Pro and cons of children's tonsillectomies?
October 26, 2010 2:46 AM Subscribe
Any serious opposition to tonsillectomies for children? We have two excellent doctors for and against it for our son.
Our 11 year old has recurrent throat infections with swollen tonsils. His GP suggested a tonsillectomy, but our other trusted family doctor, a senior internist, says it's a pointless proceedure.
FWIW, he meets the standard of at least 7 throat infections, interfering with his school through days off, etc.
I can find pro and con opinions on the internet, but it's hard to tell what's crazy (let's drink goat milk to cure cancer!) and actual medical opinion.
Can people point me to actual useful and reliable sources, for or against tonsillectomies, especially for children?
Our 11 year old has recurrent throat infections with swollen tonsils. His GP suggested a tonsillectomy, but our other trusted family doctor, a senior internist, says it's a pointless proceedure.
FWIW, he meets the standard of at least 7 throat infections, interfering with his school through days off, etc.
I can find pro and con opinions on the internet, but it's hard to tell what's crazy (let's drink goat milk to cure cancer!) and actual medical opinion.
Can people point me to actual useful and reliable sources, for or against tonsillectomies, especially for children?
I'm offering an anecdata point only. I also met the standards for tonsillectomy as a kid, but my parents elected not to go through with it. I've outgrown the susceptibility to throat infections, it would seem.
posted by bardophile at 3:09 AM on October 26, 2010
posted by bardophile at 3:09 AM on October 26, 2010
My pediatrician in the '60s was more reluctant than most to do tonsillectomies, even though I had at lot more than 7 infections before I finally got them cut out during the summer before my 17th birthday. I really wish it had been done sooner; it was very painful and took a long time to recover. They said that, even though they were not actively infected when they were removed, they had become exceptionally large. I'd think cutting them out at 11 would be less traumatic (but surgical procedures SHOULD have improved since 1971).
posted by oneswellfoop at 3:10 AM on October 26, 2010
posted by oneswellfoop at 3:10 AM on October 26, 2010
EndsOfInvention has it. Get in touch with an ENT who actually does tonsillectomies. They'll know much more than your well-intentioned GP and internist.
posted by Tehhund at 4:28 AM on October 26, 2010
posted by Tehhund at 4:28 AM on October 26, 2010
I didn't have a tonsillectomy as a child for a whole number of reasons, including an ear surgery and a wish not to put me through further procedures. I had lots of time off from school, which seemed pretty great at the time. I spent most of my late teens and early twenties having recurring, severe tonsillitis. I eventually had my tonsils out at 25 and was out of a commission for a month.
Your doctor might think it's 'pointless', but I haven't had any major illness in the nearly four years since the procedure, after years of recurring illness. Plus kids bounce back way quicker from the procedure than adults do.
And yeah, get a third opinion.
posted by Happy Dave at 5:00 AM on October 26, 2010 [2 favorites]
Your doctor might think it's 'pointless', but I haven't had any major illness in the nearly four years since the procedure, after years of recurring illness. Plus kids bounce back way quicker from the procedure than adults do.
And yeah, get a third opinion.
posted by Happy Dave at 5:00 AM on October 26, 2010 [2 favorites]
I had a tonsillectomy when I was in fourth grade. I often had throat infections when I was young. I'm not sure I have had one since. For me it was amazing. Though I know we did a consult with a ENT special before the procedure.
posted by DJWeezy at 5:03 AM on October 26, 2010
posted by DJWeezy at 5:03 AM on October 26, 2010
Best answer: Anecdotal - I had mine out when I was in kindergarten (both tonsils and adenoids - I was a mouth breather ;). My brothers got strep throat fairly frequently when we were kids, but I never did - just the odd sore throat.
Non-anecdotal: Cochrane Reviews - systematic review of surgical vs. non-surgical intervention for recurrent tonsillitis
Main results
This review includes five studies: four undertaken in children (719 participants) and one in adults (70 participants). Good information about the effects of tonsillectomy is only available for children and for effects in the first year following surgery.
Children were divided into two subgroups: those who are severely affected (based on specific criteria which are often referred to as the 'Paradise criteria') and those less severely affected.
For more severely affected children adeno-/tonsillectomy will avoid three unpredictable episodes of any type of sore throat, including one episode of moderate or severe sore throat in the next year. The cost of this is a predictable episode of pain in the immediate postoperative period.
Less severely affected children may never have had another severe sore throat anyway and the chance of them so doing is modestly reduced by adeno-/tonsillectomy. For them, surgery will mean having an average of two rather than three unpredictable episodes of any type of sore throat. The cost of this reduction is one inevitable and predictable episode of postoperative pain. The 'average' patient will have 17 rather than 22 sore throat days but some of these 17 days (between five and seven) will be in the immediate postoperative period. Whilst the concept of the 'average' patient is attractive, in practice, wide variability is likely.
One reason why the impact of surgery is so modest, is that many untreated patients get better spontaneously. There is a trade-off for the physician and patient who must weigh up a number of different uncertainties: what proportion of my throat symptoms are attributable to my tonsils, and will I get better without any treatment? Similarly, the potential 'benefit' of surgery must be weighed against the risks of the procedure.
Authors' conclusions
Adeno-/tonsillectomy is effective in reducing the number of episodes of sore throat and days with sore throats in children, the gain being more marked in those most severely affected. The size of the effect is modest, but there may be a benefit to knowing the precise timing of one episode of pain lasting several days - it occurs immediately after surgery as a direct consequence of it.
It is clear that some children get better without any surgery, and that whilst removing the tonsils will always prevent 'tonsillitis', the impact of the procedure on 'sore throats' due to pharyngitis is much less predictable.
posted by purlgurly at 5:18 AM on October 26, 2010 [2 favorites]
Non-anecdotal: Cochrane Reviews - systematic review of surgical vs. non-surgical intervention for recurrent tonsillitis
Main results
This review includes five studies: four undertaken in children (719 participants) and one in adults (70 participants). Good information about the effects of tonsillectomy is only available for children and for effects in the first year following surgery.
Children were divided into two subgroups: those who are severely affected (based on specific criteria which are often referred to as the 'Paradise criteria') and those less severely affected.
For more severely affected children adeno-/tonsillectomy will avoid three unpredictable episodes of any type of sore throat, including one episode of moderate or severe sore throat in the next year. The cost of this is a predictable episode of pain in the immediate postoperative period.
Less severely affected children may never have had another severe sore throat anyway and the chance of them so doing is modestly reduced by adeno-/tonsillectomy. For them, surgery will mean having an average of two rather than three unpredictable episodes of any type of sore throat. The cost of this reduction is one inevitable and predictable episode of postoperative pain. The 'average' patient will have 17 rather than 22 sore throat days but some of these 17 days (between five and seven) will be in the immediate postoperative period. Whilst the concept of the 'average' patient is attractive, in practice, wide variability is likely.
One reason why the impact of surgery is so modest, is that many untreated patients get better spontaneously. There is a trade-off for the physician and patient who must weigh up a number of different uncertainties: what proportion of my throat symptoms are attributable to my tonsils, and will I get better without any treatment? Similarly, the potential 'benefit' of surgery must be weighed against the risks of the procedure.
Authors' conclusions
Adeno-/tonsillectomy is effective in reducing the number of episodes of sore throat and days with sore throats in children, the gain being more marked in those most severely affected. The size of the effect is modest, but there may be a benefit to knowing the precise timing of one episode of pain lasting several days - it occurs immediately after surgery as a direct consequence of it.
It is clear that some children get better without any surgery, and that whilst removing the tonsils will always prevent 'tonsillitis', the impact of the procedure on 'sore throats' due to pharyngitis is much less predictable.
posted by purlgurly at 5:18 AM on October 26, 2010 [2 favorites]
just another data point: age 8, doctor said tonsillectomy is warranted due to repeated infections/illnesses; Dad said great, Mom said wait a minute; ended up having the tonsillectomy (don't remember much except the size of the anesthetic needle and all the ice cream afterward; think I was off school for a week, maybe 2?); it seems that ultimately the decrease in illnesses was slight; I still get a cold at least every spring and every fall. YRMV. Sorry this is not the hard facts you are looking for; I guess a third opinion is a good idea.
posted by segatakai at 5:18 AM on October 26, 2010
posted by segatakai at 5:18 AM on October 26, 2010
I have always had huge tonsils but I don't get recurrent throat infections, not even when I was a child. However, I do have sleep apnea and I wish that those tonsils had been removed when I was a child because my airway might be a bit clearer. There's no way my insurance will cover a tonsillectomy for me now, and they're really difficult to recover from as an adult besides.
posted by elsietheeel at 5:32 AM on October 26, 2010
posted by elsietheeel at 5:32 AM on October 26, 2010
Got my tonsils out at 5 or 7, barely remember anything, don't miss them now. No more throat infections or ear aches.
posted by The Biggest Dreamer at 5:46 AM on October 26, 2010
posted by The Biggest Dreamer at 5:46 AM on October 26, 2010
That was in the early 1990s, we were on Medicaid.
posted by The Biggest Dreamer at 5:47 AM on October 26, 2010
posted by The Biggest Dreamer at 5:47 AM on October 26, 2010
Go see an otolaringologist. The paper purigurly links above agrees with your internist: it's a largely useless procedure for most kids. But maybe in your child's case it wouldn't be.
Just an anecdote: my mother had her tonsils removed when she was a child (back when everyone did). Now in her fifties she often has a scratchy throat that makes her cough. Her GP said it can be due to lack of tonsils, because stuff just slides into the back of her throat. She often grumbles about her tonsils being gone.
posted by Shusha at 5:48 AM on October 26, 2010
Just an anecdote: my mother had her tonsils removed when she was a child (back when everyone did). Now in her fifties she often has a scratchy throat that makes her cough. Her GP said it can be due to lack of tonsils, because stuff just slides into the back of her throat. She often grumbles about her tonsils being gone.
posted by Shusha at 5:48 AM on October 26, 2010
Best answer: While the advice to speak to an ENT surgeon is good, be aware that they will be biased in favor of tonsillectomy. It is, after all, what they do for a living. Having said that, a good one will go over the pros and cons with you and guide you to a decision that works for you and your child. I am exhibiting my own bias here, but I tend to think if you can see a surgeon at an academic medical center, preferably one with a childrens hospital, you will get an opinion that is the most up-to-date as well as one from a doctor who is under less pressure to do as many procedures as possible.
Searching the internet for medical advice is fraught with peril; there are only a few sites I consistently recommend: the Cochrane Collaboration mentioned above, the CDC, the Mayo Clinic, and the professional society for whatever specialist treats the medical condition in question. There is other good information out there, but the sites I mention give consistently good information on a wide variety of topics. The CDC does not appear to have any information on tonsillectomies that I can easily find, but the Mayo's page is here and the American Academy of Otolaryngology' page is here.
posted by TedW at 5:50 AM on October 26, 2010 [1 favorite]
Searching the internet for medical advice is fraught with peril; there are only a few sites I consistently recommend: the Cochrane Collaboration mentioned above, the CDC, the Mayo Clinic, and the professional society for whatever specialist treats the medical condition in question. There is other good information out there, but the sites I mention give consistently good information on a wide variety of topics. The CDC does not appear to have any information on tonsillectomies that I can easily find, but the Mayo's page is here and the American Academy of Otolaryngology' page is here.
posted by TedW at 5:50 AM on October 26, 2010 [1 favorite]
Anecdotal, but very widely so: recovery from tonsillectomy is MUCH HARDER as an adult than as a child (even then, it's a tough week). See whether you can get a doc or two to take a guess as to whether kiddo's problems are likely to persist... if they're likely to have to be yanked at some point, NOW is a good point. If it's a "he'll grow out of it", that's another story.
posted by julthumbscrew at 6:18 AM on October 26, 2010 [1 favorite]
posted by julthumbscrew at 6:18 AM on October 26, 2010 [1 favorite]
When you say Sr. Internist are you also referring to age? I only ask because my pediatrician, who was older, REFUSED to give me a tonsillectomy for two reasons:
1. he was old school
2. his sister died during the operation so we was biased.
Instead he pumped me full of meds to the point of resistance from age 1-14. By the time i was in my teens, they lessoned as far as recurrances but they totally didn't go away until I left home. So the conclusions can be:
1. you can/do grow out of it
2. my parents were chronic chain smokers. Funny how I hardly got sick after I left home
Seeing an ENT is your best bet. See a few. But don't go by the 7 protocol list. To me, 7 isn't THAT bad. Then again for me I had to go on meds immediately after I gotten off of them to the point of receiving gamma globlulin shots for 6 months. So who knows what was up.
Good luck but from our son's peds and my own internist, they both agreed in my case as a child, they would have highly recommended taking them out over pumping me full of meds.
posted by stormpooper at 6:21 AM on October 26, 2010
1. he was old school
2. his sister died during the operation so we was biased.
Instead he pumped me full of meds to the point of resistance from age 1-14. By the time i was in my teens, they lessoned as far as recurrances but they totally didn't go away until I left home. So the conclusions can be:
1. you can/do grow out of it
2. my parents were chronic chain smokers. Funny how I hardly got sick after I left home
Seeing an ENT is your best bet. See a few. But don't go by the 7 protocol list. To me, 7 isn't THAT bad. Then again for me I had to go on meds immediately after I gotten off of them to the point of receiving gamma globlulin shots for 6 months. So who knows what was up.
Good luck but from our son's peds and my own internist, they both agreed in my case as a child, they would have highly recommended taking them out over pumping me full of meds.
posted by stormpooper at 6:21 AM on October 26, 2010
Yank em'. There's no good reason not to. And the best reason for having his tonsils removed now is to avoid the procedure as an adult.
posted by BostonTerrier at 6:49 AM on October 26, 2010
posted by BostonTerrier at 6:49 AM on October 26, 2010
The problem with asking the anecdotal pros/cons of an operation like this on AskMe is that you will get people saying:
- I had it done and it was great.
- I had it done and I wish I hadn't.
- I didn't have if done and it was great.
- I didn't have it done and I wish I had.
Which one should you believe?
No-one here, even if they are an actual ENT doctor, can actually advise you well enough on the yes/no decision, as they do not have access to your son or his medical records. The best they can say is that sometimes it's a good idea and sometimes not. Only someone with access to your son/'s medical records AND the right expertise (and no strong pro/con bias) can give you the right advice.
posted by EndsOfInvention at 6:56 AM on October 26, 2010 [4 favorites]
- I had it done and it was great.
- I had it done and I wish I hadn't.
- I didn't have if done and it was great.
- I didn't have it done and I wish I had.
Which one should you believe?
No-one here, even if they are an actual ENT doctor, can actually advise you well enough on the yes/no decision, as they do not have access to your son or his medical records. The best they can say is that sometimes it's a good idea and sometimes not. Only someone with access to your son/'s medical records AND the right expertise (and no strong pro/con bias) can give you the right advice.
posted by EndsOfInvention at 6:56 AM on October 26, 2010 [4 favorites]
By throat infections do you mean strep throat? Has everyone in your family gotten strep tests to make sure they're not carriers? My best friend in elementary school had a case of strep throat every month one winter and her doctor was all ready to take her tonsils out until her brother finally got tested for strep and it turns out he was carrying it all along without being sick and reinfecting her over and over. A round of antibiotics for him and my friend was fine.
posted by martinX's bellbottoms at 6:58 AM on October 26, 2010 [1 favorite]
posted by martinX's bellbottoms at 6:58 AM on October 26, 2010 [1 favorite]
Wow, I just went to Medline and found that they're seeing a correlation between tonsillectomy and cancer in women! If anyone is interested in reading this memail me.
I grew up in Europe in the 1950s, tonsillectomies were not routinely done the way they were in the US. I probably met the US criteria but never had the surgery.
I still occasionally get sore tonsils, one is sore now, but I wonder if they're like a first line of defense against other stuff because I rarely get sick.
posted by mareli at 7:02 AM on October 26, 2010
I grew up in Europe in the 1950s, tonsillectomies were not routinely done the way they were in the US. I probably met the US criteria but never had the surgery.
I still occasionally get sore tonsils, one is sore now, but I wonder if they're like a first line of defense against other stuff because I rarely get sick.
posted by mareli at 7:02 AM on October 26, 2010
@EndsOfIntervention - to be fair, the OP didn't ask for anecdotes - he asked for reliable sources to assist in evaluating the pros and cons of tonsillectomies for kids. We've just been offering them up (myself included - I couldn't resist the anecdote along with my "for-real" answer).
posted by purlgurly at 7:21 AM on October 26, 2010
posted by purlgurly at 7:21 AM on October 26, 2010
My son inherited my horizontal eustachian tubes -- he had recurrent ear infections (like 5 in 9 months) and "giant tonsils" -- the ENT said they normally won't do a tonsillectomy before age three, the scheduled him for tonsils/ tubes/ adnoids when he was 2.5yrs old (1999). His tiny little self recovered in about a week and the ear infections/frequent colds went away, plus we could no longer hear him breathing at night from the other side of the house.
It was terrifying for me, as a parent, but I feel like it was appropriate and the outcome was better than I hoped.
And lately my 5 yr old daughter has begun school and mouth breathing and coughing through the night for weeks . . .
posted by MeiraV at 7:27 AM on October 26, 2010
It was terrifying for me, as a parent, but I feel like it was appropriate and the outcome was better than I hoped.
And lately my 5 yr old daughter has begun school and mouth breathing and coughing through the night for weeks . . .
posted by MeiraV at 7:27 AM on October 26, 2010
EndsOfIntervention - to be fair, the OP didn't ask for anecdotes
Arg, my bad, I swear I read that they were asking for anecdotes. Apologies. I guess my answer is more directed at the answerers than the asker then.
posted by EndsOfInvention at 7:30 AM on October 26, 2010
Arg, my bad, I swear I read that they were asking for anecdotes. Apologies. I guess my answer is more directed at the answerers than the asker then.
posted by EndsOfInvention at 7:30 AM on October 26, 2010
My child's ENT specialist first suggested we wait and see if he outgrows the problem, which seems like common advise these days, but left it "up to us" because she felt it took a certain "lifestyle" to be able to care for the child for a week or two post-op. She was not very helpful nor informative.
I asked my ENT for advise after he finished removing my tonsils at age 35 (yoowweee that hurt!), who was far more straightforward and forthcoming with advise. His benchmark was:
Does the child breath primarily through his mouth or nose while asleep. If nose, leave the tonsils n and see what happens - most people apparently outgrow the problem. If mouth, take them out, as mouth breathing can lead to other issues later on, in addition to the symptoms already being experienced. If nose, wait and see if the person grows out of the problems as is typically experienced.
I'm not a doctor... I know next to nothing about health related issues, but that was the advise I received that helped a little to make up our minds on what to do.
posted by csmason at 7:51 AM on October 26, 2010
I asked my ENT for advise after he finished removing my tonsils at age 35 (yoowweee that hurt!), who was far more straightforward and forthcoming with advise. His benchmark was:
Does the child breath primarily through his mouth or nose while asleep. If nose, leave the tonsils n and see what happens - most people apparently outgrow the problem. If mouth, take them out, as mouth breathing can lead to other issues later on, in addition to the symptoms already being experienced. If nose, wait and see if the person grows out of the problems as is typically experienced.
I'm not a doctor... I know next to nothing about health related issues, but that was the advise I received that helped a little to make up our minds on what to do.
posted by csmason at 7:51 AM on October 26, 2010
I suffered from recurring tonsillitis as a child - and I still do. The only thing that prevents me from having them out is that as an adult it's quite a big op. I wish I'd had the bloody things out when I was a child.
posted by rhymer at 8:16 AM on October 26, 2010
posted by rhymer at 8:16 AM on October 26, 2010
ENT. When I had my tonsils out 25 years ago (ie ages ago in terms of medicine), the one my mom took me too had me try a bunch of things before finally resorting to taking out my tonsils. Although once those buggers were out, I was so much happier!
If it's any consolation, after about 20 years or so, there's a good chance the tonsils might even grow back. Mine did - according to my dentist, they're the most healthy looking pink tonsils she's ever seen. They should be - they're about 20 years younger than I am!
posted by cgg at 8:29 AM on October 26, 2010
If it's any consolation, after about 20 years or so, there's a good chance the tonsils might even grow back. Mine did - according to my dentist, they're the most healthy looking pink tonsils she's ever seen. They should be - they're about 20 years younger than I am!
posted by cgg at 8:29 AM on October 26, 2010
after about 20 years or so, there's a good chance the tonsils might even grow back
My mom's did, too! She always thought this made her a freak of nature. She'll be so relieved to hear that the same thing happened to one of my imaginary friends.
posted by tangerine at 11:40 AM on October 26, 2010
My mom's did, too! She always thought this made her a freak of nature. She'll be so relieved to hear that the same thing happened to one of my imaginary friends.
posted by tangerine at 11:40 AM on October 26, 2010
Personal anecdote time, for what it's worth (likely little if you're looking for authoritative sources):
I had mine out when I was 6-7 or so. Before that, I was endlessly sick, miserable, and constantly on antibiotics. After they were out I think I had one more brief instance of tonsillitis (quite concerning without tonsils - turns out they grew back partially after the surgery), then absolutely nothing afterward.
Honestly, it made a huge difference in quality of life terms, though I didn't think of it that way at the time. All I knew then was that pre-surgery life=being sick most of the time, but after the surgery I was well most of the time. Pretty great trade-off actually. Plus, I got lots of icecream and attention in the hospital.
posted by owls at 12:02 PM on October 26, 2010
I had mine out when I was 6-7 or so. Before that, I was endlessly sick, miserable, and constantly on antibiotics. After they were out I think I had one more brief instance of tonsillitis (quite concerning without tonsils - turns out they grew back partially after the surgery), then absolutely nothing afterward.
Honestly, it made a huge difference in quality of life terms, though I didn't think of it that way at the time. All I knew then was that pre-surgery life=being sick most of the time, but after the surgery I was well most of the time. Pretty great trade-off actually. Plus, I got lots of icecream and attention in the hospital.
posted by owls at 12:02 PM on October 26, 2010
Response by poster: Thanks for the links and feedback - we have to get a third opinion under our medical system as the next step, but I find it's better to go in and ask reasonably intelligent questions from a doctor than to just let the doctor decide. At least then I understand and can explain to my kids what's happening.
Snoring and childhood healing are both pros for tonsillectomies, but it's mainly crunching the numbers. It looks like if he meets the guidelines and the ENT approves, it will wind up giving him more days on average well than he has now.
He deeply disbelieves this myth of ice-cream in hospitals. He's decided it's all a scam by the doctor and his parents to trick him into the tonsillectomies. Youtube it turns out has lots of gory medical videos!
posted by viggorlijah at 10:09 AM on October 27, 2010
Snoring and childhood healing are both pros for tonsillectomies, but it's mainly crunching the numbers. It looks like if he meets the guidelines and the ENT approves, it will wind up giving him more days on average well than he has now.
He deeply disbelieves this myth of ice-cream in hospitals. He's decided it's all a scam by the doctor and his parents to trick him into the tonsillectomies. Youtube it turns out has lots of gory medical videos!
posted by viggorlijah at 10:09 AM on October 27, 2010
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posted by EndsOfInvention at 2:50 AM on October 26, 2010