurrent infections of the tonsil– children are treated with antibiotics for a bacterial throat infection and despite treatment with the appropriate antibiotics, they continue to get infections.
Quality Of Life Issue
While the trend has changed over the years there was still a question if the surgery really helps reduce the number of days children lose at school and the number of doctor’s visits for throat infections.
A study, “Tonsillectomy vs. Watchful Waiting for Recurrent Throat Infection,” published in the February 2017 Pediatrics compared the benefits of a tonsillectomy for throat infections and sleep apnea to watchful waiting to see if the patient does better without surgery. The study showed that throat infections and school absences did go down within the first year of surgery and children with sleep disorders slept better. But the benefits waned over time. Their conclusion was there was no “marked difference” in quality of life between those had tonsillectomy and those who didn’t.
The author of the study concluded that it becomes an individual decision of weighing the positive outcome for a better quality of life and the risks of surgery.
“Most people coming to my office who are having their tonsils out really want them out because recurrent infections have become a quality of life issue. The adults have lost time at work and children lose time at school. Parents have to stay home from work to take care of their child,” said Dr. Mann.
The general guideline to having a tonsillectomy is five infections within one year or four infections per year for two years or three infections per year for three years, said Dr. Mann.
“I tell patients if they wait to have a tonsillectomy, they may do better over time, but if they have the surgery they will get better.”
Tonsillectomy is day surgery and the kids or adult patients usually remain home about one week and recover fully in about three weeks. They will have a severe sore throat making pain management a priority. Around the clock liquid ibuprophen and acetaminophen are recommended for the first few days.
Dr. Mann also recommends a topical application of Lidocaine for temporary post-surgery pain relief in children over 10 and adults. He developed a product called the Tonsil Fire Extinguisher in 2013, a device that looks like a small fire extinguisher.
“It has a long arm that directs the lidocaine the back of the throat and puts the anesthetic where you want it,” said Dr. Mann. “The temporary pain relief lasts about 20 minutes, long enough to eat and drink or help you return to sleep.”
In addition to pain medication, Dr. Mann recommends having plenty of ice cream to soothe the throat and fluids to keep hydrated. He also suggests having activities for the kids such as movies, favorite books, and board games. These will help them keep their mind off their throat.