When Is Removal Of The Tonsils Justified?

A tonsillectomy is the surgical removal of the tonsils.

These are the criteria doctors use to decide whether the tonsils should be removed:

• Tonsillectomy is definitely required when the tonsils are so large they obstruct breathing, swallowing or both. Before surgery, however, antibiotics should be tried, perhaps for as long as a month, to see whether your child's condition can be improved. Children with obstructing tonsils commonly sleep restlessly and may have periods during sleep when breathing stops for seconds at a time because of blockage of the airway. In some children, voice quality is so sufficiently altered by large tonsils ("hot potato" voice) that tonsillectomy is justified.

• Tonsillectomy also is justified if your child is having repeated bouts of infection, to the point that everyday activities are substantially disrupted despite adequate antibiotic treatment.

• Currently, tonsillectomy is believed to provide enough benefit to justify doing the surgery in children who have developed at least 7 "significant" episodes of throat infection in 1 year, or at least 5 in each of 2 years, or at least 3 in each of 3 years. "Significant" episodes are defined as those associated with one or more of the following:
  • Fever of 101 degrees F (38.3 degrees C) or higher.

  • Enlarged or tender lymph nodes in the neck.

  • A pus-like coating, known as exudate, covering the tonsils or the surrounding throat area.

  • Evidence that the infection is streptococcal in origin.

• Peritonsillar abscess, also called quinsy, is an abscess around the tonsil, usually following a tonsillitis attack. The infection causes a painful throat, high temperature, headache, impaired speech, drooling, and swollen tender lymph glands in the neck. Not all experts believe that surgery is called for following a single case of peritonsillar abscess. Often, no further difficulty develops once the condition is successfully treated. However, following a second peritonsillar abscess, tonsillectomy is definitely indicated.

Not every child who meets these minimum criteria should have a tonsillectomy. Many children will improve spontaneously without surgery sooner or later. The decision for or against surgery should take into account many factors including cost, convenience, and the preferences of the parents and the child.

Recent evidence indicates that children who are less severely affected by tonsillitis are usually not sufficiently helped by tonsillectomy to justify doing the surgery. Accordingly, it would seem prudent in most cases to limit tonsillectomy to children who meet the stringent criteria just specified.