The Current Thinking on Tonsillectomy

By JACKIE STEVENS, Tufts Medical Center Staff

Tonsillectomy is the third most common operation performed on children in the United States, with more than 500,000 operations taking place each year. But not until recently was there any documentation that assisted parents in answering the question, "Should my child have a tonsillectomy?"

In January 2011, the American Academy of Otolaryngology (AAO) released the first and only evidence-based national practice guideline in the U.S. to help physicians and parents better understand when children require a tonsillectomy.

However, even with these guidelines in place, how do you determine if surgery is necessary? We asked Otolaryngologist-in-Chief Mark Vecchiotti, MD and Pediatric Otolaryngologist Andrew Scott, MD at Floating Hospital for Children at Tufts Medical Center to weigh in. Both doctors are experts in treating the full range of ENT conditions, one being tonsillitis.

How do you know if a tonsillectomy is right for your child?

"The general rule of thumb is that if tonsils, small or large, are not causing any problems, they should be left alone," said Dr. Vecchiotti. "However, large tonsils can contribute to breathing problems at night, swallowing difficulties and repeated infections. If this is the case, removal may be a consideration, but not a necessity."

The top two reasons children get a tonsillectomy are frequent throat infections or sleep apnea, a disorder in which breathing constantly stops and starts. One of the most noteworthy findings from the AAO is that having a tonsillectomy can reduce the frequency of sore throats (and improve the quality of life) in children who have had approximately seven throat infections over the previous year, five infections per year for the past two years, or three per year for the past three years.

Additionally, in the January 2017 edition of the Journal Pediatrics, researchers looked at the data from seven published studies, focusing on illness rates and quality of life for children who have had tonsillectomies versus those who have not. They found that throat infections decreased in the first year post-surgery, but the benefits of surgery diminished over time and there is not much information on long-term results. They also found no difference in quality of life in the surgery versus non-surgery groups.

But Dr. Vecchiotti says when chosen for the right kids, the operation can improve sleep quality and daytime functioning, and decrease doctor visits and antibiotic use.

"Above all, be an advocate in your child's care," he suggests. "Have your ENT physician guide you through the information and review the benefits and risks of different treatments, but ultimately, it's up to you to decide what's best for your child."

The above content is provided for educational purposes by Tufts Medical Center. It is free for educational use. For information about your own health, contact your physician. Posted May 2017.