An occasional sore throat is one thing. Dealing with painful tonsil infections (known as tonsillitis) is quite another. For kids who have recurrent infections, it might be time to have their tonsils removed.
What are tonsils?
Tonsils are small structures at the back of the throat made up of lymphoid tissue. They are part of the body’s immune system and work by sampling any bacteria or viruses that enter the body through the mouth and alert the immune system to produce antibodies.
However, in some people, this can cause the tonsils themselves to become infected, resulting in strep throat or chronic tonsillitis, a chronic bacterial infection in the tonsils.
“Usually by the time the tonsils become very infected, they’re causing more harm than good, and they aren’t serving the function they’re meant to serve,” said Yale New Haven Health pediatric ear, nose and throat (ENT) surgeon Sarah Maurrasse, MD, assistant professor of Surgery (Otolaryngology) at Yale School of Medicine.
Recurrent infections are just one reason why patients may need to have their tonsils removed. Trouble with sleep apnea is the other reason.
“Sometimes the tonsils swell up when you’re sick and, in some kids, they never shrink back,” said Dr. Maurrasse. “The tonsils can get so big that they block the back of the throat and make it hard to breathe, especially at night when you fall asleep.”
When breathing becomes impaired, it signals to the brain to wake up. This can result in kids waking up many times during the night and can lead to behavioral issues, difficulty concentrating, hyperactivity and bedwetting. Over time it can also put strain on the heart and lungs.
What is tonsillectomy?
Tonsillectomy is a procedure that can be performed in children as young as 18 months but can be beneficial for older kids, teens and young adults.
A total tonsillectomy involves complete removal of the tonsils and is generally done for patients with many bacterial infections per year. Before the procedure, the family meets with the anesthesia team and kids are shown the mask used to help them fall asleep. Once they are asleep under anesthesia, a breathing tube is placed, and the entire procedure is done through the mouth.
A partial tonsillectomy removes about 90% of the tonsils and leaves a small portion of tonsil tissue behind.
“Partial tonsillectomy is equally effective but it is much less painful, there’s a much lower risk of bleeding after surgery and it’s a much faster recovery for kids. So nowadays we’re doing a lot more partial tonsillectomies than total tonsillectomies because of the lower risk,” said Dr. Maurrasse.
Tonsillectomy risks and recovery
Like any procedure, there are risks associated with tonsillectomy. It can be painful, and patients can experience severe sore throats for up to two weeks. There is also a 2-4% risk of serious bleeding with total tonsillectomy, which usually happens a week or so after surgery. If patients experience bleeding, they should be taken to the emergency department, and while rare, may require another surgery to stop the bleeding.
However, most patients are back to eating and drinking normally, as well as back to their normal activities in around one to two weeks.
What to consider before tonsillectomy
Dr. Maurrasse says it’s important for caregivers to have a good relationship with their child’s provider and make sure all their questions are answered. They should discuss all the risks and benefits and gather as much information as possible.
In some cases, it might make sense to gather additional information to see if surgery is necessary, such as a sleep study to diagnose sleep apnea, or to try other interventions first, like medication. However, tonsillectomy is often the best option.
“I think parents should know that sleep apnea can be very serious and should be treated, even if it means a minor procedure,” said Dr. Maurrasse. “I also get a lot of questions about whether taking out the tonsils is going to cause kids to get sicker in the future. But removing the tonsils does not weaken the immune system long term. Overall, it is a very safe procedure and can have an enormous positive impact on your child’s quality of life.”
