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The Surprising Reason Some Kids Still Get Tonsillectomies

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If you were a child in the 1950s, 60s or 70s and had numerous throat infections traced to your tonsils—aka tonsillitis—chances are you had your tonsils removed in an attempt to stop the infections. By the 1980s, that approach took a radical shift after Dartmouth epidemiologist John Wennberg, MD, MPH, demonstrated that where you lived affected your child’s likelihood of undergoing tonsillectomy for throat infection. In fact, he found that in two adjacent counties in Vermont, the rate of tonsillectomy varied from 70% in one to 20% in the other. Such evidence started the move toward a more conservative approach to managing chronic tonsillitis. Today, antibiotics plus acetaminophen for fever and pain are the go-to treatments, and the number of tonsillectomies per capita has been greatly reduced. But some kids are still having this operation. Why? This may surprise you because it’s not just for chronic throat infections. It’s also for a condition you probably associate with overweight adults—obstructive sleep apnea.

Children, even ones who aren’t overweight, can have obstructive sleep apnea when their tonsils are large and get in the way of breathing during sleep. The cause may be different, but the effect is the same as it is for adults—poor sleep quality from waking up repeatedly during the night. However, sleep apnea in kids presents a unique problem. When sleep apnea occurs during developmental years, the lack of restorative sleep can do more than make them tired and put them in a bad mood. It can severely affect their ability to learn. So it’s not a problem to ignore.

Unlike throat infections, obstructive sleep apnea in children is hard to treat nonsurgically, mostly because kids often refuse to wear the face mask that must be worn all night with traditional “CPAP” (continuous positive airway pressure) treatment to correct the breathing issue. That’s when a tonsillectomy can help—removing the tonsils clears the airway.

If your child’s doctor has recommended tonsillectomy for sleep apnea, here are steps to take first…

Ask about a sleep study for your child. That’s the best way to correctly diagnose sleep apnea, but many kids do not get one, because there’s no hard-and-fast rule that it must be done before surgery. Sometimes cost is the roadblock—some insurance companies cover a diagnostic sleep study when apnea is suspected, but others don’t. Some states cover it for people on Medicaid, so it’s important to ask your provider.

Ask whether it’s possible to take a wait-and-watch approach. This will depend on the severity of the apnea and your child’s age. If he/she is beyond the early learning years, over age eight for instance, you might be able to wait to see whether he outgrows the obstructive sleep apnea. (As children grow physically, their tonsils get proportionally smaller compared with the size of the airway, so breathing might no longer be obstructed.)

Weigh the benefits of correcting childhood sleep apnea against the potential long-term risks from removing tonsils. In most cases, there are negligible long-term risks associated with having tonsils removed, although some studies show that removing tonsils (or adenoids, which is a common approach to treating chronic middle-ear infections) might increase the risk for infections, allergies and respiratory conditions later in life.

Important: There still is a role for removing tonsils in some children with chronic tonsillitis—it usually depends on how frequent and how severe the throat infections are. Some adults who get chronic throat infections (more than three per year) may also benefit from tonsillectomies.

While children tend to recover pretty easily from having their tonsils out, it’s a more difficult procedure for adults because repeated infections have usually created scar tissue, which can make tonsils harder to remove and make the healing process more painful. Adults also tend to have more pain than kids and may need pain medication for up to 10 days afterward.

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Source: David O. Francis, MD, assistant professor in the department of surgery, section of laryngology, and director of the Otolaryngology Outcomes Research Center at University of Wisconsin School of Medicine and Public Health in Madison. Date: December 5, 2018 Publication: Bottom Line Health
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